Effect of Paramedic Airway Experience on Patient Outcomes

护理人员气道经验对患者预后的影响

基本信息

批准号：
7824725
负责人：
Henry E. Wang
金额：
$ 0.85万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-01 至 2009-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7824725
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 Effectiveness Electronics Emergency medical service Frequencies Goals Health Care Costs Health Services Research Heart Heart failure Hospitals Individual Inpatients Intervention Intratracheal Intubation Life Link Measures Medical Medical Errors Methods National Heart, Lung, and Blood Institute 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 clinical practice design experience hospital patient care innovation mortality novel programs skills success tool

项目摘要

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创新研究赠款计划的一项建议，该计划鼓励对现有数据集进行分析以探索新的假设。气管插管（ETI）是将塑料管插入气管（喉咙）中，以帮助患有危害疾病的患者的呼吸，例如心肺停滞，心力衰竭，呼吸衰竭或重大创伤。尽管ETI是由医院的医生进行的，但复苏通常是在医护人员的护理下的医院外部开始的。在许多临床实践领域中，已知医学错误与从业人员的程序量和患者结局都相关。许多研究发现，护理人员在执行ETI时会犯错。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进行ETI，并且在远低于维持程序水平，安全性和有效性所需的频率上。程序，成功和错误与患者结果（包括医院课程或资源利用率）之间的直接联系很少。我们认为，ETI由具有较低程序经验的护理人员进行，可能会对患者的预后和医院护理过程产生不利影响。这项研究的目的是确定护理人员（ETI）程序经验是否与患者的结果和医院内护理过程有关。在拟议的研究中，我们将概率地链接三个公开可用的全州行政数据库，其中包括护理人员患者遭遇，承认住院患者和死亡。我们将对链接的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），结果（死亡率和院内不良事件）和院内资源利用之间的联系。我们建议在匹兹堡大学和犹他州大学之间进行新的合作，这些研究团队在院外护理，卫生服务研究，大规模数据集的分析和概率联系方面具有专业知识。这些发现可能表明，护理人员ETI的经验直接影响患者的结果，并可能促进这种挽救生命的医院干预的设计和交付的重大变化。这些发现还将确认这种联系方法是一种新的，有力的工具，可以评估急性医疗服务的最早部分 - 从院外环境开始。