在资源有限的患者护理模拟过程中进行指导的随机对照试验可提高护理人员的工作表现和患者存活率。

Q4 Medicine
Critical care explorations Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI:10.1097/CCE.0000000000001090
Jeremy C Pamplin, Sena R Veazey, Stacie Barczak, Stephanie J Fonda, Maria L Serio-Melvin, Kevin S Ross, Christopher J Colombo
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引用次数: 0

摘要

目的:确定在资源有限的环境中,高仿真医学模拟模型(HFMSM)中的辅导对护理人员工作表现的影响:在资源有限的环境中,确定在重症患者的高保真医学模拟模型(HFMSM)中,辅导对护理人员表现的影响:设计:一项由两个中心进行的随机对照研究,研究对象为社区获得性肺炎并发急性呼吸窘迫综合征患者:地点:偏远地区的一个名义诊所,由一名临床医生和一名非医疗助理组成:干预措施:远程医疗(TM):干预措施:远程医疗(TM)支持:主要结果是临床表现,以护理的准确性、可靠性和效率来衡量。次要结果为患者存活率、程序质量、对高频医疗管理系统的主观评估以及感知工作量:在提供预期护理(准确性)、更一致地提供护理(可靠性)以及效率(护理的及时性)方面,TM 参与者(N = 11)的表现优于非 TM 参与者(NTM,N = 12)。准确性:TM 完成了 91% 的预期任务和程序,NTM 完成了 42% 的预期任务和程序。效率:在成功获得先进气道(TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4,p = 0.10)或用针为张力性气胸减压(TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9,p = 0.65)的平均(± sd)分钟数上,两组没有差异。在完成胸腔造口术方面,TM 比 NTM 慢(22.3 ± 10.2 vs. 12.3 ± 4.8,p = 0.03)。可靠性:在 17 项任务中,TM 完成了 13 项(76%),时间一致性高于 NTM。在程序质量指标方面,TM 完成了 68%,NTM 完成了 29%。82% 的 TM 参与者和 17% 的 NTM 参与者模拟了患者的存活率(P = 0.003)。这两组人都同样认为高频医疗管理系统是现实的,他们都以个人主人翁的态度管理病人,并经历了相似的工作量和压力:结论:在资源有限的环境中,向护理人员提供远程专业技术可提高护理人员的工作绩效和护理质量,并有可能提高患者的实际存活率。高频医疗管理系统可用于研究干预措施,这是真实病人无法做到的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival.

Objectives: To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting.

Design: A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome.

Setting: A notional clinic in a remote location staffed by a single clinician and nonmedical assistant.

Participants: Clinicians with limited experience managing critically ill patients.

Interventions: Telemedicine (TM) support.

Measurements: The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload.

Main results: TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress.

Conclusions: Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.

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