Evaluating the Clinical Impact of Simulation & Team Training on OB Safety

描述(申请人提供)：“我们的工作人员时间有限，很难让他们远离病人护理，以改善他们的病人护理。”在美国，每天有超过75名婴儿死亡。JCAHO估计，三分之二的新生儿死亡或分娩期间永久性残疾的病例可归因于沟通问题等人为因素。我们已经开发了模拟产科应急演习和安全(CORDS)的标准化课程，允许团队排练OB紧急情况，并提供最佳证据机组人员资源管理(CRM)团队培训。不太可能所有的CRM技术都同样影响临床安全性。正如一位小型乡村医院首席执行官的开场白所反映的那样，当关键医院人员已经超负荷工作时，重要的是评估哪些因素对安全护理过程至关重要。这项建议的主要目标是评估模拟和团队培训在日常临床产科实践中的临床影响和持久性。我们的具体目标是：1)评估团队培训(CRM)的哪些要素与日常和急诊OB护理中日常临床实践的“尖端”良好的团队合作有关2)将研究转化为实践(TRIP)：评估团队培训的哪些要素从模拟环境(研究/长凳)的表现转化为临床环境(实践/床边)的表现。为了检验这一目标，我们将：a)在模拟中评估团队绩效和CRM元素之间的关联，并比较它们是否与临床实践中的结果一致(AIM I)b)探索哪些CRM元素在临床环境中是可转移、持久和可持续的3)探索使用IT来创建一种安全文化，其中包括关键但通常沉默的团队成员--患者。该项目的结果将：1)区分哪些CRM元素对常规实践和紧急情况至关重要；2)提供有关日常临床实践中模拟和团队培训的可转移性和可持续性的见解；3)为管理人员和政策制定者提供有关模拟和团队培训的投资回报的重要信息；4)从患者的角度评估安全性；以及5)优化模拟和团队培训。我们目前的工作是评估模拟环境中的表现；本建议侧重于将模拟和团队培训转换到临床环境中。

DESCRIPTION (PROVIDED BY APPLICANT): "Our staff is time constrained and it is hard to get them away from patient care to improve their patient care." More than 75 infants die each day in the United States. JCAHO estimates that 2/3 of cases of neonatal death or permanent disabilities during childbirth are attributable to human factors such as communication problems. We have developed a standardized Curriculum for simulated Obstetric emergency Response Drills and Safety (CORDS) that allows teams to rehearse OB emergencies and provides best evidence crew resource management (CRM) team training. It is unlikely that all CRM techniques equally impact clinical safety. When critical hospital personnel are already overextended, as reflected by the opening quote from a small rural hospital CEO, it is important to evaluate which elements are critical to safe processes of care. The main goal of this proposal is to evaluate the clinical impact and durability of simulations and team training in everyday clinical obstetric practice. Specifically we aim to: 1) Evaluate which elements of team training (CRM) are associated with good teamwork at the "sharp end" of everyday clinical practice in routine and emergency OB care 2) Translating research into practice (TRIP): Evaluate which elements of team training translate from performance in the simulated environment (research/bench) to the clinical environment (practice/bedside). To examine this aim we will: a) Evaluate associations between team performance and CRM elements in simulation and compare whether they are consistent with findings in clinical practice (AIM I) b) Explore which elements of CRM are transferable, durable and sustainable in the clinical environment 3) Explore the use of IT to create a safety culture that includes a critical but often silent team member - the patient. The results of this project will: 1) distinguish which CRM elements are essential to routine practice versus emergencies; 2) provide insights regarding the transferability and sustainability of simulation and team training in everyday clinical practice; 3) provide administrators and policy-makers important information regarding return on investment from simulation and team training; 4) evaluate safety from the patient perspective; and 5) optimize simulation and team training. Our current work evaluates performance in the simulated environment; this proposal focuses on the translation of simulation and team training to the clinical environment.