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.

摘要/摘要 在 COVID-19 大流行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，对于临床医生如何获取创新信息并做出决策，人们知之甚少。 不确定时期的实施和取消实施。随着 SARS-CoV-2 最初迅速传播 在全国范围内，临床医生担心即将到来的重症患者激增会压垮治疗能力， 由于缺乏呼吸机和其他必要资源，导致患者死亡。此外，短缺 个人防护装备对遵循通常的标准以保护临床医生免受感染提出了挑战 感染。为了防止最坏情况发生，紧急部门采取了大规模应对措施 (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 个人防护装备的可持续供应。为了应对这些不寻常的情况，ED 临床医生转向非传统信息来源，例如 Twitter、Facebook、播客和预 印刷期刊出版物——了解他们可用于护理急诊室中的 COVID-19 患者的创新。 虽然这些信息源可以轻松获取有关创新的信息，但它们也 传播错误信息。很少有研究来优化传播和实施 突发公共卫生事件期间的创新。疫情爆发前，线上平台不断扩张 促进创新信息交流的做法已经出现，而且现在还有更多。 信息还通过专业协会和社交媒体共享。但理解 由于共享量大，目前急诊科之间创新的传播受到限制 发生在 COVID-19 期间；与这些创新相关的紧迫性和恐惧；以及需要 取消那些被认为无效甚至危险的干预措施。目前尚不清楚这些如何 处理发生的情况以及它们是否可能因 ED 临床医生或患者的人口统计数据而有所不同 他们所服务的社区和人群。对创新流的综合评估将引领 深入了解传播者和实施者如何在大流行和 快速演变的紧急情况以及如何优化流程以获得更稳定的状态 状况。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 急诊室。研究方法将先进的自然语言处理技术与访谈相结合（目标 1）， 焦点小组对 ED 专业人员进行调查（目标 2），并对结果进行系统综合以确定 改善急诊护理创新传播的策略（目标 3）。该研究还将提供以下结果： 可行的格式，例如传播和实施战略工具包。