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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 25 of 38 Research Studies Displayed
Murray DJ, Boulet JR, Boyle WA
Competence in decision making: setting performance standards for critical care.
Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. In this study, the investigators hypothesized that simulation could be used effectively to assess decision-making competence.
Citation: Murray DJ, Boulet JR, Boyle WA . Competence in decision making: setting performance standards for critical care. Anesth Analg 2021 Jul 1;133(1):142-50. doi: 10.1213/ane.0000000000005053..
Keywords: Critical Care, Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Colman N, Newman JW, Nishisaki A
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
This single-center retrospective review discusses a translational simulation conducted to improve compliance with the National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) bundle to improve the safety of tracheal intubations. The simulation was implemented between March and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months after. Primary outcomes measures were compliance with the bundle and utilization of apneic oxygenation and secondary outcomes was the occurrence of adverse tracheal intubation-associated events. Preintervention bundle compliance was 66%, which increased to 93.7% after the simulation intervention. Adherence to apneic oxygenation was 27.9% before the intervention and increased to 77.9% after. There was no difference in the occurrence of tracheal intubation events.
Citation: Colman N, Newman JW, Nishisaki A . Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU. Pediatr Qual Saf 2021 May-Jun;6(3):e409. doi: 10.1097/pq9.0000000000000409..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Registries, Simulation, Patient Safety, Quality Improvement, Quality of Care
Sinz E, Banerjee A, Steadman R
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. In this study, standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.
Citation: Sinz E, Banerjee A, Steadman R . Reliability of simulation-based assessment for practicing physicians: performance is context-specific. BMC Med Educ 2021 Apr 12;21(1):207. doi: 10.1186/s12909-021-02617-8..
Keywords: Simulation, Education: Continuing Medical Education, Training, Provider Performance
Mazur LM, Adams R, Mosaly PR
Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance.
The purpose of this study was to assess the effect of a combined intervention - simulation-based training supported by neurofeedback sessions - on radiation technologists' (RTs') workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. The investigators found that RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores but did have better performance compared with other study groups (P < .01).
Citation: Mazur LM, Adams R, Mosaly PR . Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance. Pract Radiat Oncol 2021 Mar-Apr;11(2):e124-e33. doi: 10.1016/j.prro.2020.08.005..
Keywords: Simulation, Training, Provider Performance, Provider: Health Personnel
Balikai SC, Badheka A, Casey A
Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19.
This paper describes the outcomes of pediatric intensive care unit (PICU) simulation training to safely perform endotracheal intubations in children with suspected or confirmed COVID-19. Confidence levels before and after training was measured using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale 0-2). Fifty unique PICU staff members participated in 9 simulation sessions and mean confidences scores increased from 0.9 to 2.
Citation: Balikai SC, Badheka A, Casey A . Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19. Pediatr Qual Saf 2021 Jan-Feb;6(1):e373. doi: 10.1097/pq9.0000000000000373..
Keywords: Children/Adolescents, COVID-19, Intensive Care Unit (ICU), Critical Care, Simulation, Training, Public Health, Infectious Diseases
Ellis AG, Iskandar R, Schmid CH
Active learning for efficiently training emulators of computationally expensive mathematical models.
The authors described a self-terminating active learning algorithm to efficiently develop emulators tailored to a specific emulation task and compared it with algorithms that optimize geometric criteria and other active learning algorithms. They found that the proposed algorithm attained satisfactory performance in all analyses, had smaller variability than the treed Gaussian Processes, and, on average, had similar or better performance as the treed Gaussian Processes in six out of seven benchmark functions and in the prostate cancer model.
Citation: Ellis AG, Iskandar R, Schmid CH . Active learning for efficiently training emulators of computationally expensive mathematical models. Stat Med 2020 Nov 10;39(25):3521-48. doi: 10.1002/sim.8679..
Luo B, McLoone M, Rasooly IR
Analysis: protocol for a new method to measure physiologic monitor alarm responsiveness.
A team of researchers including biomedical engineers, human factors engineers, information technology specialists, nurses, physicians, facilitators from a hospital’s simulation center, clinical informaticians, and hospital administrative leadership worked with three units at a pediatric hospital to design and conduct simulations on newly implemented monitoring technology that will be used for patient critical alarms. The system was tested using a simulation with existing hospital technology to transmit an unambiguously critical alarm that appeared to originate from an actual patient to the nurse’s mobile device, with discreet observers measuring responses.
Citation: Luo B, McLoone M, Rasooly IR . Analysis: protocol for a new method to measure physiologic monitor alarm responsiveness. Biomed Instrum Technol 2020 Nov/Dec;54(6):389-96. doi: 10.2345/0899-8205-54.6.389..
Keywords: Children/Adolescents, Hospitals, Simulation, Quality Improvement, Quality of Care, Patient Safety, Health Information Technology (HIT)
Dadiz R, Riccio J, Brown K
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
This study’s objective was to identify 1) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and 2) LSTs that remained unresolved 1-year post-occupancy. This qualitative study included 111 healthcare professionals who participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were analyzed to characterize LSTs. Three-hundred threats with four major themes affecting staff function and patient safety emerged: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy 29 (9%) LSTs were still unresolved.
AHRQ-funded; R18 HS023460.
Citation: Dadiz R, Riccio J, Brown K . Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit. J Perinatol 2020 Sep;40(Suppl 1):29-35. doi: 10.1038/s41372-020-0749-3..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Safety, Simulation
Rozenfeld RA, Nannicelli AP, Brown AR
Verbal communication during airway management and emergent endotracheal intubation: observations of team behavior among multi-institutional pediatric intensive care unit in situ simulations.
The objective of this study was to assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. The investigators found that no uniform statement was identified to declare an airway emergency among the care teams. Preintubation medication dosages were not consistently included in intubation medication orders, and frequently, there were multiple requests to obtain medications.
Citation: Rozenfeld RA, Nannicelli AP, Brown AR . Verbal communication during airway management and emergent endotracheal intubation: observations of team behavior among multi-institutional pediatric intensive care unit in situ simulations. J Patient Saf 2020 Sep;16(3):e114-e19. doi: 10.1097/pts.0000000000000272..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Teams, Communications, Simulation
Nuamah JK, Adapa K, Mazur L
Electronic health records (EHR) simulation-based training: a scoping review protocol.
This article describes a literature review that will be conducted on the evidence for electronic health record (EHR)-based training interventions to facilitate improved EHR use for healthcare providers. Three databases will be searched for published articles and ProQuest and Google Scholar will be searched to identify unpublished articles from inception to January 29, 2020. Two reviewers will independently screen titles and abstracts using inclusion and exclusion criteria. Based on the extracted data, research evidence will be synthesized.
Citation: Nuamah JK, Adapa K, Mazur L . Electronic health records (EHR) simulation-based training: a scoping review protocol. BMJ Open 2020 Aug 11;10(8):e036884. doi: 10.1136/bmjopen-2020-036884..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Simulation
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
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
McCarthy DM, Powell RE, Cameron KA
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial.
The purpose of this study was to evaluate the effectiveness of the Uncertainty Communication Education Module (UCEM) in improving physician communications. Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. This trial has been designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake.
Citation: McCarthy DM, Powell RE, Cameron KA . Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial. BMC Med Educ 2020 Feb 19;20(1):49. doi: 10.1186/s12909-020-1926-y..
Keywords: Education: Continuing Medical Education, Clinician-Patient Communication, Communications, Emergency Department, Simulation, Provider: Physician, Provider
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
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
Barker LT, Bond WF, Vincent AL
A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.
Researchers studied a simulation-based introduction to new technologies in order to address specific factors that influence adoption. They found that a novel 3-stage simulation-debriefing structure positively targeted factors influencing the adoption of new healthcare technologies.
Citation: Barker LT, Bond WF, Vincent AL . A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model. Adv Simul 2020 Sep 25;5:25. doi: 10.1186/s41077-020-00145-x..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Simulation
Long SA, Thomas G, Karam MD
Do skills acquired from training with a wire navigation simulator transfer to a mock operating room environment?
This study compared performance of residents getting traditional and simulation orthopedic surgery training at three medical centers: University of Iowa, University of Minnesota, and the Mayo Clinic. All residents first received traditional training in how to treat an intertrochanteric fracture. Then the groups were divided up with two groups getting additional simulated-based training and another group getting proficiency training for specific components of wire navigation. The two simulation-based training groups performed better in lower tip-apex distance than the traditional training group. Residents in the proficiency training group used more images than the other groups.
AHRQ-funded; HS022077; HS025353.
Citation: Long SA, Thomas G, Karam MD . Do skills acquired from training with a wire navigation simulator transfer to a mock operating room environment? Clin Orthop Relat Res 2019 Oct;477(10):2189-98. doi: 10.1097/corr.0000000000000799..
Keywords: Simulation, Training, Education: Continuing Medical Education, Surgery, Orthopedics
Long S, Thomas GW, Anderson DD
An extensible orthopaedic wire navigation simulation platform.
The demand for simulation-based skills training in orthopaedics is steadily growing. Wire navigation, or the ability to use 2D images to place an implant through a specified path in bone, is an area of training that has been difficult to simulate given its reliance on radiation based fluoroscopy. The investigators group previously presented on the development of a wire navigation simulator for a hip fracture module. In this paper, they present a new methodology for extending the simulator to other surgical applications of wire navigation.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Anderson DD . An extensible orthopaedic wire navigation simulation platform. J Med Device 2019 Sep;13(3):031001-310017. doi: 10.1115/1.4043461..
Keywords: Orthopedics, Simulation, Training, Surgery, Education: Continuing Medical Education
Martin JR, Anton N, Timsina L
Performance variability during training on simulators is associated with skill transfer.
Researchers looked at performance variability during training on simulators for performing laparoscopic surgery. Their hypothesis was that participants (surgery residents and medical students) who had consistent scores were most likely to have the most expertise and be capable of training others. The trainees first used the Fundamentals of Laparoscopic Surgery (FLS) simulator to learn laparoscopic suturing and then were transfer tested on a live, anesthetized porcine model. Their hypothesis was proven true and those with decreased practice variability was associated with greater scores in posttests and transfer tests.
AHRQ-funded; R18 HS022080.
Citation: Martin JR, Anton N, Timsina L . Performance variability during training on simulators is associated with skill transfer. Surgery 2019 Jun;165(6):1065-68. doi: 10.1016/j.surg.2019.01.013..
Keywords: Simulation, Training, Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Provider
Rosenman ED, Vrablik MC, Brolliar SM
Targeted simulation-based leadership training for trauma team leaders.
Effective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work was to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners.
Citation: Rosenman ED, Vrablik MC, Brolliar SM . Targeted simulation-based leadership training for trauma team leaders. West J Emerg Med 2019 May;20(3):520-26. doi: 10.5811/westjem.2019.2.41405..
Keywords: TeamSTEPPS, Teams, Simulation, Training, Emergency Department, Education: Continuing Medical Education, Quality Improvement, Quality of Care
Farra S, Hodgson E, Miller ET
Effects of virtual reality simulation on worker emergency evacuation of neonates.
This study compared differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent emergency evacuation training either with virtual reality simulation (VRS) or web-based clinical updates (CU). The workers were evaluated based on knowledge gained, confidence with evacuation, and performance in a live evacuation exercise. Workers were randomly assigned to VRS or CU. The groups did not statistically differ based on Cognitive Assessment scores or self-evaluations. However, the VRS group performed statistically better than the CU group in the live exercise. This study points to the effectiveness of virtual reality training.
Citation: Farra S, Hodgson E, Miller ET . Effects of virtual reality simulation on worker emergency evacuation of neonates. Disaster Med Public Health Prep 2019 Apr;13(2):301-08. doi: 10.1017/dmp.2018.58..
Keywords: Emergency Preparedness, Newborns/Infants, Intensive Care Unit (ICU), Simulation, Training, Education: Continuing Medical Education
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S . Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care. Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communications, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
Bond WF, Barker LT, Cooley KL
A simple low-cost method to integrate telehealth interprofessional team members during in situ simulation.
This article describes the integration of remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams and the technical challenges of creating shared awareness of the patient's condition and the care team's progress among the care team, the eICU, and those running the simulation. The purpose of the simulations was to introduce telehealth technology and new processes of engaging the eICU via telehealth during sepsis care in rural EDs; development of the scenarios included experts in sepsis, telehealth, and emergency medicine. A shared in situ simulation clinical actions observational checklist was created using an off-the-shelf survey software program. The checklist was completed during the simulations by an onsite observer, and shared with the eICU team via teleconferencing software to and cue eICU nurse engagement. Staff from the two EDs were engaged and an eICU nurse participated in debriefing via the telehealth video system.
Citation: Bond WF, Barker LT, Cooley KL . A simple low-cost method to integrate telehealth interprofessional team members during in situ simulation. Simul Healthc 2019 Apr;14(2):129-36. doi: 10.1097/sih.0000000000000357..
Keywords: Critical Care, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Rural Health, Simulation, Teams, Telehealth
Anton NE, Mizota T, Timsina LR
Attentional selectivity, automaticity, and self-efficacy predict simulator-acquired skill transfer to the clinical environment.
The objective of this study was to identify trainee characteristics that predict the transfer of simulator-acquired skill to the operating room. The investigators concluded that promoting automaticity, self-efficacy, and attention selectivity may help improve the transfer of simulator-acquired skill. They indicated that mental skills training and training to automaticity may therefore be valuable interventions to achieve this goal.
Citation: Anton NE, Mizota T, Timsina LR . Attentional selectivity, automaticity, and self-efficacy predict simulator-acquired skill transfer to the clinical environment. Am J Surg 2019 Feb;217(2):266-71. doi: 10.1016/j.amjsurg.2018.11.028..
Keywords: Education: Continuing Medical Education, Patient Safety, Provider, Provider: Physician, Simulation, Surgery, Training