Effect of Out-of-Hospital Endotracheal Intubation Errors

描述（由申请人提供）：这是一个职业发展奖的申请，旨在帮助候选人获得健康服务和患者安全研究的知识和技能，重点是提供院外（OOH）紧急医疗服务（EMS）护理。该计划的培训部分包括卫生服务研究的正式教学课程以及参加国家卫生服务研究研讨会和会议。候选人将参加由卫生保健研究中心举办的HSR研讨会，该中心是匹兹堡大学一个高度活跃的HSR合作机构。患者安全培训将通过匹兹堡地区医疗保健倡议（PRHI）组织的正式教学计划、与PRHI正在进行的区域范围内患者安全倡议的互动以及参加患者安全方面的国家研讨会和会议来获得。赞助商将在HSR、卫生经济学和与这些领域相关的生物统计方法领域的独立研究任务中补充教学培训。 拟议的研究项目是一项努力，以确定模式和发生在医院外的气管插管（OOH-ETI）的护理人员进行的错误的影响。气道、呼吸和循环的支持是危重病人复苏的中心主题，气道管理被认为是这一概念中最重要的干预措施。ETI被认为是院内和院外气道管理的标准治疗。OOH-ETI是一个困难的容易出错的过程，因为它的底层系统的复杂性和依赖于先决条件。初步研究表明，院前人员进行的ETI发生错误的几率很高，包括未能完成OOH-ETI、多次OOH-ETI尝试或气管插管错位或移位。在本研究的第一阶段，候选人将检查EMS系统结构、人群环境、社会经济地位或患者种族和民族背景的变化是否与OOH-ETI错误的发生率相关。在第二阶段，他将确定OOH-ETI错误是否会影响患者结局或院内资源利用。这些分析在EMS、患者安全和卫生服务研究领域具有创新性，将有助于证明全系统努力减少这一复杂程序中的错误是合理的。

DESCRIPTION (provided by the applicant): This is an application for a career development award designed to help the candidate gain knowledge and skills in health services and patient safety research, with an emphasis upon the delivery of out-of-hospital (OOH) Emergency Medical Services (EMS) care. The training component of this plan includes formal didactic coursework in health services research (HSR) as well as attendance at national HSR seminars and conferences. The candidate will participate in HSR seminars held by the Center for Research in Health Care, a highly active HSR collaborative based at the University of Pittsburgh. Patient safety training will be acquired through a formal didactic program organized by the Pittsburgh Regional Healthcare Initiative (PRHI), interaction with PRHI's ongoing region-wide patient safety initiatives, and participation in national seminars and conferences in patient safety. The sponsors will supplement didactic training with independent study assignments in the areas of HSR, health economics and biostatistical methods related to these areas. The proposed research project is an effort to identify the patterns and effects of errors occurring in out-of-hospital endotracheal intubation (OOH-ETI) performed by paramedics. Support of airway, breathing and circulation is the central theme of the resuscitation of the critically ill, and airway management is considered the most important intervention in this concept. ETI is considered the standard-of-care for airway management in both the in-hospital and out-of-hospital settings. OOH-ETI is a difficult error-prone procedure because of its underlying system complexity and dependence on preconditions. Pilot studies suggest that ETI performed by pre-hospital personnel is subject to a high incidence of error, including failure to accomplish OOH-ETI, multiple OOH-ETI attempts, or endotracheal tube misplacement or dislodgement. In the first stage of this study, the candidate will examine whether variations in EMS system structure, population setting, socioeconomic status, or patient racial and ethnic background are associated with the incidence of OOH-ETI errors. In the second phase, he will determine whether OOH-ETI errors affect patient outcomes or in-hospital resource utilization. These analyses are innovative in the fields of EMS, patient safety and health services research and will help to justify system-wide efforts to reduce errors in this complex procedure.