Bond William F, Barker Lisa T, Cooley Kimberly L, Svendsen Jessica D, Tillis William P, Vincent Andrew L, Vozenilek John A, Powell Emilie S
From Jump Simulation (W.F.B., L.T.B., K.L.C., J.D.S., J.A.V.), an OSF HealthCare and University of Illinois College of Medicine at Peoria Collaboration; Department of Emergency Medicine (W.F.B., L.T.B., A.L.V., J.A.V.), Division of Pulmonary and Critical Care Medicine (W.P.T), and OSF ConstantCare (W.P.T.), OSF HealthCare; Departments of Emergency Medicine (W.F.B., L.T.B., A.L.V., J.A.V.), and Internal Medicine (W.P.T.), University of Illinois College of Medicine at Peoria; and Department of Emergency Medicine (E.S.P.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Simul Healthc. 2019 Apr;14(2):129-136. doi: 10.1097/SIH.0000000000000357.
With the growth of telehealth, simulation personnel will be called upon to support training that integrates these new technologies and processes. We sought to integrate remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams. We describe how we overcame technical challenges of creating shared awareness of the patient's condition and the care team's progress among those executing the simulation, the care team, and the eICU.
The objective of the simulations was to introduce telehealth technology and new processes of engaging the eICU via telehealth during sepsis care in 2 rural EDs. Scenario development included experts in sepsis, telehealth, and emergency medicine. We describe the operational systems challenges, alternatives considered, and solutions used. Participants completed surveys on self-confidence presimulation/postsimulation in using telehealth and in managing patients with sepsis (1-10 Likert scale, with 10 "completely confident"). Pre-post responses were compared by two-tailed paired t test.
We successfully engaged the staff of two EDs: 42 nurses, 9 physicians or advanced practice providers, and 9 technicians (N = 60). We used a shared in situ simulation clinical actions observational checklist, created within an off-the-shelf survey software program, completed during the simulations by an on-site observer, and shared with the eICU team via teleconferencing software, to message and cue eICU nurse engagement. The eICU nurse also participated in debriefing via the telehealth video system with successful simulation engagement. These solutions avoided interfering with real ED or eICU operations. The postsimulation mean ± SD ratings of confidence using telehealth increased from 5.3 ± 2.9 to 8.9 ± 1.1 (Δ3.5, P < 0.05) and in managing patients with sepsis increased from 7.1 ± 2.5 to 8.9 ± 1.1 (Δ1.8, P < 0.05).
We created shared awareness between remote eICU personnel and in situ simulations in rural EDs via a low-cost method using survey software combined with teleconferencing methods.
随着远程医疗的发展，模拟人员将被要求支持整合这些新技术和流程的培训。我们试图将远程远程医疗电子重症监护病房（eICU）人员与农村急诊科（ED）护理团队纳入现场模拟。我们描述了我们如何克服在模拟执行者、护理团队和eICU之间建立对患者病情和护理团队进展的共同认知的技术挑战。
模拟的目的是在两个农村急诊科的脓毒症护理期间引入远程医疗技术以及通过远程医疗与eICU互动的新流程。情景开发包括脓毒症、远程医疗和急诊医学方面的专家。我们描述了运营系统挑战、考虑的替代方案以及使用的解决方案。参与者完成了关于模拟前/模拟后使用远程医疗和管理脓毒症患者的自信心的调查（1-10李克特量表，10表示“完全有信心”）。前后反应通过双尾配对t检验进行比较。
我们成功地让两个急诊科的工作人员参与进来：42名护士、9名医生或高级实践提供者以及9名技术人员（N = 60）。我们使用了一个在现成的调查软件程序中创建的共享现场模拟临床行动观察清单，由现场观察员在模拟期间完成，并通过电话会议软件与eICU团队共享，以传达信息并提示eICU护士参与。eICU护士还通过远程医疗视频系统参与了汇报，模拟参与取得成功。这些解决方案避免了干扰实际的急诊科或eICU操作。模拟后使用远程医疗的自信心平均±标准差评分从5.3±2.9提高到8.9±1.1（Δ3.5，P < 0.05），管理脓毒症患者的自信心评分从7.1±2.5提高到8.9±1.1（Δ1.8，P < 0.05）。
我们通过使用调查软件结合电话会议方法的低成本方法，在农村急诊科的远程eICU人员和现场模拟之间建立了共同认知。
