Dissemination and Implementation of COVID-19 Care Innovations in ED Settings

摘要/摘要 在新冠肺炎大流行等突发公共卫生事件期间，信息的快速传播 向临床医生介绍正在出现的创新对于确保患者获得最佳结果至关重要。 然而，关于临床医生如何获得有关创新的信息并做出决定，人们知之甚少。 在不确定时期执行和取消执行。随着SARS-CoV-2病毒的最初快速传播 在全国范围内，临床医生担心即将到来的危重病人数量会超过能力， 由于缺乏呼吸机和其他基本资源而导致患者死亡。此外，还出现了 个人防护装备对遵循通常标准以保护临床医生免受 感染。为了防止最糟糕的情况成为现实，紧急情况部门做出了大规模的反应 (ED)员工迅速创新，提供有效的护理，保护前线工作人员，并确保 个人防护装备的可持续供应。为了应对这些不寻常的情况，艾德 临床医生求助于非传统的信息来源--例如，Twitter、Facebook、播客和Pre. 印刷期刊出版物-了解他们可以用来护理急诊室中的新冠肺炎患者的创新。 虽然这些信息来源提供了轻松获取创新信息的途径，但它们也 散布错误信息。在优化传播和实施方面做的研究很少 在公共卫生紧急情况下的创新。在大流行之前，在线平台的扩张 促进关于创新的信息交流已经发生，而且现在还存在更多。 信息也通过专业协会和社交媒体共享。但我们的理解是 在大流行期间，由于共享的数量，创新在ED之间的扩散目前是有限的 这发生在新冠肺炎期间；与这些创新相关的紧迫性和恐惧；以及对 取消实施被发现无效甚至危险的干预措施。目前还不清楚这些是如何 是否根据急诊科临床医生的人口统计数据或 他们所服务的社区和人口。对创新流动的全面评估将导致 深入了解传播者和实施者如何在大流行和 快速变化的紧急情况以及如何优化流程以实现更稳定的状态 条件。我们的研究采用了强有力的跨学科和混合方法。我们强大的团队 将与代表急诊医生和护士的研究伙伴以及其他学科的专家合作 艾德。研究方法将先进的自然语言处理技术与访谈相结合(目标1)， 对急诊科专业人员进行调查的焦点小组(目标2)，并系统地综合结果以确定 改进急诊护理创新传播的战略(目标3)。该研究还将在#年提供结果。 可操作的形式，如传播和执行战略的工具包。

SUMMARY/ABSTRACT During a public health emergency such as the COVID-19 pandemic, rapid dissemination of information to clinicians about emerging innovations is critical to ensuring the best outcomes for patients. However, little is known about how clinicians obtain information about innovations make decisions about implementation and de-implementation during uncertain times. As SARS-CoV-2 made its initial, rapid spread across the nation, clinicians feared that the impending surge of critically ill patients would overwhelm capacity, causing patient deaths due to a lack of ventilators and other essential resources. Additionally, shortages of personal protective equipment posed a challenge to following the usual standards to protect clinicians from infection. In a massive response to prevent worst-case scenarios from materializing, emergency department (ED) staff have rapidly innovated to deliver effective care, protect frontline workers, and ensure a sustainable supply of personal protective equipment. In response to these unusual conditions, ED clinicians turned to nontraditional sources of information—for example, Twitter, Facebook, podcasts, and pre- print journal publications—to learn about innovations they could use to care for COVID-19 patients in EDs. While these sources of information provided easy access to information about innovations, they also spread misinformation. Little research has been done to optimize dissemination and implementation of innovations during a public health emergency. Before the pandemic, an expansion of online platforms facilitating exchange of information about innovations had already occurred, and many more exist now. Information is also shared through professional societies and also through social media. But the understanding of the diffusion of innovations among EDs during the pandemic is currently limited due to the volume of sharing that happened during COVID-19; the urgency and fear associated with these innovations; and the need for deimplementation of interventions that were found to be ineffective or even dangerous. It is not clear how these processed happened and whether they might have differed based on the demographics of ED clinicians or the communities and populations they serve. A comprehensive evaluation of the flow of innovations will lead to insights into how disseminators and implementers can improve practices during pandemic and rapidly evolving emergencies and also how processes can be optimized for more steady-state conditions. Our study incorporates a strong interdisciplinary and mixed methods approach. Our strong team will work with study partners representing emergency physicians and nurses and experts in other disciplines in the ED. Study methods combine advanced natural language processing techniques with interviews (Aim 1), focus groups with a survey of ED professionals (Aim 2), and systematic synthesis of results to identify strategies for improving diffusion of ED care innovations (Aim 3). The study will also provide results in actionable formats, such as a toolkit of dissemination and implementation strategies.