Optimizing the use of noninvasive respiratory support in the Emergency Department

优化急诊科无创呼吸支持的使用

• 批准号: 10591839
• 负责人: Neha Neelam Goel
• 金额: $ 19.02万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-20 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591839
• 关键词: Accident and Emergency department; Acute; Acute respiratory failure; Address; Adherence; COVID-19 pandemic; Caring; Censuses; Clinical; Clinical Investigator; Clinical Management; Consolidated Framework for Implementation Research; Critical Care; Critical Illness; Data; Development; Development Plans; Effectiveness; Emergency Care; Emergency Department patient; Emergency research; Ensure; Evidence based practice; Failure; Feedback; Focus Groups; Funding; Future; Goals; Guidelines; Health system; Hospitals; Intensive Care Units; International; Interruption; Intervention; Intubation; Lung; Mechanical ventilation; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Monitor; Morbidity - disease rate; Nose; Outcome; Oxygen; Patient Care; Patient-Focused Outcomes; Patients; Phase; Physicians; Positioning Attribute; Process; Process Measure; Protocols documentation; Provider; Quality of Care; Recommendation; Research; Research Personnel; Research Project Grants; Resources; Sample Size; Sampling; Scientist; Shock; Statistical Data Interpretation; Testing; Time Series Analysis; Training; United States; Work; Workload; acute care; acute hypoxemic respiratory failure; care delivery; career; career development; clinical application; cohort; design; effectiveness testing; effectiveness/implementation study; evidence base; evidence based guidelines; implementation evaluation; implementation process; implementation science; implementation strategy; improved; mortality; mortality risk; multidisciplinary; pilot test; pressure; research study; respiratory; skills; standardized care; ventilation

PROJECT SUMMARY The goal of Dr. Neha Goel’s K23 project is to enable her to become an independent physician-investigator who conducts research on the implementation of evidence-based care for patients with acute respiratory failure. Building upon her strengths as a pulmonary-critical care physician and her prior training in clinical emergency care research, Dr. Goel will transition into the next phase of her career through a well-defined training plan. The training plan is meticulously designed to enable her to acquire requisite skills in guideline development, implementation science methodology, and advanced statistical analyses. Her career development plan contains focused training through conduct of a mentored research study, relevant didactic coursework, and close mentorship from leaders in the fields of emergency and critical care medicine, and implementation science. Dr. Goel’s ultimate research objective is to improve clinical outcomes for patients with acute respiratory failure through the implementation of a systematically developed, evidence-based, high flow nasal oxygen (HFNO) monitoring protocol for the emergency department (ED). In keeping with this objective, her K23 mentored research project will focus on investigating the implementation of evidence-based protocol on HFNO use and management for The Mount Sinai Hospital ED. HFNO use and management is a timely and important research topic. Since the COVID-19 pandemic began, there has been a rapid increase in HFNO usage. However, guidance on HFNO use and monitoring in the ED setting is lacking, and adverse clinical outcomes occur in the absence of guidance. Dr. Goel’s K23 research project specific aims are to: (Aim 1) develop a pragmatic protocol for HFNO use and management in ED setting for hypoxemic acute respiratory failure using feedback from a national panel of multi-disciplinary experts and current evidence; (Aim 2) select implementation strategies that address the determinants of protocol-concordant HFNO use and management, commensurate with the ED’s capabilities, resources, and needs of its patients; and (Aim 3) examine both the implementation process for the HFNO protocol and the applicable clinical outcomes in a pilot hybrid effectiveness-implementation study. The completed project will include an implementation plan for HFNO management in the ED setting, and will provide estimates of effect and sample sizes for a future R01 implementing and testing the impact of HFNO monitoring protocols across health systems. Using the skills and preliminary data gained throughout this K23 mentored career development project, Dr. Goel will be well positioned to become an independent physician-scientist with R01 funding to implement and test the effectiveness of respiratory care protocols for improving patient and process outcomes across health systems. Larger scale implementation of such interventions can help standardized care delivery, with the ultimate goal of improving patient outcomes for more than a million acutely ill patients presenting to EDs annually in the United States with respiratory complaints.

项目摘要 Neha Goel博士的K23项目的目标是使她成为一名独立的医生-研究者， 就急性呼吸衰竭病人循证护理的实施进行研究。 凭借她作为一名肺重症监护医生的优势和她之前在临床急诊方面的培训 Goel博士将通过一个明确的培训计划过渡到她职业生涯的下一个阶段。的 培训计划经过精心设计，使她能够获得制定指南的必要技能， 实施科学方法和先进的统计分析。她的职业发展计划包括 通过指导研究性学习、相关教学课程和密切的 来自急诊和重症监护医学领域的领导者的指导，以及实施科学。 Goel博士的最终研究目标是改善急性呼吸衰竭患者的临床结局 通过实施系统开发的、循证的、高流量鼻氧（HFNO） 急诊科（艾德）的监测方案。为了实现这一目标，她的K23 研究项目将侧重于调查HFNO使用的循证协议的执行情况， HFNO的使用和管理是一项及时而重要的研究 话题自COVID-19疫情开始以来，HFNO的使用迅速增加。然而，在这方面， 在艾德环境中缺乏HFNO使用和监测的指导， 缺乏指导。Goel博士的K23研究项目的具体目标是：（目标1）开发一个实用的协议 在艾德环境中使用HFNO治疗低氧性急性呼吸衰竭， 国家多学科专家小组和现有证据;（目标2）选择执行战略， 解决方案一致性HFNO使用和管理的决定因素，与艾德的 能力，资源和患者的需求;（目标3）检查实施过程， HFNO方案和试点混合有效性实施研究中的适用临床结局。的 已完成的项目将包括一个在艾德环境下HFNO管理的实施计划，并将提供 未来R01实施和测试HFNO监测影响的效果和样本量估计 卫生系统的协议。利用在K23培训中获得的技能和初步数据， 职业发展项目，Goel博士将很好地定位成为一名独立的医生，科学家， R01资金用于实施和测试呼吸护理方案的有效性，以改善患者和 在整个卫生系统中取得成果。更大规模地实施这些干预措施有助于 标准化的护理服务，最终目标是改善100多万急性 在美国，每年因呼吸系统疾病就诊于急诊室的患者。