Resilient EMS PSLL: Using a Systems Engineering Approach to Enhance EMS Cognitive Work and Safety for Older Adults During Prehospital Care.

弹性 EMS PSLL：使用系统工程方法来增强院前护理期间老年人的 EMS 认知工作和安全。

• 批准号: 10769353
• 负责人: AYSE PINAR GURSES
• 金额: $ 50万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10769353
• 关键词: Resilient; EMS; PSLL; Using; Systems

Project Summary- Prehospital Emergency Medical Services (EMS) are an indispensable component of the US health care system, occupying a crucial role at the intersection of medical care, public health, and public safety. EMS professionals' work is unique, extraordinarily demanding at cognitive and physical levels, and requires highly adaptive, unwaveringly resilient performances. The unpredictable nature of each dispatch, scene setting and patient presentation brings together a myriad of performance shaping factors that often very dynamic and highly variable. Study of `real time' pre-hospital cognitive work, at the individual (EMS professionals) and distributed/ team-based levels (EMS interactions with patients/caregivers, 911 dispatch) is limited despite being fundamental for navigating fluctuating degrees of risk inherent in prehospital emergency care. In response to the need for targeted research in support of overlooked areas of EMS cognitive work, we propose to establish the Resilient_EMS Patient Safety Learning Lab (PSLL), focused on enhancing and supporting safety, quality, and equity within pre-hospital emergency care. This project will focus particularly on prehospital care of older adults (≥ 65 yrs). The Resilient_EMS PSLL is tailored to use systems and human factors engineering approaches to innovate in support of EMS professionals' cognitive work as individuals (e.g., decision making) and in a distributed manner (e.g., sharing mental models). As such, we will conduct a 4- year, multi-site, multi-method field study of geriatric pre-hospital emergency care to achieve 3 specific aims: Aim 1. To identify and define individual and distributed cognitive work system characteristics that impact safety, quality, and equity along the continuum of prehospital resuscitative care (dispatch call transition of care) for older adults presenting with a `potentially critical' chief medical (non- trauma related) complaint (e.g., respiratory distress, acute onset of altered mental status etc.). Aim 2. To co-design with key stakeholders (EMS professionals, patients (older adults)/ caregivers, other professionals) potential solutions to support cognitive work of EMS professionals (individual and team/based levels) required for dynamic resilient performances using `human-centered/ inclusive design' principles and methodologies. Aim 3. To implement and evaluate proposed design/redesign solutions using a multi-pronged approach for improving safety/ quality/ equity along the continuum of resuscitative care for older adults through support and enhancement of EMS professionals' individual and distributed cognitive team-based work. Resilient_EMS PSLL's long term impact will be new insights into the very challenging domain of prehospital care that will aid in creation of innovative and inclusive/ human-centered solutions. Our research team is composed of experts in patient safety, human factors, systems engineering, communication, prehospital care, emergency medicine, geriatrics, nursing, health disparities, and patient/family partners. The study will address several AHRQ priority populations (older adults, low income, racial/ ethnic minorities, rural/inner-city residents, women).

项目摘要 - 院前紧急医疗服务（EMS）是必不可少的组成部分 美国医疗保健系统，在医疗，公共卫生和公共的交集中扮演至关重要的角色 安全。 EMS专业人员的工作是独特的，在认知和身体水平上的要求非常大，并且 需要高度适应性的，坚定的弹性性能。每个调度的不可预测性， 场景设置和病人的演示汇集了众多的性能塑造因素通常非常 动态和高度可变。对个人（EMS）的“实时”院前认知工作的研究 专业人士）和分布式/基于团队的水平（EMS与患者/护理人员的互动，911派遣）是 有限的任务是导航在院前紧急情况下的风险继承程度的基础 关心。为了响应有针对性的研究以支持EMS认知工作的被忽视领域的需求，我们 建立RESILIENT_EMS患者安全学习实验室（PSLL）的建议，重点是增强和 支持院前急诊室内的安全性，质量和平等。这个项目将特别关注 老年人的院前护理（≥65岁）。 resilient_ems psll量身定制用于使用系统和人类 因素工程方法的创新方法，以支持EMS专业人员作为个人的认知工作 （例如，决策）和分布式方式（例如，共享心理模型）。因此，我们将进行4- 年份，老年医院急诊室的多站点，多方法现场研究，以实现3个特定目标： 目的1。识别并定义影响影响的个人和分布式认知工作系统特征 院前复苏的连续体的安全性，质量和公平性（调度调用 护理）针对出现“潜在至关重要”的主要医学（与非创伤相关的）投诉的老年人（例如 呼吸窘迫，急性心理状况改变等）。目标2。与主要利益相关者共同设计 （EMS专业人士，患者（老年人）/护理人员，其他专业人员）潜在的解决方案 EMS专业人员的认知工作（个人和团队/基于团队/团队/基于团队/团队的级别），需要动态弹性 使用“以人为本/包容性设计”原理和方法的表演。目标3。实施 并使用多管齐下的方法评估了建议的设计/重新设计解决方案，以提高安全/质量/ 通过支持和增强EMS的支持和增强，沿着老年人复苏的连续性公平性 专业人士的个人和分布式基于认知团队的工作。 resilient_ems psll的长期影响 将是对院前护理的挑战领域的新见解，这将有助于创造创新 和包容性/以人为本的解决方案。我们的研究团队由患者安全专家组成 因素，系统工程，沟通，院前护理，急诊医学，老年医学，护士， 健康差异和患者/家庭伴侣。该研究将解决几个AHRQ优先级人群（较老 成人，低收入，种族/族裔少数民族，农村/市中心居民，妇女）。