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).

项目概要-院前急救医疗服务（EMS）是医院不可或缺的组成部分 美国的医疗保健体系在医疗保健、公共卫生和公众健康的交叉点上占据着至关重要的作用 安全。EMS 专业人员的工作是独特的，在认知和身体层面上要求极高，并且 需要高度适应性、坚定不移的弹性性能每次调度的不可预测性， 场景设置和患者演示汇集了无数的表现塑造因素，这些因素通常非常重要 动态且高度可变的个体“实时”院前认知工作研究（EMS） 专业人士）和分布式/基于团队的级别（EMS 与患者/护理人员的互动、911 调度） 尽管对于应对院前急救固有的波动程度的风险至关重要，但仍然有限 为了满足支持 EMS 认知工作被忽视领域的有针对性的研究的需要，我们 建立提议 Resilient_EMS 患者安全学习实验室 (PSLL)，重点是加强和 支持院前急救护理的安全、质量和公平。该项目将特别关注。 老年人（≥ 65 岁）的院前护理 Resilient_EMS PSLL 专为使用系统和人类而定制。 因素工程方法进行创新，以支持 EMS 专业人员作为个体的认知工作 （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- 今年，对老年院前急救进行多地点、多方法的实地研究，以实现3个具体目标： 目标 1. 识别和定义影响个人和分布式认知工作系统的特征 院前复苏护理连续过程中的安全、质量和公平（调度呼叫→过渡 针对出现“潜在危重”主要医疗（非创伤相关）主诉（例如， 目标 2. 与主要利益相关者共同设计。 （EMS 专业人员、患者（老年人）/护理人员、其他专业人员）支持的潜在解决方案 动态弹性所需的 EMS 专业人员（个人和团队/团队水平）的认知工作 使用“以人为本/包容性设计”原则和方法进行表演 目标 3. 实施。 并使用多管齐下的方法评估拟议的设计/重新设计解决方案，以提高安全/质量/ 通过支持和加强 EMS，实现老年人复苏护理的公平连续性 专业人员基于个人和分布式认知团队的工作。Resilient_EMS PSLL 的长期影响。 将是对院前护理这一极具挑战性领域的新见解，这将有助于创造创新 我们的研究团队由患者安全、人类方面的专家组成。 因素、系统工程、沟通、院前护理、急诊医学、老年病学、护理、 该研究将针对几个 AHRQ 优先人群（老年人）。 成人、低收入、种族/少数民族、农村/内城居民、妇女）。