Risk-Informed In-Situ Simulations for Pediatric Emergency Transfers

描述（由申请人提供）：在《五年后犯错是人》报告中，有人指出：“复杂性、职业分化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责任，形成了一个令人生畏的障碍，阻碍了建立共同目标、团队合作和个人责任的习惯和信念，而这是安全文化所需要的。”培训医生、护士和其他专业人员在团队中工作是许多患者安全专家所提倡的一个概念。本应用程序旨在建立在临床医生沟通，团队合作和微系统风险确定在当前资助的研究，儿科紧急转移的风险评估（1 P20 HS017125，医疗保健研究和质量机构），通过将这些风险整合到开发，评估和传播现场模拟培训，重点是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，以解决已确定的临床医生沟通、团队合作和微系统风险。通过在卫生保健单位和楼层的操作环境中进行现场模拟，可能会揭示微系统以及组织系统或过程风险。具体目标包括：目标1。开展现场模拟培训，以解决儿科急诊转诊的沟通、团队合作和微系统风险；目标2。进行风险知情的现场模拟；目标3。通过评估现场模拟在沟通、团队合作、安全文化和微系统风险方面的变化，对现场模拟作为一种干预措施对提高儿科急诊转诊患者安全的影响进行风险评估；目标4。传播项目的研究结果和为协助他人实施现场模拟而开发的现场模拟工具包。

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.