Leeper W Robert, Haut Elliott R, Pandian Vinciya, Nakka Sajan, Dodd-O Jeffrey, Bhatti Nasir, Hunt Elizabeth A, Saheed Mustapha, Dalesio Nicholas, Schiavi Adam, Miller Christina, Kirsch Thomas D, Berkow Lauren
Department of Surgery, Western University, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore Maryland.
J Surg Educ. 2018 Sep-Oct;75(5):1264-1275. doi: 10.1016/j.jsurg.2018.03.001. Epub 2018 Apr 5.
A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC).
The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management. The MDAC occurs within the Johns Hopkins Medicine Simulation Center approximately four times per year and uses a combination of didactic lectures, hands-on sessions, and high-fidelity simulation training. Participation in MDAC is the main intervention being investigated in this study. Data were collected prospectively using course evaluation survey with quantitative and qualitative components, and prepost course knowledge assessment multiple choice questions (MCQ). Outcomes include course evaluation scores and themes derived from qualitative assessments, and prepost course knowledge assessment MCQ scores.
Tertiary care academic hospital center PARTICIPANTS: Students, residents, fellows, and practicing physicians from the departments of Surgery, Otolaryngology Head and Neck Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine; advanced practice providers (nurse practitioners and physician assistants), nurse anesthetists, nurses, and respiratory therapists.
Totally, 23 MDACs have been conducted, including 499 participants. Course evaluations were uniformly positive with mean score of 86.9 of 95 points. Qualitative responses suggest major value from high-fidelity simulation, the hands-on skill stations, and teamwork practice. MCQ scores demonstrated significant improvement: median (interquartile range) pre: 69% (60%-81%) vs post: 81% (72%-89%), p < 0.001.
Implementation of a MDAC successfully disseminated principles and protocols to all airway providers. Demonstrable improvement in prepost course knowledge assessment and overwhelmingly positive course evaluations (quantitative and qualitative) suggest a critical and ongoing role for the MDAC course.
2008年，约翰·霍普金斯医院组建了一个全院范围的困难气道应对小组，该小组有三大核心支柱：操作、安全监测和教育。本研究的目的是评估困难气道应对小组项目中教育支柱（即多学科困难气道课程，MDAC）的成果。
全面、为期一天的MDAC面向所有参与气道管理的医疗人员群体的学员和工作人员。MDAC每年在约翰·霍普金斯医学模拟中心举办约四次，采用理论讲座、实践操作和高仿真模拟培训相结合的方式。参与MDAC是本研究调查的主要干预措施。通过带有定量和定性成分的课程评估调查问卷以及课程前后知识评估多项选择题（MCQ）对数据进行前瞻性收集。结果包括课程评估分数和定性评估得出的主题，以及课程前后知识评估MCQ分数。
三级医疗学术医院中心
来自外科、耳鼻咽喉头颈外科、麻醉学/重症医学和急诊医学科的学生、住院医师、研究员和执业医师；高级执业提供者（执业护士和医师助理）、麻醉护士、护士和呼吸治疗师。
共举办了23期MDAC，包括499名参与者。课程评估总体呈积极态度，平均得分为95分中的86.9分。定性反馈表明，高仿真模拟、实践技能站和团队协作练习具有重要价值。MCQ分数有显著提高：中位数（四分位间距）课前为69%（60%-81%），课后为81%（72%-89%），p<0.001。
MDAC的实施成功地向所有气道医疗人员传播了原则和方案。课程前后知识评估的明显改善以及压倒性的积极课程评估（定量和定性）表明MDAC课程具有关键且持续的作用。
