Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1533
M. Ueoka, F. Kan, S.C. Guo
RATIONALE: Acute respiratory distress syndrome (ARDS) has a mortality rate that approaches 40%. While several studies have identified key strategies for managing ARDS, there are many potential barriers to adherence, particularly in a busy, trainee-driven ICU setting. As such, we created a fast, but high yield ARDS curriculum and aimed to improve knowledge and confidence in managing ARDS among residents. METHODS: This is a quality improvement (QI) project measuring resident performance on a 3-question test before and after a “crash-course” didactic on ARDS throughout a 4-week medical ICU (MICU) rotation. A resident and MICU attending developed the didactic, which reviewed ARDS definitions, evidence-based strategies for ARDS management, case examples and troubleshooting techniques. The didactic was delivered by the above-mentioned resident. The pre- and post-tests were identical;the questions addressed ARDS recognition, diagnosis and management, as well as each resident's comfort level in recognizing and managing ARDS. The pre- and post-tests were given at the start and end of the MICU rotation, respectively, and the didactic was given immediately after the pre-test. The correct answers were not directly revealed. RESULTS: Data was gathered over a total of nine 4-week blocks;50 residents participated, but 20 were excluded for not completing the post test. A majority of the cohort were second year medical residents and had only completed an average of 0.87 ICU rotations ± 0.82 prior to the study. The average correct score for the pre-test was 46.7% ± 27.1 and average score for posttest was 72.2% ± 21.6 with an absolute difference of +25.7% (p=0.0003, CI 95% 11.8-39.5%). There was also a significant increase in the subjective comfort levels and confidence regarding ventilator management and ARDS recognition and management. (Table 1). CONCLUSIONS: Statistically significant differences were seen in objective test scores pre- and postdidactic, highlighting the effectiveness of an informal, peer-delivered curriculum. Additionally, there was an increase in comfort level towards ventilator and ARDS management. A main limitation is that this study encompassed various times throughout the COVID-19 pandemic, therefore it is unclear whether differences in ARDS patient census also affected our results. Further studies should be conducted to see if these findings correlate with improved patient outcomes in a trainee-driven MICU. (Table Presented).
理由:急性呼吸窘迫综合征(ARDS)的死亡率接近40%。虽然有几项研究已经确定了管理ARDS的关键策略，但仍有许多潜在的障碍阻碍依从性，特别是在繁忙的、由实习生驱动的ICU环境中。因此，我们创建了一个快速，但高收益的ARDS课程，旨在提高住院医师管理ARDS的知识和信心。方法:这是一个质量改进(QI)项目，在为期四周的医学ICU (MICU)轮转期间，在ARDS“速成班”教学前后，测量住院医生在3个问题测试中的表现。一名当地居民和驻海地国际支助团与会者制定了教学大纲，其中审查了ARDS的定义、基于证据的ARDS管理策略、案例示例和故障排除技术。说教是由上述居民讲的。前后测试是相同的;问题涉及ARDS的识别、诊断和管理，以及每个居民在识别和管理ARDS方面的舒适度。分别在特派团轮换开始和结束时进行前测和后测，并在前测之后立即进行教学。正确答案没有直接透露。结果:共收集了9个4周街区的数据;50名居民参与，但20名因未完成后测而被排除在外。大多数队列是第二年的住院医师，在研究之前平均只完成了0.87次ICU轮转±0.82次。前测平均正确率为46.7%±27.1分，后测平均正确率为72.2%±21.6分，绝对差值为+25.7% (p=0.0003, CI 95%为11.8 ~ 39.5%)。对呼吸机管理和ARDS识别和管理的主观舒适度和信心也有显着增加。(表1)结论:在教学前和教学后的客观测试分数中可以看到统计学上显著的差异，突出了非正式的、同伴交付的课程的有效性。此外，患者对呼吸机和ARDS管理的舒适度也有所提高。一个主要的限制是，本研究涵盖了整个COVID-19大流行的不同时间，因此尚不清楚ARDS患者普查的差异是否也影响了我们的结果。应该进行进一步的研究，看看这些发现是否与在实习生驱动的MICU中改善患者预后相关。(表)。
{"title":"Effect of a Peer Driven ARDS Curriculum: A Quality Improvement Project","authors":"M. Ueoka, F. Kan, S.C. Guo","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1533","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1533","url":null,"abstract":"RATIONALE: Acute respiratory distress syndrome (ARDS) has a mortality rate that approaches 40%. While several studies have identified key strategies for managing ARDS, there are many potential barriers to adherence, particularly in a busy, trainee-driven ICU setting. As such, we created a fast, but high yield ARDS curriculum and aimed to improve knowledge and confidence in managing ARDS among residents. METHODS: This is a quality improvement (QI) project measuring resident performance on a 3-question test before and after a “crash-course” didactic on ARDS throughout a 4-week medical ICU (MICU) rotation. A resident and MICU attending developed the didactic, which reviewed ARDS definitions, evidence-based strategies for ARDS management, case examples and troubleshooting techniques. The didactic was delivered by the above-mentioned resident. The pre- and post-tests were identical;the questions addressed ARDS recognition, diagnosis and management, as well as each resident's comfort level in recognizing and managing ARDS. The pre- and post-tests were given at the start and end of the MICU rotation, respectively, and the didactic was given immediately after the pre-test. The correct answers were not directly revealed. RESULTS: Data was gathered over a total of nine 4-week blocks;50 residents participated, but 20 were excluded for not completing the post test. A majority of the cohort were second year medical residents and had only completed an average of 0.87 ICU rotations ± 0.82 prior to the study. The average correct score for the pre-test was 46.7% ± 27.1 and average score for posttest was 72.2% ± 21.6 with an absolute difference of +25.7% (p=0.0003, CI 95% 11.8-39.5%). There was also a significant increase in the subjective comfort levels and confidence regarding ventilator management and ARDS recognition and management. (Table 1). CONCLUSIONS: Statistically significant differences were seen in objective test scores pre- and postdidactic, highlighting the effectiveness of an informal, peer-delivered curriculum. Additionally, there was an increase in comfort level towards ventilator and ARDS management. A main limitation is that this study encompassed various times throughout the COVID-19 pandemic, therefore it is unclear whether differences in ARDS patient census also affected our results. Further studies should be conducted to see if these findings correlate with improved patient outcomes in a trainee-driven MICU. (Table Presented).","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122519474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1530
K. Driggers, L. Johnson, M. Atkin, K. Irby, M. Kovacs, M. Mir-Kasimov, W.Z. Sabbahi, J. Sellman, L. M. Keenan
{"title":"Unintended Consequences of Code Status in the Intensive Care Unit - What Happens After a Do-Not-Resuscitate Order Is Placed?","authors":"K. Driggers, L. Johnson, M. Atkin, K. Irby, M. Kovacs, M. Mir-Kasimov, W.Z. Sabbahi, J. Sellman, L. M. Keenan","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1530","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1530","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126213945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：