Effect of Paramedic Airway Experience on Patient Outcomes

护理人员气道经验对患者结果的影响

• 批准号: 7197718
• 负责人: Henry E. Wang
• 金额: $ 15.83万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-12-05 至 2008-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7197718
• 关键词: Acute; Admission activity; Adverse event; Affect; Area; Breathing; Cardiopulmonary Arrest; Caring; Cessation of life; Clinical; Collaborations; Commit; Complex; Cost Control; Critical Illness; Data Set; Databases; Devices; Disease regression; Effectiveness; Electronics; Emergency medical service; Frequencies; Goals; Health Care Costs; Health Services Research; Healthcare; Heart Arrest; Heart failure; Hospitals; Individual; Inpatients; Intervention; Intratracheal Intubation; Intubation; Life; Link; Measures; Medical; Medical Errors; Methods; Numbers; Outcome; Paramedical Personnel; Patient Care; Patients; Pennsylvania; Pharyngeal structure; Phase; Physicians; Plastics; Procedures; Provider; Registries; Reporting; Research; Research Personnel; Research Project Grants; Resources; Respiratory Failure; Resuscitation; Role; Safety; Techniques; Testing; Time; Trachea; Training; Trauma; Tube; Universities; Utah; administrative database; design; endotracheal; experience; hospital patient care; innovation; mortality; novel; programs; skills; success; tool

DESCRIPTION (provided by applicant): This is a proposal for the NHLBI R21 Innovative Research Grant Program, which encourages the analysis of existing data sets to explore new hypotheses. Endotracheal intubation (ETI) is the insertion of a plastic tube into the trachea (throat) to assist the breathing of a patient with a critical illness such as cardiopulmonary arrest, heart failure, respiratory failure or major trauma. While ETI is performed by physicians in the hospital, resuscitation usually begins in the out-of- hospital setting under the care of paramedics. In many fields of clinical practice, medical errors are known to be associated with both practitioner procedural volume as well as patient outcome. Many studies have found that paramedics commit errors when performing ETI. Furthermore in a preliminary study, we found that paramedics perform ETI infrequently in clinical practice and at frequencies far below that needed to maintain procedural proficiency, safety and effectiveness. Few direct links between the procedure, success and errors, and patients outcomes (including hospital course or resource utilization) exist. We posit that ETI performed by paramedics with low procedural experience may adversely affect patient outcome and hospital course of care. The goal of this study is to determine if paramedic (ETI) procedural experience is associated with patient outcomes and in-hospital course of care. In the proposed study we will probabilistically link three publicly- available statewide administrative databases encompassing paramedic patient encounters, admitted inpatients and deaths. We will apply multivariable regression to the linked data set to evaluate the connection between paramedic ETI procedural experience (annual volume of ETI), outcomes (mortality and in-hospital adverse events) and in-hospital resource utilization. We propose a new collaboration between research teams at the Universities of Pittsburgh and Utah, which have expertise in the areas of out-of-hospital care, health services research, the analysis of large-scale data sets and probabilistic linkage. These findings may demonstrate that paramedic ETI experience directly impacts patient outcome, and may promote major changes in the design and delivery of this life-saving out- of-hospital intervention. These findings would also confirm this linkage method as a new, powerful tool to evaluate the earliest portion of acute medical care - that begun in the out-of-hospital setting.

描述（由申请人提供）：这是 NHLBI R21 创新研究资助计划的提案，该计划鼓励分析现有数据集以探索新的假设。气管插管（ETI）是将塑料管插入气管（喉咙），以帮助患有心肺骤停、心力衰竭、呼吸衰竭或重大创伤等危重疾病的患者呼吸。虽然 ETI 是由医院内的医生进行的，但复苏通常在护理人员的护理下在院外环境中开始。在临床实践的许多领域，众所周知，医疗错误与医生的手术量以及患者的治疗结果有关。许多研究发现护理人员在执行 ETI 时会犯错误。此外，在一项初步研究中，我们发现护理人员在临床实践中很少执行 ETI，且执行频率远远低于维持程序熟练程度、安全性和有效性所需的频率。手术、成功和错误以及患者结果（包括医院病程或资源利用）之间几乎不存在直接联系。我们认为由手术经验不足的护理人员进行 ETI 可能会对患者的治疗结果和医院护理过程产生不利影响。本研究的目的是确定护理人员 (ETI) 程序经验是否与患者结果和院内护理过程相关。在拟议的研究中，我们将概率性地链接三个公开的全州行政数据库，包括护理人员的患者接触情况、住院患者和死亡情况。我们将对关联数据集应用多变量回归，以评估护理人员 ETI 程序经验（ETI 的年度量）、结果（死亡率和院内不良事件）和院内资源利用之间的联系。我们提议匹兹堡大学和犹他大学的研究团队之间进行新的合作，这些研究团队在院外护理、卫生服务研究、大规模数据集分析和概率关联领域拥有专业知识。这些发现可能表明护理人员 ETI 经验直接影响患者的治疗结果，并可能促进这种挽救生命的院外干预措施的设计和实施发生重大变化。这些发现也将证实这种联系方法是一种新的、强大的工具，用于评估急性医疗护理的最早部分——从院外环境开始。