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方面的知识和技能，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(HSR)的正式教学课程，以及参加国家HSR研讨会和会议。候选人将参加由卫生保健研究中心举办的高铁研讨会，该中心是匹兹堡大学高度活跃的高铁合作组织。患者安全培训将通过匹兹堡地区医疗保健计划(PRHI)组织的正式教学计划、与PRHI正在进行的地区范围内的患者安全计划的互动以及参与有关患者安全的全国性研讨会和会议来获得。赞助商将在与这些领域相关的高铁、卫生经济学和生物统计学方法领域进行独立研究任务，以补充教学培训。 这项拟议的研究项目旨在确定护理人员在院外气管插管(ONG-ETI)中发生错误的模式和影响。支持呼吸道、呼吸和循环是危重病人复苏的中心主题，而呼吸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呼吸道管理的标准护理。OO-ETI是一个困难的、容易出错的过程，因为其潜在的系统复杂性和对前提条件的依赖。初步研究表明，由院前人员进行的ETI错误发生率很高，包括未能完成OO-ETI、多次OO-ETI尝试、或气管插管错位或移位。在这项研究的第一阶段，候选人将检查EMS系统结构、人口环境、社会经济地位或患者种族和民族背景的变化是否与OOE-ETI错误的发生率有关。在第二阶段，他将确定OOH-ETI错误是否会影响患者的结局或医院资源的利用。这些分析在EMS、患者安全和健康服务研究领域具有创新性，并将有助于证明全系统减少这一复杂程序中的错误的努力是合理的。

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.