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

描述（由申请人提供）：“我们的员工时间有限，很难让他们离开病人护理来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残疾病例可归因于沟通问题等人为因素。我们为模拟产科紧急反应演习和安全（cord）制定了标准化课程，使团队能够排练产科紧急情况，并提供最佳证据，以证明机组资源管理（CRM）团队培训。不太可能所有的CRM技术都对临床安全产生同样的影响。正如一家小型农村医院首席执行官的开场白所反映的那样，当医院的关键人员已经超负荷时，重要的是要评估哪些因素对安全护理过程至关重要。本提案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。具体而言，我们的目标是：1)评估团队培训（CRM）的哪些要素与日常临床实践（常规和急诊产科护理）中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/实验）中的表现转化为临床环境（实践/床边）。为了检验这一目标，我们将：a)在模拟中评估团队绩效与客户关系管理要素之间的关联，并比较它们是否与临床实践中的发现相一致（aim I）； b)探索客户关系管理的哪些要素在临床环境中是可转移的、持久的和可持续的；3)探索利用IT来创建一种安全文化，其中包括一个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要素对日常实践和紧急情况至关重要；2)提供关于模拟和团队培训在日常临床实践中的可转移性和可持续性的见解；3)为管理者和决策者提供有关模拟和团队培训投资回报的重要信息；4)从患者角度评价安全性；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性能；本建议的重点是将模拟和团队训练转化为临床环境。

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.