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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 21 of 21 Research Studies Displayed
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J . The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children. Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Burgdorf JG, Arbaje AI, Wolff JL
Training needs among family caregivers assisting during home health, as identified by home health clinicians.
This study’s objective was to estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. This nationally representative retrospective cohort study included 1758 Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. More than 1 in 3 family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Training needs varied widely, from 8.6% among caregiving helping with advocacy to 48.2% among caregivers helping with medical procedures. Weighted analyses adjusted for older adults’ health and function showed family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.
Citation: Burgdorf JG, Arbaje AI, Wolff JL . Training needs among family caregivers assisting during home health, as identified by home health clinicians. J Am Med Dir Assoc 2020 Dec;21(12):1914-19. doi: 10.1016/j.jamda.2020.05.032..
Keywords: Caregiving, Home Healthcare, Education: Patient and Caregiver, Training
Brady AK, Brown W, Denson JL
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
This study looked at outcomes of participation of fellows for Pulmonary and Critical Medicine (PCCM) training in endotracheal intubation in the medical intensive care unit (ICU). The authors administered a survey to a convenience sample of US PCCM fellows. A total of 89 discrete US PCCM and Internal Medicine CCM training programs were represented. Almost half (43%) of PCCM fellows were “always or almost always” designed the primary operator for intubation, whereas 21% of programs had the PCCM fellow “rarely or never” the primary operator responsible for intubating in the ICU. Various influencing factors included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program but not program size whether the PCCM fellow was the primary operator.
Citation: Brady AK, Brown W, Denson JL . Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship. ATS Sch 2020 Dec;1(4):395-405. doi: 10.34197/ats-scholar.2020-0004OC..
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Training, Education: Academic, Critical Care
Brown W, Santhosh L, Brady AK
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
This article presents a review of endotracheal intubation (EI) training for healthcare professionals in pulmonary and critical care medicine (PCCM). Although the ACGME mandates that trainees in PCCM achieve competence, only 60% of US PCCM trainees feel they are proficient in EI upon graduation. This article includes a review of EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
Citation: Brown W, Santhosh L, Brady AK . A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit. Crit Care 2020 Oct 22;24(1):621. doi: 10.1186/s13054-020-03317-3..
Keywords: Training, Education: Continuing Medical Education, Critical Care, Intensive Care Unit (ICU), Guidelines
Alley L, Novak K, Havlin T
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
The authors developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; to improve integration of prescription drug monitoring program (PDMP) into daily workflow; and to enhance communication between pharmacists, prescribers, and patients. In this paper, they described the development of the RESPOND Toolkit and summarized their findings from initial pilot testing. They concluded that the RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training to promote behavioral shifts supporting opioid safety for patients.
Citation: Alley L, Novak K, Havlin T . Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists Res Social Adm Pharm 2020 Oct;16(10):1422-30. doi: 10.1016/j.sapharm.2019.12.023..
Keywords: Opioids, Substance Abuse, Medication, Medication: Safety, Patient Safety, Tools & Toolkits, Communication, Provider: Pharmacist, Provider, Training
Glass M, Rana S, Coghlan R
Global palliative care education in the time of COVID-19.
This paper describes the Global Palliative Education Collaborative (GPEC), which is a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S., and international palliative care (PC) programs in Uganda and India. U.S.-based fellowships are offered by GPEC to learn about resource-limited PC provision, gain perspectives on global challenges to caring for patients at the end of life, and cultivate resiliency. They also offer a novel educational project that the GPEC faculty and fellows are participating in called the Resilient Inspirational Storytelling Empathy Project. Palliative care has become even more important during the COVID-19 pandemic.
Citation: Glass M, Rana S, Coghlan R . Global palliative care education in the time of COVID-19. J Pain Symptom Manage 2020 Oct;60(4):e14-e19. doi: 10.1016/j.jpainsymman.2020.07.018..
Keywords: Palliative Care, COVID-19, Education: Continuing Medical Education, Training
Zittleman L, Curcija K, Sutter C
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT.
Citation: Zittleman L, Curcija K, Sutter C . Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training. J Prim Care Community Health 2020 Jan-Dec;11:2150132720953723. doi: 10.1177/2150132720953723..
Keywords: Medication, Primary Care, Opioids, Substance Abuse, Rural Health, Training, Education: Continuing Medical Education
Costar DM, Hall KK
Improving team performance and patient safety on the job through team training and performance support tools: a systematic review.
This systematic review’s objective was to identify recent studies that implemented practices to improve teamwork in health care and were associated with positive improvements on the job. Two databases were searched to identify relevant articles published between 2008 and 2018. Twenty articles were selected for inclusion. Across studies, measures assessing teamwork skills on the job were most often collected and sustained improvements were shown for up to 12 months. Evidence of improved clinical practices and increased patient safety was found in both studies team training interventions, as well as those that introduced performance support tools. All studies were conducted in hospitals with very few studies found in other health care settings such as office-based care.
Citation: Costar DM, Hall KK . Improving team performance and patient safety on the job through team training and performance support tools: a systematic review. J Patient Saf 2020 Sep;16(3S Suppl 1):S48-s56. doi: 10.1097/pts.0000000000000746..
Keywords: Teams, Patient Safety, Training, Patient Safety, Provider Performance, Quality Improvement, Quality of Care
Kraut AS, Sheehy L, Schnapp BH
Effect of resident physicians in a supervisory role on efficiency in the emergency department.
The authors sought to examine the impact of a staffing model involving a supervisory resident "pre-attending" (PAT) on emergency department (ED) throughput and length of stay (LOS). Over 26,000 unique patient encounters at a university-affiliated community ED were retrospectively analyzed. They found that the presence of a PAT is associated with a statistically significant increase in service time of five minutes, but this magnitude is likely operationally insignificant. They concluded that the negligible increase in service time is offset by the benefit to residents' training.
Citation: Kraut AS, Sheehy L, Schnapp BH . Effect of resident physicians in a supervisory role on efficiency in the emergency department. West J Emerg Med 2020 Aug 24;21(5):1266-69. doi: 10.5811/westjem.2020.7.46587..
Keywords: Emergency Department, Education: Academic, Training
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M . A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery. Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Daly Guris RJ, Doshi A, Boyer DL
Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management.
This paper describes the development and enactment of a number of simulation exercises, increasing in complexity for clinicians to practice intubation of critically ill children while wearing personal protective equipment due to coronavirus disease. The simulations ended up aiding in a real-life situation that then occurred less than 12 hours later that validated potential failure points and effectiveness of rapidly generated guidance. From this simulation a COVID-19 airway bundle template was created.
AHRQ-funded; HS026939; HS024511.
Citation: Daly Guris RJ, Doshi A, Boyer DL . Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management. Pediatr Crit Care Med 2020 Aug;21(8):e485-e90. doi: 10.1097/pcc.0000000000002435..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Workflow, Simulation, Training
Lurie JD, Zagaria AB, Ellis L
Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial.
This study’s objective was to determine if adding a component of surface-perturbation training to usual gait/balance training was more effective than gait/balance training alone for reducing falls and fall-related injuries in high-risk older adults referred to physical therapy. This multi-center trial took place at 8 outpatient physical therapy clinics. The cohort included 506 patients aged 65 and older at high fall risk. The group was randomized between treatment with and without surface-perturbation treadmill training. The results were that the training did not significantly reduce risk of any fall but did significantly reduce chance of a fall-related injury after the first 3 months.
Citation: Lurie JD, Zagaria AB, Ellis L . Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial. Phys Ther 2020 Jul 19;100(7):1153-62. doi: 10.1093/ptj/pzaa023..
Keywords: Elderly, Falls, Prevention, Training
Panchal AR, Finnegan G, Way DP
Assessment of paramedic performance on difficult airway simulation.
The purpose of this study was to assess paramedic comprehensive airway management practices during a difficult airway simulation through which paramedics were obligated to consider alternatives to endotracheal intubation (ETI). The investigators concluded that in a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices.
Citation: Panchal AR, Finnegan G, Way DP . Assessment of paramedic performance on difficult airway simulation. Prehosp Emerg Care 2020 May-Jun;24(3):411-20. doi: 10.3109/10903127.2015.1102993..
Keywords: Simulation, Emergency Medical Services (EMS), Training, Quality of Care, Care Management, Provider Performance
Anton NE, Bean EA, Myers E
Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training.
This study compared small group versus individualized training results for a group of residents learning laparoscopic suturing. Residents at one institution completed small group training and the second institution completed individualized training. After mental skills training, the completed FLS training at which time they completed the Short State Stress Questionnaire detailing the training. Twenty-one residents completed the training. Individualized training showed greater engagement and mental skills than small group training.
Citation: Anton NE, Bean EA, Myers E . Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training. Am J Surg 2020 Feb;219(2):335-39. doi: 10.1016/j.amjsurg.2019.12.022..
Keywords: Training, Education: Continuing Medical Education, Simulation, Surgery, Education: Curriculum
Salzman DH, Rising KL, Cameron KA
Setting a minimum passing standard for the uncertainty communication checklist through patient and physician engagement.
Historically, medically trained experts have served as judges to establish a minimum passing standard (MPS) for mastery learning. As mastery learning expands from procedure-based skills to patient-centered domains, such as communication, there is an opportunity to incorporate patients as judges in setting the MPS. In this study, the investigators described their process of incorporating patients as judges to set the minimum passing standard (MPS) and compared the MPS set by patients and emergency medicine residency program directors (PDs).
Citation: Salzman DH, Rising KL, Cameron KA . Setting a minimum passing standard for the uncertainty communication checklist through patient and physician engagement. J Grad Med Educ 2020 Feb;12(1):58-65. doi: 10.4300/jgme-d-19-00483.1..
Keywords: Clinician-Patient Communication, Communication, Patient and Family Engagement, Patient Safety, Education: Continuing Medical Education, Training, Provider Performance
Boehm LM, Stolldorf DP, Jeffery AD
Implementation science training and resources for nurses and nurse scientists.
This study discusses the need for implementation science training for nurses and nurse scientists and to encourage training in implementation science for these professions. The differences between quality improvement and implementation science is described as well. Implementation science educational opportunities were reviewed internationally along with organizations and literature. The role of nurses and nurse scientists in translating evidence into routine practice was also examined.
Citation: Boehm LM, Stolldorf DP, Jeffery AD . Implementation science training and resources for nurses and nurse scientists. J Nurs Scholarsh 2020 Jan;52(1):47-54. doi: 10.1111/jnu.12510..
Keywords: Provider: Nurse, Provider, Implementation, Training, Evidence-Based Practice
Fernandez R, Rosenman ED, Olenick J
Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial.
This study’s objective was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during trauma resuscitations. A total of 79 second- and third-year residents at the Harborview Medical Center (a level 1 trauma center) were randomized and 360 resuscitations were analyzed. Participant-led actual trauma resuscitations were video recorded and then coded for leadership behaviors and patient care. Then the residents were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. The leadership behaviors were then scored pre- and post-training. There was a significant difference in post-training leadership behaviors between the intervention and control conditions.
Citation: Fernandez R, Rosenman ED, Olenick J . Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial. Crit Care Med 2020 Jan;48(1):73-82. doi: 10.1097/ccm.0000000000004077..
Keywords: Teams, Trauma, Simulation, Training, Provider
Sherman M, Leland F, Ross B
Simopoly: improving simulation center operations through a tabletop simulation exercise.
In this article, the authors described a novel simulation, Simopoly, designed to provide the opportunity to think creatively about simulation center staff development, retention, and promotion in the context of daily operations and management.
AHRQ-funded; HS020295; HS022458.
Citation: Sherman M, Leland F, Ross B . Simopoly: improving simulation center operations through a tabletop simulation exercise. Simul Healthc 2014 Oct;9(5):304-11. doi: 10.1097/sih.0000000000000051.
Keywords: Provider, Quality Improvement, Training
Smith CS, Hill W, Francovich C
Diagnostic reasoning across the medical education continuum.
The researchers aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. They identified three major findings: (1) The "apprentice effect" in novices (high stress and low narrative competence); (2) logistic concept growth in intermediates; and (3) a cognitive state transition (between analytical and intuitive approaches) in experts.
Citation: Smith CS, Hill W, Francovich C . Diagnostic reasoning across the medical education continuum. Healthcare 2014 Jul 15;2(3):253-71. doi: 10.3390/healthcare2030253.
Keywords: Education: Continuing Medical Education, Education: Continuing Medical Education, Patient Safety, Training
Wehbe-Janek H, Pliego J, Sheather S
System-based interprofessional simulation-based training program increases awareness and use of rapid response teams.
The objective of this study was to develop and implement an interprofessional simulation-based training program for rapid response and cardiac arrest emergencies with emphasis on early recognition and effective communication. The researchers concluded that their study demonstrated that rapid response team underuse due to system barriers may be overcome by this type of program targeting specific needs of the institution.
Citation: Wehbe-Janek H, Pliego J, Sheather S . System-based interprofessional simulation-based training program increases awareness and use of rapid response teams. Jt Comm J Qual Patient Saf. 2014 Jun;40(6):279-87..
Keywords: Critical Care, Cardiovascular Conditions, Simulation, Training, Communication
Boyer DL, Nishisaki A
Evaluating patient outcomes in medical education research: mission impossible?*.
This editorial examines evaluation of the impact of pediatric supplemental crisis resource management (CRM) training among first- and second-year residents. The author suggests that increasing CRM training and using debriefing for skill retention may link this training to patient outcomes.
Citation: Boyer DL, Nishisaki A . Evaluating patient outcomes in medical education research: mission impossible?*. Pediatr Crit Care Med. 2014 May;15(4):382-4. doi: 10.1097/pcc.0000000000000116..
Keywords: Education: Continuing Medical Education, Outcomes, Children/Adolescents, Training