IMPACTS: Improving Medical Performance during Acute Crises Through Simulation

影响：通过模拟提高急性危机期间的医疗绩效

• 批准号: 9754845
• 负责人: MATTHEW BRET WEINGER
• 金额: $ 39.29万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-02 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9754845
• 关键词: IMPACTS; Improving; Medical; Performance; during

Understanding and improving clinicians' ability to manage critical events is important for patient safety. A team of clinician-scientists, simulation educators, and cognitive scientists propose a five-site in-depth study of the real-time action-oriented decision- making strategies of anesthesiologists during generalizable high-fidelity critical event simulations. The Specific Aims are to: 1) Develop and test a unified cognitive model and taxonomy of the decision-making strategies clinicians use during critical event management; 2) Create detailed profiles of participants' clinical practice and simulation experience; 3) Evaluate the factors affecting physicians' critical event performance; and 4) Evaluate the relationship between simulation-based performance assessment and existing metrics of physician competence (participants' primary board certification exam scores). We will create four 20-minute realistic simulations of critical events that are relevant to many acute-care specialties. 120 anesthesiologists at varying career points will provide detailed demographic, clinical practice, and simulation experience data. They will wear head-mounted video cameras as they perform in all four scenarios. Success of each participant's event management will be assessed later from overhead videos by independent trained experts based on timely completion of pre-defined `critical performance elements' and global technical and non-technical scores. After each scenario, cognitive interviews will be conducted using video-cued recall to ascertain how and why they made their clinical management decisions. We will iteratively code and analyze all of the interview data to develop a taxonomy of decision strategies; Every scenario will be coded for the strategies used. We will then analyze how event performance ratings vary with: participants' actual practice and simulation experience, the decision strategies used, and written and oral board certification examination scores. This innovative study will delineate in depth the thought processes of a diverse sample of physicians in managing critical events. Along with these empirical data, the project will create a new model and taxonomy for dynamic clinical decision-making, extending models previously developed for healthcare and other arenas of similar cognitive demands (e.g. aviation). The study will yield best-practice guidelines on decision-making in critical event management and information to support policymaking about the content, execution, and timing of simulation-based training and assessment.

了解和提高临床医生管理危急事件的能力很重要 为了患者的安全。由临床医生科学家、模拟教育工作者和认知专家组成的团队 科学家提出对实时行动导向决策进行五点深入研究 麻醉师在普遍的高保真度关键事件期间制定策略 模拟。具体目标是： 1）开发和测试统一的认知模型 临床医生在危急事件期间使用的决策策略的分类 管理; 2) 创建参与者临床实践和模拟的详细档案 经验; 3）评估影响医生危急事件绩效的因素；和 4) 评估基于模拟的绩效评估与绩效评估之间的关系 医生能力的现有指标（参与者的主要委员会认证 考试成绩）。我们将为关键事件创建四个 20 分钟的真实模拟 与许多急症护理专业相关。 120 名不同职业的麻醉师 积分将提供详细的人口统计、临床实践和模拟经验 数据。他们在所有四种场景中表演时都将佩戴头戴式摄像机。 稍后将通过管理费用评估每位参与者的活动管理是否成功 由经过独立培训的专家根据及时完成预定义的内容制作的视频 “关键绩效要素”以及全球技术和非技术分数。每次之后 场景中，将使用视频提示回忆进行认知访谈以确定 他们如何以及为何做出临床管理决策。我们将迭代编码 分析所有访谈数据以制定决策策略分类；每一个 场景将针对所使用的策略进行编码。接下来我们将分析事件是如何发生的 表现评级因以下因素而异：参与者的实际练习和模拟经验， 使用的决策策略以及书面和口头委员会认证考试 分数。这项创新研究将深入描绘多元化的思维过程 管理危急事件的医生样本。除了这些经验数据之外， 该项目将为动态临床决策创建新的模型和分类法， 扩展了之前为医疗保健和其他类似领域开发的模型 认知需求（例如航空）。该研究将产生最佳实践指南 关键事件管理决策和支持政策制定的信息 关于基于模拟的培训和评估的内容、执行和时间安排。