Digital Innovation, Simulation, and Collaboration using Virtual Environment Realities (DISCOVER) for Pediatric Diagnostic

项目摘要 超过三分之一的儿科不良事件归因于诊断错误-失败 对儿童的健康问题作出准确和及时的解释。在儿科 重症监护病房（PICU），高风险，复杂，团队驱动的环境，诊断错误 税率由8%至25%不等。为了提高诊断准确性，临床决策支持（CDS） 包括人工智能和机器学习算法在内的工具已经开发出来， 在儿科重症监护室里没有被收养将CDS实施到活跃的高风险临床 如果不全面了解提供者和工作人员如何与 系统可能导致患者安全后果。这些后果可能包括： 工作流程、警报疲劳和可能导致直接患者伤害的不准确文档。我们 建议利用当前构建的高度逼真的沉浸式虚拟现实PICU临床 环境，以评估临床医生接受CDS工具的实施策略， 在患者安全学习实验室中实现卓越诊断。我们将使用一个 系统工程方法结合LiveWell的专业知识，LiveWell是一个屡获殊荣的设计 与以用户为中心的设计和人为因素的专业知识，与临床知识， 实施科学专业知识和世界著名的辛辛那提虚拟仿真程序 儿童医院医疗中心（CCHMC）。我们将：重新设计临床医生与CDS的接口方式 用于儿科重症监护环境中诊断密集型事件的工具，包括 入院和临床恶化;开发和实施设计知情的CDS工具， 诊断，并评价其适当性/可接受性和对诊断的影响 数字孪生沉浸式虚拟现实模拟中的不确定性、准确性和及时性;以及 建立在重症监护环境中实施CDS工具的最佳实践指南 来提高诊断的准确性结果将包括1）适当性、可接受性和 采用设计知情CDS工具; 2）对诊断准确性和及时性的影响 模拟临床环境;以及3）积极主动的实施计划， 设计知情的CDS工具，以提高重症监护环境中的诊断卓越性。

Project Summary More than a third of pediatric adverse events have been attributed to diagnostic error—the failure to establish an accurate and timely explanation of a child’s health problem. Within the pediatric intensive care unit (PICU), a high-stakes, complex, team-driven environment, diagnostic error rates vary between 8% and 25%. To improve diagnostic accuracy, clinical decision support (CDS) tools, including artificial intelligence and machine learning algorithms, have been developed but have failed to be adopted within the PICU. Implementation of CDS into an active high-risk clinical context without a comprehensive understanding of how providers and staff interface with the system can lead to patient safety consequences. These consequences can include disrupted workflows, alert fatigue, and inaccurate documentation that can lead to direct patient harm. We propose leveraging a currently built highly realistic immersive virtual reality PICU clinical environment to assess implementation strategies on clinician acceptance of CDS tools to improve diagnostic excellence within a patient safety learning lab. We will evaluate three aims using a systems-engineering approach combining the expertise of LiveWell, an award-winning design collaborative with user-centered design and human factors expertise, with the clinical knowledge, implementation science expertise, and world-renowned virtual simulation program of Cincinnati Children’s Hospital Medical Center (CCHMC). We will: redesign how clinicians interface with CDS tools for diagnosis-intensive events within the pediatric critical care environment including admission and clinical deterioration; develop and implement design-informed CDS tools for diagnosis and to evaluate their appropriateness/acceptability and impact on diagnostic uncertainty, accuracy, and timeliness within a digital twin immersive virtual reality simulation; and establish best practice guidance for implementation of CDS tools in the critical care environment to improve diagnostic excellence. Outcomes will include 1) appropriateness, acceptability, and adoption of design informed CDS tools; 2) impact on diagnostic accuracy and timeliness in the simulated clinical environment; and 3) a proactive implementation plan for the integration of design informed CDS tools to improve diagnostic excellence into the critical care environment.