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.

了解和改善临床医生管理关键事件的能力很重要 为了患者安全。一个临床医生，模拟教育者和认知的团队 科学家提出了一项针对实时行动决策的五个站点的深入研究 - 在可推广的高保真关键事件中制定麻醉师的策略 模拟。具体目的是：1）开发和测试统一的认知模型 以及临床医生在关键事件中使用的决策策略的分类法 管理; 2）创建参与者的临床实践和模拟的详细概况 经验; 3）评估影响医师关键事件表现的因素；和 4）评估基于模拟的性能评估与 现有的医师能力指标（参与者的初级董事会认证 考试分数）。我们将对关键事件进行四个20分钟的现实模拟 与许多急性护理专业有关。 120个不同职业的麻醉师 积分将提供详细的人口统计学，临床实践和模拟经验 数据。在所有四种情况下，他们都会佩戴头部摄像机。 每个参与者的活动管理的成功将在稍后从间接头顶进行评估 基于及时完成预定的独立培训专家的视频 “关键绩效要素”以及全球技术和非技术分数。每个之后 场景，认知访谈将使用视频召回来确定 他们如何以及为什么做出临床管理决策。我们将迭代编码 并分析所有访谈数据以制定决策策略的分类法；每一个 场景将被编码为所使用的策略。然后，我们将分析事件的方式 性能等级随：参与者的实际实践和模拟经验， 使用的决策策略以及书面和口头认证考试 分数。这项创新的研究将深入描述多样化的思维过程 医师在管理关键事件中的样本。与这些经验数据一起 项目将为动态临床决策创建一个新的模型和分类法， 扩展了以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）。该研究将产生有关的最佳实践指南 关键事件管理和信息的决策以支持决策 关于基于模拟的培训和评估的内容，执行和时间。