Evaluation of paramedic decision making in triage and transport of adults with acute uncomplicated alcohol intoxication to the emergency department versus sobering center

急性无并发症酒精中毒成人急诊室与清醒中心的分诊和转运中护理决策的评估

• 批准号: 10448973
• 负责人: Shannon Smith-Bernardin
• 金额: $ 18.96万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448973
• 关键词: Accident and Emergency department; Acute; Address; Adult; Affect; Alcohol consumption; Alcohol withdrawal syndrome; Alcoholic Intoxication; Ambulances; Assessment tool; Cardiac; Caring; Characteristics; Clinical; Communities; Community Health Systems; Complication; Data; Decision Making; Deterioration; Development; Diagnosis; Doctor of Philosophy; Effectiveness of Interventions; Emergency Care; Emergency Medicine; Emergency department visit; Environmental Risk Factor; Evaluation; Event; Evidence based intervention; Evidence based treatment; Foundations; Funding; Future; Goals; Grant; Harm Reduction; Health; Health Policy; Health Services Research; Health system; Healthcare; Homelessness; Hospitals; Hour; Human Resources; Incidence; Individual; Injury; Interview; Intoxication; Intracranial Hemorrhages; Intubation; Lead; Leadership; Liver Failure; Maps; Medical; Medical emergency; Mentored Research Scientist Development Award; Mentorship; Methods; Monitor; Morbidity - disease rate; Nurses; Paramedical Personnel; Patient Care; Patient Triage; Patients; Persons; Play; Policies; Provider; Publications; Qualitative Research; Recording of previous events; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Safety; Sampling; San Francisco; Scientist; Solid; Statistical Methods; System; Testing; Training; Training Programs; Transportation; Triage; United States; Variant; Ventilatory Depression; Visit; Vulnerable Populations; Writing; acute care; addiction; alcohol use disorder; base; chronic alcohol ingestion; cost effective; design; dissemination science; experience; hospital patient care; hybrid type 2 trial; implementation science; improved; innovation; mortality; multidisciplinary; novel; prevent; programs; provider factors; psychiatric emergency; recruit; skills; statistics; treatment services

PROJECT SUMMARY/ ABSTRACT The long-term goal of this K01 Mentored Research Scientist Development Award is to advance Dr. Shannon Smith-Bernardin's development as an independent clinician-investigator focusing on novel treatment paradigms for people with alcohol-use disorders and acute alcohol intoxication. This proposed project has four training aims: advanced training in: 1) implementation science; 2) obtaining, merging and analyzing administrative data; 3) qualitative and mixed-methods research; and 4) grant writing. Dr. Smith- Bernardin has assembled a multi-disciplinary mentorship team including nationally recognized experts in implementation science, emergency medicine, alcohol use disorders, vulnerable populations, frequent utilizers of health care, mixed methods, and qualitative research. Alcohol use disorders are associated with significant morbidity and mortality worldwide. In the United States, emergency departments (EDs) and the ambulance system (EMS) provide the majority of acute care for alcohol intoxication. Between 2-12% of patients in medical or psychiatric EDs are acutely intoxicated. “Sobering centers” were designed to address the needs of people with acute uncomplicated alcohol intoxication who do not require ED care, so that these individuals could receive safe, high value care in an alternative care setting. If used appropriately, sobering centers can reduce the need for ED visits and reduce ED overcrowding. In Aim 1, Dr. Smith-Bernardin will characterize and define the incidence of patients with acute alcohol intoxication in the Sobering Center, the ED, and EMS system and compare the patient, provider, and environmental-level factors that influence the transport decision using administrative data. In Aim 2, using the CFIR framework, she will conduct and analyze in-depth interviews to determine modifiable factors influencing ambulance personnel's decision to transport patients with acute uncomplicated alcohol intoxication to an ED instead of the Sobering Center. The proposed study is the first to: 1) evaluate paramedic decision making in a community with an established sobering center alternative; and 2) recruit ambulance, ED, and Sobering Center personnel to examine the factors affecting triage in the field for uncomplicated alcohol intoxication. Both aims will use innovative implementation science methods to triangulate health related data from EMS, EDs, and the San Francisco Sobering Center. The training and research conducted in the proposed project will form the basis of a future R01-proposal hybrid type II trial to test the implementation and effectiveness of an intervention to reduce provider and environmental level variation in order to increase of appropriate use of sobering centers and reduce reliance on the ED for acute alcohol intoxication. The proposed project will provide Dr. Smith-Bernardin the support necessary to become an independent clinician-scientist using implementation science and mixed-methods research to develop, evaluate, and disseminate innovative, evidence-based treatment paradigms for individuals with alcohol-use disorders and acute alcohol intoxication.

项目摘要/摘要