Improving Rural Pediatric Emergency Care Through Tele-Simulation

通过远程模拟改善农村儿科急救护理

• 批准号: 9148425
• 负责人: Jessica Haran Katznelson
• 金额: $ 24.8万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9148425
• 关键词: Improving; Rural; Pediatric; Emergency; Care

Project Summary: This project will assess the impact of a pediatric tele-simulation program in the Critical Access Hospital Emergency Department setting on the safety of the emergency care provided to children treated at these rural safety net institutions. The Critical Access Hospital (CAH) system was created to serve as a healthcare safety net for rural America. These 25 or fewer bed hospitals provide 24/7 emergency care for patients living in their catchment areas. Many of these hospitals do not have access to pediatricians or to physicians with significant pediatric training. Medical simulation has been shown to improve team performance, acquisition of skills and knowledge, and provider comfort level. Our prior work demonstrated that a pediatric simulation program is feasible and sustainable in the CAH Emergency Department (ED) setting. Recently we found that this program can be run effectively via “tele-simulation”, and that program participation improves ED provider comfort with pediatric patients, performance skills, and team functioning during simulated resuscitations. However, the impact on patient safety of these improved skills is unknown. Hypothesis: A novel, longitudinal, in-situ pediatric tele-simulation program will improve the safety of emergency care delivered to rural children in the Critical Access Hospital Emergency Department setting. Previously identified pediatric emergency care safety metrics will be abstracted from the electronic medical records of all patients < 18 years old seen in the four participating EDs throughout the three year study period. Monthly, over the second year of the study period, standardized pediatric scenarios will be run via tele- simulation in three CAH EDs, expanding our previously proven methodology. The additional CAH will serve as a control hospital. Team performance will be documented using a validated checklist. Safety of care over time will be assessed via longitudinal changes in pediatric emergency care safety metrics. Changes in simulation performance and high acuity patient care performance over time will be assessed and compared with changes in patient safety metrics. Children in rural areas have restricted choices for local emergency care. Many are seen in resource- limited settings where concerns have been raised about pediatric care. CAHs are a medical safety net for rural patients, yet safety issues have been raised regarding these institutions. We propose a unique pilot project designed both to assess the safety of pediatric emergency care provided in the CAH setting and to employ a tele-simulation program aimed at improving that care. We will do this using a set of rigorously developed, not yet widely implemented, safety metrics. Demonstrated success of this intervention will provide a crucial framework for the widespread implementation of tele- simulation programs designed to improve the emergency care available to rural children.

项目摘要： 该项目将评估小儿电信模拟计划在关键访问医院的影响 急诊科设置了为在这些农村治疗的儿童提供的急诊护理的安全 安全网机构。 创建了关键的访问医院（CAH）系统，以作为美国农村地区的医疗安全网。 这25个或更少的床医院为居住在集水区的患者提供24/7的急诊护理。 这些医院中的许多人都无法与儿科医生或医生接受大量儿科培训。 已显示医学模拟可以改善团队绩效，技能和知识的获取以及 提供者舒适度。我们先前的工作表明，儿科模拟计划是可行的， CAH急诊室（ED）设置的可持续发展。最近，我们发现该程序可以运行 通过“ tele-simulation”有效地，该计划参与改善了ED提供者的舒适性儿科舒适性 在模拟复苏期间，患者，表现技巧和团队功能。但是，对 这些提高技能的患者安全尚不清楚。 假设：一种新颖的，纵向的，原位的儿科远程模拟计划将提高 急诊室交付给关键访问医院急诊科环境中的农村儿童。 先前确定的儿科紧急护理安全指标将从电子医疗中抽象 在整个三年研究期间，在四个参与的ED中看到了所有<18岁的患者的记录。 每月，在研究期的第二年，标准化的儿科场景将通过远程传播 在三个CAH ED中进行仿真，扩展了我们先前已验证的方法。额外的CAH将作为 控制医院。团队绩效将使用经过验证的清单进行记录。护理安全 时间将通过小儿紧急护理安全指标的纵向变化来评估。变更 随着时间的推移，将评估并比较仿真性能和高敏锐的患者护理表现 随着患者安全指标的变化。 粗糙地区的儿童在当地急诊室有限制的选择。在资源中看到了许多 有限的设置在对小儿护理方面提出了担忧。 CAHS是医疗安全网 对于粗糙的患者，有关这些机构已经提出了安全问题。我们提出了一个 独特的飞行员项目既旨在评估在 CAH设置并采用旨在改善该护理的远程模拟计划。我们会这样做 使用一组严格开发但尚未广泛实施的安全指标。证明 这种干预的成功将为远程实施的宽度实施提供至关重要的框架。 旨在改善农村儿童可用的急诊护理的模拟计划。