Prehospital Activation of ED Teams to Improve Sepsis Care

项目摘要/摘要 来自该指导职业发展奖的支持将为Ithan Peltan，医学博士，理学硕士提供额外的技能 和培训，他需要成功的目标，成为一名独立的医生-科学家专注于 改善早期脓毒症护理。佩尔坦博士是一名获得董事会认证的肺部和重症监护医生， InterMountain Healthcare拥有研究成功的记录，对临床研究的奉献精神得到证明， 为高质量的临床研究奠定了良好的方法基础。这项提案将完成Dr。 Peltan通过建立在他之前的基础上的结构化职业发展计划过渡到研究独立 培训和经验，并利用拥有丰富研究和职业发展资源的环境 以及访问细粒度的多中心临床数据。具体学习目标包括(1)高级 流行病学和生物统计学方法；(2)实施科学和相关方法；(3) 临床试验的设计和实施。佩尔坦博士将通过以下方式获得这些新技能和知识 正规课程、专业发展培训和创新的指导性研究计划 将提高脓毒症的医学知识，并确定促进高质量脓毒症交付的策略 急诊科的护理。佩尔坦博士的职业发展将由一位经验丰富的 凝聚力强的多学科指导团队，在危重护理、急救和院前研究方面拥有专业知识， 败血症、实施科学、临床试验和先进的分析方法。 每年有100多万美国患者因脓毒症住院或使其复杂化，死亡率为15%- 20%早期、适当的抗生素对于最佳的脓毒症预后至关重要。许多患者在向 然而，患有脓毒症的急诊科(ED)没有在推荐的时间间隔内接受抗生素治疗 根据国际准则和政府标准要求。考虑到完成任务的障碍 及时使用抗生素利用现有的护理模式，迫切需要新的方法来护理ED脓毒症。这个 这项K23奖项计划的研究旨在(1)验证识别可能患有败血症的患者的方法或 在急救到达之前和(2)了解优先考虑快速的护理系统的意外后果 脓毒症的抗生素模拟，以(3)检验是否围绕多学科重新设计ED脓毒症护理 在患者急诊到达时或之前激活的“代码败血症”小组可以改善高质量脓毒症的交付 关心。重要的是，这项提案解决了问题，并开发了适用于护理提供的方法 其他高危危重疾病。这项研究的结果将为R01或 用于支持Code Sepsis方案的多中心群组随机试验的等额资金。

PROJECT SUMMARY/ABSTRACT Support from this Mentored Career Development Award will provide Ithan Peltan, MD, MSc the additional skills and training he needs to succeed in his goal of becoming an independent physician-scientist focused on improving early sepsis care. Dr. Peltan is a board-certified pulmonary and critical care physician at Intermountain Healthcare with a track record of research success, proven dedication to clinical investigation, and an excellent foundation in methods for high-quality clinical research. This proposal will complete Dr. Peltan’s transition to research independence via a structured career development plan that builds on his prior training and experience and leverages an environment with rich research and career development resources as well as access to granular multicenter clinical data. Specific learning objectives include (1) advanced epidemiologic and biostatistical methods; (2) implementation science and associated methodologies; and (3) the design and conduct of clinical trials. Dr. Peltan will acquire these new skills and knowledge by means of formal coursework, professional development training, and an innovative program of mentored research that will advance medical knowledge about sepsis and identify strategies to facilitate delivery of high-quality sepsis care in the emergency department. Dr. Peltan’s career development will be guided by an experienced and cohesive multidisciplinary mentorship team with expertise in critical care, emergency and prehospital research, sepsis, implementation science, clinical trials, and advanced analytic methods. Sepsis causes or complicates hospital stays for over 1 million U.S. patients every year, with mortality of 15- 20%. Early, appropriate antibiotics are critical to optimal sepsis outcomes. Many patients who present to the emergency department (ED) with sepsis, however, do not receive antibiotics within the intervals recommended by international guidelines and required under government standards. Given the barriers to accomplishing timely antibiotics using current care models, new approaches to ED sepsis care are urgently needed. The research planned for this K23 award aims to (1) validate methods to identify patients likely to have sepsis at or before ED arrival and (2) understand the unintended consequences of care systems that prioritize rapid antibiotic imitation for sepsis in order to (3) test whether redesigning ED sepsis care around multidisciplinary “Code Sepsis” teams activated on or before patient’s ED arrival could improve delivery of high-quality sepsis care. Importantly, this proposal addresses questions and develops methods applicable to care delivery for other high-risk critical illnesses. Findings from this research will provide the preliminary data for R01 or equivalent funding to support a multicenter cluster-randomized trial of the Code Sepsis protocol.