Improving patient and clinician safety during COVID-19 through a rapidly adaptive simulation intervention

项目概要-摘要 对 2019 年新型冠状病毒 (COVID-19) 大流行的长期应对增加了临床医生的工作量 感染的负担和风险，同时创造不确定的环境，特别是在政府放松政策的情况下 预计在不久的将来采取封锁措施，感染人数可能会进一步激增。系统 需要响应能力和临床医生做好准备，以防止患者和工作人员受到安全威胁。 针对 COVID-19 患者的护理指南的快速发展导致医院的实施不断发生变化 床边，有可能产生意想不到的后果并引入潜在的安全威胁。 临床医生暴露于急性职业应激事件可能导致交感神经激活 系统，导致关键的生理变化，包括心率变异性的降低。重复或 持续的压力暴露会导致心率变异性降低，这与医疗错误的增加有关，并且 患者满意度下降。模拟，将体验技术应用于实践的技术领域， 学习、评估、测试系统或人类行为，为改进系统提供经过验证的方法 响应能力和流程改进。 我们最近开发并试点了一种新的快速自适应模拟干预措施，以增加指导方针 COVID-19 护理服务的采用和准备。在此工作的基础上，我们的总体目标是开发 并测试 COVID-19 响应干预：系统改进模拟 (CRI:SIS)，这是一个模拟 基于培训和质量改进干预，将最大限度地减少医生压力并改进系统 反应能力。为了实现这一目标，我们将首先识别促进因素、障碍和意外的安全风险 通过与急诊医生的深入访谈来采用新的 COVID-19 指南 在护理重症 COVID-19 患者期间进行结构化现场观察。接下来我们将进行两地 随机临床试验，测试 CRI:SIS 作为基于模拟的准备干预措施的有效性 通过以下方式减少急诊医生在急诊室护理 COVID-19 患者期间的压力和焦虑 心率变异性的值班测量作为压力和对状态的反应的生理标志 轮班后特质焦虑调查表。最后，我们将通过快速测试 CRI:SIS 作为流程改进策略 与我们部门一起进行基于模拟的指南测试和设计原型的迭代循环 管理人员，衡量 AHRQ 医院患者安全文化调查的变化。我们将迅速 将 CRI:SIS 作为两种模拟干预措施进行传播，一种是关于临床医生的准备，另一种是关于系统 通过交互式虚拟远程模拟、网络研讨会和提供指导的虚拟研讨会来改进 并为面临类似挑战的其他机构分享学习成果。如果证明成功，我们基于模拟的 CRI：可以广泛开展 SIS 干预，以帮助临床医生快速做好准备并提高系统响应能力 分发给其他机构，以应对预计对 COVID-19 安全挑战的漫长反应。

Project Summary-Abstract The extended response to the novel coronavirus 2019 (COVID-19) pandemic has increased clinician work burden and risk for infection while creating an environment of uncertainty, especially as easing of government lockdown measures and potential additional surges of infection are expected in the near future. System responsiveness and clinician preparedness are needed to prevent safety threats for both patients and staff. Rapidly evolving care guidelines for COVID-19 patients result in continuous changes to implementation at the bedside, presenting the opportunity for unintended consequences and the introduction of latent safety threats. Clinician exposure to acute occupational stress events can lead to an activation of the sympathetic nervous system, resulting in key physiologic changes including a decrease in heart rate variability. Repeated or continuous stress exposure, leading to lower heart rate variability, is linked to increased medical errors and decreased patient satisfaction. Simulation, a technical field that applies experiential techniques to practice, learn, evaluate, test, systems or human actions, provides a proven methodology for improving system responsiveness and process improvement. We recently developed and piloted a new rapidly adaptive simulation intervention to increase guideline adoption and preparedness for COVID-19 care delivery. Building upon this work, our overall goal is to develop and test the COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), a simulation- based training and quality improvement intervention that will minimize physician stress and improve system responsiveness. To accomplish this goal, we will first identify facilitators, barriers, and unintended safety risks in the adoption of new COVID-19 guidelines through in-depth interviews with emergency physicians and structured field observations during the care of critically ill COVID-19 patients. Next, we will conduct a two-site randomized clinical trial to test the efficacy of CRI:SIS as a simulation-based preparedness intervention on decreasing emergency physician stress and anxiety during the care of COVID-19 patients in the ED through on-shift measurements of heart rate variability as a physiologic marker of stress and responses to the State- Trait Anxiety Inventory post-shift. Finally, we will test CRI:SIS as a process improvement strategy through rapid cycle iterative loops of simulation-based testing of guidelines and design prototyping with our departmental administrators, measuring changes to the AHRQ Hospital Survey on Patient Safety Culture. We will rapidly disseminate CRI:SIS as two simulation interventions, one on clinician preparedness and the other on system improvement, through interactive virtual tele-simulations, webinars, and virtual workshops providing mentorship and shared learning for other institutions facing similar challenges. If proven successful, our simulation-based CRI:SIS intervention to rapidly prepare clinicians and improve system responsiveness can be widely disseminated to other institutions to combat the anticipated lengthy response to COVID-19 safety challenges.