Evaluation of paramedic decision making in triage and transport of adults with acute uncomplicated alcohol intoxication to the emergency department versus sobering center

急性单纯性酒精中毒成人急诊室与清醒中心的分诊和转运的护理决策评估

• 批准号: 10646487
• 负责人: Shannon Smith-Bernardin
• 金额: $ 18.96万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10646487
• 关键词: Accident and Emergency department; Acute; Address; Adult; Affect; Alcohol consumption; Alcohol withdrawal syndrome; Alcoholic Intoxication; Ambulances; Assessment tool; Cardiac; Caring; Characteristics; Classification; Clinical; Communities; Community Health; Complication; Crowding; Data; Decision Making; Deterioration; Development; Diagnosis; Doctor of Philosophy; Effectiveness of Interventions; Emergency Care; Emergency Medicine; Emergency department visit; Environmental Risk Factor; Evaluation; Event; Evidence based intervention; Evidence based treatment; Foundations; Funding; Future; Goals; Grant; Harm Reduction; Health; Health Policy; Health Services Research; Health system; Healthcare; Homeless persons; Homelessness; Hospitals; Hour; Human Resources; Incidence; Individual; Injury; Interview; Intoxication; Intracranial Hemorrhages; Intubation; Leadership; Liver Failure; Maps; Medical; Medical emergency; Mentored Research Scientist Development Award; Mentorship; Methods; Monitor; Morbidity - disease rate; Nurses; Paramedical Personnel; Patient Care; Patient Triage; Patients; Persons; Play; Policies; Provider; Publications; Qualitative Research; Recording of previous events; Research; Research Methodology; Research Personnel; Resources; Safety; Sampling; San Francisco; Scientist; Services; Solid; Statistical Methods; System; Testing; Training; Training Programs; Transportation; Triage; United States; Variant; Ventilatory Depression; Visit; Vulnerable Populations; Writing; acute care; addiction; alcohol use disorder; chronic alcohol ingestion; cost effective; design; dissemination science; experience; hospital patient care; hybrid type 2 trial; implementation science; improved; innovation; mortality; multidisciplinary; novel; prevent; programs; provider factors; psychiatric emergency; recruit; skills; sobriety; statistics

PROJECT SUMMARY/ ABSTRACT The long-term goal of this K01 Mentored Research Scientist Development Award is to advance Dr. Shannon Smith-Bernardin's development as an independent clinician-investigator focusing on novel treatment paradigms for people with alcohol-use disorders and acute alcohol intoxication. This proposed project has four training aims: advanced training in: 1) implementation science; 2) obtaining, merging and analyzing administrative data; 3) qualitative and mixed-methods research; and 4) grant writing. Dr. Smith- Bernardin has assembled a multi-disciplinary mentorship team including nationally recognized experts in implementation science, emergency medicine, alcohol use disorders, vulnerable populations, frequent utilizers of health care, mixed methods, and qualitative research. Alcohol use disorders are associated with significant morbidity and mortality worldwide. In the United States, emergency departments (EDs) and the ambulance system (EMS) provide the majority of acute care for alcohol intoxication. Between 2-12% of patients in medical or psychiatric EDs are acutely intoxicated. “Sobering centers” were designed to address the needs of people with acute uncomplicated alcohol intoxication who do not require ED care, so that these individuals could receive safe, high value care in an alternative care setting. If used appropriately, sobering centers can reduce the need for ED visits and reduce ED overcrowding. In Aim 1, Dr. Smith-Bernardin will characterize and define the incidence of patients with acute alcohol intoxication in the Sobering Center, the ED, and EMS system and compare the patient, provider, and environmental-level factors that influence the transport decision using administrative data. In Aim 2, using the CFIR framework, she will conduct and analyze in-depth interviews to determine modifiable factors influencing ambulance personnel's decision to transport patients with acute uncomplicated alcohol intoxication to an ED instead of the Sobering Center. The proposed study is the first to: 1) evaluate paramedic decision making in a community with an established sobering center alternative; and 2) recruit ambulance, ED, and Sobering Center personnel to examine the factors affecting triage in the field for uncomplicated alcohol intoxication. Both aims will use innovative implementation science methods to triangulate health related data from EMS, EDs, and the San Francisco Sobering Center. The training and research conducted in the proposed project will form the basis of a future R01-proposal hybrid type II trial to test the implementation and effectiveness of an intervention to reduce provider and environmental level variation in order to increase of appropriate use of sobering centers and reduce reliance on the ED for acute alcohol intoxication. The proposed project will provide Dr. Smith-Bernardin the support necessary to become an independent clinician-scientist using implementation science and mixed-methods research to develop, evaluate, and disseminate innovative, evidence-based treatment paradigms for individuals with alcohol-use disorders and acute alcohol intoxication.

项目摘要/摘要 这个K01指导研究科学家发展奖的长期目标是促进香农博士 史密斯 - 伯纳丁作为一种独立临床评估者的发展，重点是新治疗 患有酒精疾病和急性酒精中毒的人的范例。这个提议的项目有四个 培训目标：高级培训：1）实施科学； 2）获得，合并和分析 行政数据； 3）定性和混合方法研究； 4）赠款写作。史密斯博士 - 伯纳丁（Bernardin）组建了一个多学科心态团队 实施科学，急诊医学，酒精使用障碍，脆弱人群，经常使用 医疗保健，混合方法和定性研究。饮酒障碍与重要相关 全球发病率和死亡率。在美国，急诊科（ED）和救护车 系统（EMS）提供大部分用于酒精中毒的急性护理。医疗中2-12％的患者 或精神科ED急性陶醉。 “清醒中心”旨在满足人们的需求 使用不需要ED护理的急性简单的酒精中毒，以便这些人可以 在替代护理环境中获得安全，高价值的护理。如果适当使用，清醒中心可以减少 需要ED访问并减少ED人满为患。在AIM 1中，Smith-Bernardin博士将描述和定义 急性酒精醉酒患者在醒目中心，急诊室和EMS系统中的事件以及 比较使用使用的患者，提供者和环境级别的因素 管理数据。在AIM 2中，使用CFIR框架，她将进行并分析深入的访谈 确定影响救护人员决定急性患者决定的可修改因素 不复杂的酒精对ED而不是醒目的中心。拟议的研究是第一个： 1）评估一个具有既定清醒中心替代方案的社区中的护理人员决策；和2） 招募救护车，ED和清醒中心人员，以检查影响现场分类的因素 简单的酒精中毒。这两个目标都将使用创新的实施科学方法来 来自EMS，EDS和旧金山Sobering Center的三角研究与健康相关的数据。培训和 在拟议的项目中进行的研究将构成未来R01 proposal Hybrid II型试验的基础 测试干预措施的实施和有效性，以减少提供商和环境层面 差异以增加适当使用醒目中心并减少急性的缓解 酒精肠毒性。拟议的项目将为Smith-Bernardin博士提供所需的支持 使用实施科学和混合方法研究的独立临床科学家来开发， 评估并传播针对饮酒的人的创新的，基于证据的治疗范例 疾病和急性酒精中毒。