Dissemination and Implementation of COVID-19 Care Innovations in ED Settings

在急诊室传播和实施 COVID-19 护理创新

• 批准号: 10583523
• 负责人: Shira Hannah Fischer
• 金额: $ 77.28万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-04 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583523
• 关键词: 2019-nCoV; Access to Information; Accident and Emergency department; Adoption; Azithromycin; Beds; COVID-19; COVID-19 pandemic; COVID-19 patient; Caring; Cessation of life; Combined Modality Therapy; Communication; Communities; Critical Care; Critical Illness; Dangerousness; Decision Making; Deimplementation; Diffusion; Diffusion of Innovation; Discipline; Discourse analysis; Disease; Dissemination and Implementation; Drug Prescriptions; Educational workshop; Emergency Care; Emergency Department Physician; Emergency Medicine; Emergency Nursing; Emergency Situation; Ensure; Environment; Evaluation; Explosion; Facebook; Focus Groups; Fright; Frontline worker; Future; Government; Health; Health Policy; Healthcare; Healthcare Systems; Hospitals; Hydroxychloroquine; Infection; Information Dissemination; Intensive Care Units; Intervention; Interview; Journals; Learning; Long-Term Care; Methods; Misinformation; Natural Language Processing; Nurses; Patient-Focused Outcomes; Patients; Persons; Physicians; Population; Printing; Process; Professional Organizations; Publications; Recommendation; Research; Resources; Role; Services; Source; Stress Tests; Surveys; System; Techniques; Technology; Time; Twitter; Ventilator; Work; demographics; implementation science; implementation strategy; improved; improved outcome; innovation; insight; pandemic disease; personal protective equipment; podcast; prevent; public health emergency; respiratory; response; social media

SUMMARY/ABSTRACT During a public health emergency such as the COVID-19 pandemic, rapid dissemination of information to clinicians about emerging innovations is critical to ensuring the best outcomes for patients. However, little is known about how clinicians obtain information about innovations make decisions about implementation and de-implementation during uncertain times. As SARS-CoV-2 made its initial, rapid spread across the nation, clinicians feared that the impending surge of critically ill patients would overwhelm capacity, causing patient deaths due to a lack of ventilators and other essential resources. Additionally, shortages of personal protective equipment posed a challenge to following the usual standards to protect clinicians from infection. In a massive response to prevent worst-case scenarios from materializing, emergency department (ED) staff have rapidly innovated to deliver effective care, protect frontline workers, and ensure a sustainable supply of personal protective equipment. In response to these unusual conditions, ED clinicians turned to nontraditional sources of information—for example, Twitter, Facebook, podcasts, and pre- print journal publications—to learn about innovations they could use to care for COVID-19 patients in EDs. While these sources of information provided easy access to information about innovations, they also spread misinformation. Little research has been done to optimize dissemination and implementation of innovations during a public health emergency. Before the pandemic, an expansion of online platforms facilitating exchange of information about innovations had already occurred, and many more exist now. Information is also shared through professional societies and also through social media. But the understanding of the diffusion of innovations among EDs during the pandemic is currently limited due to the volume of sharing that happened during COVID-19; the urgency and fear associated with these innovations; and the need for deimplementation of interventions that were found to be ineffective or even dangerous. It is not clear how these processed happened and whether they might have differed based on the demographics of ED clinicians or the communities and populations they serve. A comprehensive evaluation of the flow of innovations will lead to insights into how disseminators and implementers can improve practices during pandemic and rapidly evolving emergencies and also how processes can be optimized for more steady-state conditions. Our study incorporates a strong interdisciplinary and mixed methods approach. Our strong team will work with study partners representing emergency physicians and nurses and experts in other disciplines in the ED. Study methods combine advanced natural language processing techniques with interviews (Aim 1), focus groups with a survey of ED professionals (Aim 2), and systematic synthesis of results to identify strategies for improving diffusion of ED care innovations (Aim 3). The study will also provide results in actionable formats, such as a toolkit of dissemination and implementation strategies.

摘要/摘要 在公共卫生紧急情况下，例如COVID-19大流行，信息迅速传播 对于临床医生而言，关于新兴创新对于确保患者的最佳结果至关重要。 但是，关于如何获得有关创新的信息做出决定的信息知之甚少 在不确定时间的实施和实施。随着SARS-COV-2的最初，快速传播 在全国范围内，临床医生锻造，即将发生重病患者的激增将使能力不堪重负， 由于缺乏呼吸机和其他基本资源而导致患者死亡。此外，短缺 个人保护设备对遵循通常的标准构成了挑战，以保护临床医生免受 感染。在巨大的反应以防止最坏情况下，急诊科 （ed）员工已经迅速创新以提供有效的护理，保护一线工人并确保 个人保护设备的可持续供应。为了应对这些异常条件， 临床医生转向非传统信息来源，例如，Twitter，Facebook，Podcasts和Pre- 印刷期刊出版物 - 了解他们可以用来照顾Eds的Covid-19患者的创新。 尽管这些信息来源可轻松访问有关创新的信息，但它们也 传播错误信息。很少进行研究以优化传播和实施 公共卫生紧急情况下的创新。大流行之前，在线平台的扩展 促进有关创新信息的交换已经发生，现在还有更多有关创新的信息。 信息也通过专业社会以及社交媒体共享。但是理解 由于共享的数量，目前在大流行期间的创新扩散 这发生在19日期间；与这些创新相关的紧迫性和恐惧；以及需要 被发现无效甚至危险的干预措施的降低。尚不清楚这些 经过处理的情况以及根据ED临床医生的人口统计或 他们服务的社区和人口。对创新流的全面评估将导致 深入了解发射者和实施者如何改善大流行期间的实践 快速发展的紧急情况以及如何优化过程以稳定状态 状况。我们的研究结合了强大的跨学科和混合方法方法。我们坚强的团队 将与代表其他学科的急诊医师和护士以及专家的学习伙伴合作 ED。研究方法将先进的自然语言处理技术与访谈结合在一起（AIM 1）， 焦点小组对ED专业人员进行调查（AIM 2），并系统地合成结果以识别 改善ED护理创新扩散的策略（AIM 3）。该研究还将提供结果 可操作的格式，例如传播和实施策略的工具包。