Optimizing the use of noninvasive respiratory support in the Emergency Department

项目总结 Neha Goel博士K23项目的目标是使她能够成为一名独立的医生-研究员， 对急性呼吸衰竭患者实施循证护理进行研究。 凭借她作为一名肺部重症监护医生的优势和她先前的临床急救培训 在护理研究方面，Goel博士将通过一个明确的培训计划过渡到她职业生涯的下一个阶段。这个 培训计划经过精心设计，使她能够在准则制定方面获得必要的技能， 实施科学方法论和高级统计分析。她的职业发展计划包括 通过进行有指导的研究性研究、相关的教学课程和结束语进行重点培训 来自急诊和重症护理医学以及实施科学领域的领导者的指导。 戈埃尔博士的最终研究目标是改善急性呼吸衰竭患者的临床结果 通过实施系统开发的、循证的、高流量鼻氧(HFNO) 急诊科(ED)的监测方案。为了与这个目标保持一致，她的K23指导 研究项目将重点调查关于HFNO使用和使用的循证议定书的执行情况 西奈山医院的管理。HFNO的使用和管理是一项及时而重要的研究 主题。自新冠肺炎大流行开始以来，高频一氧化氮的使用迅速增加。然而， 在急诊室环境中缺乏对HFNO使用和监测的指导，在急诊室发生不良临床后果 缺乏指导。Goel博士的K23研究项目的具体目标是：(目标1)制定一项务实的协议 在急诊室使用和管理HFNO治疗低氧性急性呼吸衰竭 国家多学科专家小组和现有证据；(目标2)选择执行战略， 处理符合规程的HFNO使用和管理的决定因素，与ED相称 其患者的能力、资源和需求；以及(目标3)审查 HFNO方案和试验性混合有效性实施研究中适用的临床结果。这个 已完成的项目将包括在ED环境下对HFNO管理的实施计划，并将提供 对实施和测试HFNO监测影响的未来R01的影响和样本量的估计 医疗系统之间的协议。使用在整个K23指导过程中获得的技能和初步数据 职业发展项目，戈埃尔博士将处于有利地位，成为一名独立的内科科学家 R01资金，用于实施和测试呼吸护理方案的有效性，以改善患者和 在整个卫生系统中处理结果。更大规模地实施此类干预措施可以有所帮助 标准化护理提供，最终目标是显著改善患者结果100多万 在美国，每年有呼吸系统疾病的病人都会去急诊室就诊。

PROJECT SUMMARY The goal of Dr. Neha Goel’s K23 project is to enable her to become an independent physician-investigator who conducts research on the implementation of evidence-based care for patients with acute respiratory failure. Building upon her strengths as a pulmonary-critical care physician and her prior training in clinical emergency care research, Dr. Goel will transition into the next phase of her career through a well-defined training plan. The training plan is meticulously designed to enable her to acquire requisite skills in guideline development, implementation science methodology, and advanced statistical analyses. Her career development plan contains focused training through conduct of a mentored research study, relevant didactic coursework, and close mentorship from leaders in the fields of emergency and critical care medicine, and implementation science. Dr. Goel’s ultimate research objective is to improve clinical outcomes for patients with acute respiratory failure through the implementation of a systematically developed, evidence-based, high flow nasal oxygen (HFNO) monitoring protocol for the emergency department (ED). In keeping with this objective, her K23 mentored research project will focus on investigating the implementation of evidence-based protocol on HFNO use and management for The Mount Sinai Hospital ED. HFNO use and management is a timely and important research topic. Since the COVID-19 pandemic began, there has been a rapid increase in HFNO usage. However, guidance on HFNO use and monitoring in the ED setting is lacking, and adverse clinical outcomes occur in the absence of guidance. Dr. Goel’s K23 research project specific aims are to: (Aim 1) develop a pragmatic protocol for HFNO use and management in ED setting for hypoxemic acute respiratory failure using feedback from a national panel of multi-disciplinary experts and current evidence; (Aim 2) select implementation strategies that address the determinants of protocol-concordant HFNO use and management, commensurate with the ED’s capabilities, resources, and needs of its patients; and (Aim 3) examine both the implementation process for the HFNO protocol and the applicable clinical outcomes in a pilot hybrid effectiveness-implementation study. The completed project will include an implementation plan for HFNO management in the ED setting, and will provide estimates of effect and sample sizes for a future R01 implementing and testing the impact of HFNO monitoring protocols across health systems. Using the skills and preliminary data gained throughout this K23 mentored career development project, Dr. Goel will be well positioned to become an independent physician-scientist with R01 funding to implement and test the effectiveness of respiratory care protocols for improving patient and process outcomes across health systems. Larger scale implementation of such interventions can help standardized care delivery, with the ultimate goal of improving patient outcomes for more than a million acutely ill patients presenting to EDs annually in the United States with respiratory complaints.