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.

项目概要 Neha Goel 博士的 K23 项目的目标是使她成为一名独立的医生兼研究者 对急性呼吸衰竭患者实施循证护理进行研究。 凭借她作为肺部重症监护医生的优势以及她之前在临床急诊方面的培训 护理研究后，Goel 博士将通过明确的培训计划过渡到职业生涯的下一阶段。这 精心设计的培训计划使她能够获得指南制定所需的技能， 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、相关教学课程和密切关注进行集中培训 来自急诊和重症监护医学以及实施科学领域领导者的指导。 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果 通过实施系统开发的、基于证据的高流量经鼻吸氧 (HFNO) 急诊科 (ED) 的监测协议。为了实现这一目标，她的 K23 指导 研究项目将侧重于调查关于 HFNO 使用的循证协议的实施情况和 西奈山医院急诊室的管理。 HFNO的使用和管理是一项及时而重要的研究 话题。自 COVID-19 大流行开始以来，HFNO 使用量迅速增加。然而， 缺乏关于 HFNO 在 ED 环境中使用和监测的指导，不良临床结果发生在 缺乏指导。 Goel 博士的 K23 研究项目的具体目标是：（目标 1）制定实用的方案 使用 HFNO 在 ED 环境中使用和管理低氧性急性呼吸衰竭的反馈 国家多学科专家小组和现有证据； （目标 2）选择实施策略 解决符合方案的 HFNO 使用和管理的决定因素，与 ED 的要求相称 患者的能力、资源和需求； （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适用的临床结果。这 已完成的项目将包括 ED 环境中 HFNO 管理的实施计划，并将提供 对未来 R01 实施和测试 HFNO 监测影响的效果和样本量的估计 跨卫生系统的协议。使用在 K23 指导过程中获得的技能和初步数据 职业发展项目中，戈埃尔博士将有能力成为一名独立的医师科学家 R01 资金用于实施和测试呼吸护理方案的有效性，以改善患者和患者的健康状况 处理整个卫生系统的结果。更大规模地实施此类干预措施可以帮助 标准化护理服务，最终目标是显着改善超过 100 万患者的治疗结果 在美国，每年都有因呼吸系统疾病而到急诊科就诊的病人。