Risk-Informed In-Situ Simulations for Pediatric Emergency Transfers

描述（申请人提供）：在《犯错是人的五年后》报告中，有人指出，“复杂性、专业分散和个人主义传统的结合，加上根深蒂固的等级权威结构和分散的问责制，形成了一个令人生畏的障碍，阻碍了建立共同目标、团队合作、以及安全文化所要求的成功相互依存的个人责任。“培训医生、护士和其他专业人员团队工作是许多患者安全专家提倡的一个概念。本申请旨在通过将这些风险整合到现场模拟培训的开发、评估和传播中，以目前资助的研究“儿科紧急转移的风险评估”（1 P20 HS 017125，医疗保健研究和质量局）中确定的临床医生沟通、团队合作和微系统风险为基础，重点关注儿科紧急转移患者的接收。该应用程序还将集成特定的TeamSTEPPS（tm）技能类别，以解决已识别的临床医生沟通、团队合作和微系统风险。通过在现场进行模拟-在卫生保健单位和楼层的操作环境中-微系统以及组织系统或过程风险都可能被揭示。具体目标包括：目标1。开发现场模拟培训，以解决沟通，团队合作和微系统风险，为接收儿科紧急转移;目标2。进行风险知情的现场模拟;目标3。对原位模拟作为干预措施的影响进行风险知情评价，通过评估沟通、团队合作、安全文化和微系统风险的变化，提高儿科急诊转院患者的安全性;目标4。传播该项目的调查结果和为协助其他人实施现场模拟而开发的现场模拟工具包。 公共卫生相关性：根据儿科紧急转移风险评估的结果，并使用TeamSTEPPS团队合作技能类别，本项目将开发和进行风险知情的现场模拟，旨在解决儿科紧急转移接收过程中已识别的临床医生沟通、团队合作和微系统风险。现场模拟是对医疗保健工作者面临的挑战、系统和操作环境的现实表示。将在现场模拟后评估沟通和团队合作功能的改善情况，可能会发现更多的微系统和组织系统和流程风险。

DESCRIPTION (provided by applicant): In the report Five Years After to Err is Human, it was noted that "the combination of complexity, professional fragmentation, and a tradition of individualism, enhanced by a well-entrenched hierarchical authority structure and diffuse accountability, forms a daunting barrier to creating the habits and beliefs of common purpose, teamwork, and individual accountability for successful interdependence that a safe culture requires." Training physicians, nurses, and other professionals to work in teams is a concept that has been promoted by many patient safety experts. This application seeks to build upon the clinician communication, teamwork, and microsystem risks identified in a currently funded study, Risk Assessments of Pediatric Emergency Transfers (1 P20 HS017125, Agency for Healthcare Research and Quality), through integration of these risks into the development, evaluation, and dissemination of an in-situ simulation training focused on the receipt of pediatric emergency transfer patients. This application will also integrate specific TeamSTEPPS(tm) skill categories to address the identified clinician communication, teamwork, and microsystem risks. By conducting the simulations in-situ-in the operational environment of health care units and floors-both microsystem as well as organizational systemic or process risks are likely to be revealed. The specific aims include: Aim 1. Develop in-situ simulation trainings to address communication, teamwork, and microsystem risks for receipt of pediatric emergency transfers; Aim 2. Conduct the risk-informed in-situ simulations; Aim 3. Conduct a risk-informed evaluation of the impact of in-situ simulation as an intervention to improve the safety for receiving pediatric emergency transfer patients through assessment of the change in communication, teamwork, safety culture, and microsystem risks; Aim 4. Disseminate the project's findings and the In-Situ Simulation Toolkit developed to assist others with implementation of in-situ simulation. PUBLIC HEALTH RELEVANCE: Based of the findings from Risk Assessments of Pediatric Emergency Transfers and using the TeamSTEPPS teamwork skill categories, this project will develop and conduct risk-informed In-situ simulations designed to address identified clinician communication, teamwork, and microsystem risks in the receipt of pediatric emergency transfers. In-situ simulations are a realistic representation of the challenges, systems, and operational environments of health care workers. Improvement in communication and teamwork function will be assessed following the in-situ simulations and additional both microsystem and organizational systemic and process risks are likely to be revealed.