Optimizing ED to ICU triage decisions for critically ill patients in respiratory distress

项目总结 拟议研究和职业发展计划的目标是使首席调查员(PI)成为 独立的临床研究人员使用多种研究方法直接提高护理质量 位于急诊科(ED)和重症监护病房(ICU)之间的危重病人。 过渡到她职业生涯的下一个阶段，并巩固她作为重症监护医生的优势和她的 在临床调查和定量分析方面的培训之前，PI将学习高级研究技能 通过个性化和课堂培训，包括多层次建模、定性和混合方法 方法、决策分析和临床决策支持工具开发。ICU周围的分诊决定 ED患者的入院对患者的预后以及对ED和ICU的利用有着深远的影响 资源。这一决定中存在的差异超出了患者相关因素和病床的解释范围 可用性。拟议的K23研究旨在改善获得适当ICU护理的机会，并发展 通过了解主观和主观因素之间的相互作用来降低死亡率的创新临床解决方案 急诊ICU分诊决策的客观因素。这项建议的具体目的是(1) 在现有的多医院危重病人数据集中检查当前ICU分诊实践中的差异程度 ED合并呼吸窘迫患者，使用混合方法方法和多水平建模，(2)识别 影响主观评估病情严重程度和受益于ICU的可能性的因素， 使用半结构化医生访谈和根据数据集分析开发的场景，以及3)开发 并测试基于电子健康记录的临床决策支持工具的可行性，以减少潜在的 ICU入院决定中的有害变化。这些目标有可能1)识别分诊中的差异 当资源有限时，为具有某些特征的患者做出决定，2)提供对哪些 最影响医生分诊做法的因素以及他们对敏锐性和受益可能性的看法，以及 3)使用临床决策支持工具确定干预的目标区域，以改善急诊ICU的护理 界面。

PROJECT SUMMARY The goal of the proposed research and career development plan is for the Principal Investigator (PI) to become an independent clinical investigator using multiple research methods to directly improve the quality of care for critically ill patients at the interface between the Emergency Department (ED) and Intensive Care Unit (ICU). To transition into the next phase of her career and build upon her strengths as a critical care physician and her prior training in clinical investigation and quantitative analysis, the PI will learn advanced research skills through individualized and classroom training, including multi-level modeling, qualitative and mixed methods approaches, decision analysis, and clinical decision support tool development. Triage decisions around ICU admission for ED patients have profound implications for patient outcomes and utilization of ED and ICU resources. Variation in this decision exists beyond what is explained by patient-related factors and bed availability. The proposed K23 research seeks to improve access to appropriate ICU care and develop innovative clinical solutions to reduce mortality by understanding the interaction between subjective and objective factors on triage decision-making at the ED-ICU interface. The specific aims of this proposal are (1) Examine the extent of variation in current ICU triage practice in an existing multi-hospital dataset of critically ill ED patients with respiratory distress, using a mixed methods approach and multi-level modeling, (2) Identify factors influencing subjective assessments of illness severity and likelihood to benefit from ICU admission, using semi-structured physician interviews with scenarios developed from dataset analysis, and 3) Develop and test the feasibility of an electronic health record-based clinical decision support tool to reduce potentially harmful variation in ICU admission decisions. These aims have the potential to 1) identify disparities in triage decisions for patients with certain characteristics when resources are limited, 2) provide insight into which factors most affect physician triage practices as well as their perceptions of acuity and likelihood to benefit, and 3) pinpoint target areas for intervention using clinical decision support tools to improve care at the ED-ICU interface.