Dissemination and Implementation of COVID-19 Care Innovations in ED Settings

在急诊室传播和实施 COVID-19 护理创新

• 批准号: 10583523
• 负责人: Shira Hannah Fischer
• 金额: $ 77.28万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-04 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583523
• 关键词: 2019-nCoV; Access to Information; Accident and Emergency department; Adoption; Azithromycin; Beds; COVID-19; COVID-19 pandemic; COVID-19 patient; Caring; Cessation of life; Combined Modality Therapy; Communication; Communities; Critical Care; Critical Illness; Dangerousness; Decision Making; Deimplementation; Diffusion; Diffusion of Innovation; Discipline; Discourse analysis; Disease; Dissemination and Implementation; Drug Prescriptions; Educational workshop; Emergency Care; Emergency Department Physician; Emergency Medicine; Emergency Nursing; Emergency Situation; Ensure; Environment; Evaluation; Explosion; Facebook; Focus Groups; Fright; Frontline worker; Future; Government; Health; Health Policy; Healthcare; Healthcare Systems; Hospitals; Hydroxychloroquine; Infection; Information Dissemination; Intensive Care Units; Intervention; Interview; Journals; Learning; Long-Term Care; Methods; Misinformation; Natural Language Processing; Nurses; Patient-Focused Outcomes; Patients; Persons; Physicians; Population; Printing; Process; Professional Organizations; Publications; Recommendation; Research; Resources; Role; Services; Source; Stress Tests; Surveys; System; Techniques; Technology; Time; Twitter; Ventilator; Work; demographics; implementation science; implementation strategy; improved; improved outcome; innovation; insight; pandemic disease; personal protective equipment; podcast; prevent; public health emergency; respiratory; response; social media

SUMMARY/ABSTRACT During a public health emergency such as the COVID-19 pandemic, rapid dissemination of information to clinicians about emerging innovations is critical to ensuring the best outcomes for patients. However, little is known about how clinicians obtain information about innovations make decisions about implementation and de-implementation during uncertain times. As SARS-CoV-2 made its initial, rapid spread across the nation, clinicians feared that the impending surge of critically ill patients would overwhelm capacity, causing patient deaths due to a lack of ventilators and other essential resources. Additionally, shortages of personal protective equipment posed a challenge to following the usual standards to protect clinicians from infection. In a massive response to prevent worst-case scenarios from materializing, emergency department (ED) staff have rapidly innovated to deliver effective care, protect frontline workers, and ensure a sustainable supply of personal protective equipment. In response to these unusual conditions, ED clinicians turned to nontraditional sources of information—for example, Twitter, Facebook, podcasts, and pre- print journal publications—to learn about innovations they could use to care for COVID-19 patients in EDs. While these sources of information provided easy access to information about innovations, they also spread misinformation. Little research has been done to optimize dissemination and implementation of innovations during a public health emergency. Before the pandemic, an expansion of online platforms facilitating exchange of information about innovations had already occurred, and many more exist now. Information is also shared through professional societies and also through social media. But the understanding of the diffusion of innovations among EDs during the pandemic is currently limited due to the volume of sharing that happened during COVID-19; the urgency and fear associated with these innovations; and the need for deimplementation of interventions that were found to be ineffective or even dangerous. It is not clear how these processed happened and whether they might have differed based on the demographics of ED clinicians or the communities and populations they serve. A comprehensive evaluation of the flow of innovations will lead to insights into how disseminators and implementers can improve practices during pandemic and rapidly evolving emergencies and also how processes can be optimized for more steady-state conditions. Our study incorporates a strong interdisciplinary and mixed methods approach. Our strong team will work with study partners representing emergency physicians and nurses and experts in other disciplines in the ED. Study methods combine advanced natural language processing techniques with interviews (Aim 1), focus groups with a survey of ED professionals (Aim 2), and systematic synthesis of results to identify strategies for improving diffusion of ED care innovations (Aim 3). The study will also provide results in actionable formats, such as a toolkit of dissemination and implementation strategies.

总结/摘要 在COVID-19疫情等突发公共卫生事件期间，信息的快速传播 向临床医生介绍新兴创新对于确保患者获得最佳结果至关重要。 然而，很少有人知道临床医生如何获得有关创新的信息， 在不确定时期的实施和取消。当SARS-CoV-2开始快速传播时， 在全国范围内，临床医生担心即将到来的重症患者激增将超过能力， 由于缺乏呼吸机和其他必要资源而导致患者死亡。此外， 个人防护设备对遵循保护临床医生免受 感染为了防止最坏情况的发生，紧急情况部门采取了大规模的应对措施， (ED)工作人员迅速创新，提供有效的护理，保护一线工人，并确保 个人防护设备的可持续供应。为了应对这些不寻常的情况，艾德 临床医生转向非传统的信息来源，例如，Twitter，Facebook，播客，和预 印刷期刊出版物-了解他们可以用来照顾急诊科COVID-19患者的创新。 虽然这些信息来源提供了获取创新信息的便捷途径， 传播错误信息在优化传播和执行《公约》方面， 在公共卫生紧急情况下的创新。疫情前，线上平台的扩张 促进创新信息交流的工作已经开展，现在还有更多的工作。 还通过专业协会和社交媒体分享信息。但是理解 由于共享量大，目前在流行病期间， COVID-19期间发生的事情;与这些创新相关的紧迫性和恐惧;以及需要 取消被认为无效甚至危险的干预措施。目前尚不清楚这些 处理发生的情况以及它们是否可能根据艾德临床医生的人口统计数据或 他们所服务的社区和人群。对创新流动的全面评估将导致 深入了解传播者和实施者如何在大流行期间改进做法， 快速演变的紧急情况，以及如何优化流程， 条件我们的研究采用了强大的跨学科和混合方法。我们强大的团队 将与代表急诊医生和护士以及其他学科专家的研究伙伴合作， 研究方法联合收割机结合先进的自然语言处理技术与访谈（目标1）， 焦点小组与艾德专业人员的调查（目标2），并系统地综合结果，以确定 改善艾德护理创新传播的战略（目标3）。该研究还将提供以下结果： 可采取的形式，如传播和执行战略工具包。