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首页> 外文期刊>The Internet Journal of Medical Simulation >Acute Critical Events Simulation (A.C.E.S): a Novel Program to Improve Resuscitation of the Critically Ill
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Acute Critical Events Simulation (A.C.E.S): a Novel Program to Improve Resuscitation of the Critically Ill

机译：急性关键事件模拟​​（A.C.E.S）：提高对严重疾病的复苏的新颖程序

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Introduction: The Acute Critical Events Simulation (ACES) Program was designed to aid acquisition of knowledge, skills, and behaviours needed to care for the critically-ill. Methods: ACES originated following identification of recurrent deficiencies with resuscitation, and incorporated peer-reviewed material and nationwide faculty. Questionnaires provided demographics and satisfaction scores. We compared results from 2002 and 2003 to assess ongoing modifications. Participant evaluation and perceived usefulness were measured using a 5-point Likert-scale. Multiple-linear-regression analysis determined whether past-training influenced perceived usefulness. Results: Questionnaires showed very little prior training in resuscitation or crisis resource management (CRM). Roughly half had prior simulator experience. Evaluations showed ACES to be well received: with scores of 4.38 out of 5 in 2002, and 4.44 in 2003. Modifications were associated with a significant increase in the evaluation of simulation/CRM sessions (4.01 in 2002, versus 4.67 in 2003, p = 0.0004). Prior training had minimal effect upon the perceived usefulness.Conclusion: ACES represents a portable, modifiable, peer-reviewed program to improve care of the critically-ill. It was well reviewed by participants. Our results confirm that CRM training is lacking and that medical simulators are well received. Introduction The Acute Critical Events Simulation (ACES) program is a two day course intended to provide knowledge, skills and behaviours essential in acute resuscitation. The goal is to promote better care of the critically-ill and decrease the likelihood of medical errors. This manuscript discusses its design and implementation. ACES is complementary to excellent course such as Advanced Cardiac Life Support? (ACLS?) and Advanced Trauma Life Support? (ATLS?). However, it teaches strategies applicable for any critical illness, rather than stressing algorithmic solutions applicable only to certain diagnoses. Furthermore, while many courses focus on knowledge and procedural dexterity, ACES covers not only these potential sources of adverse outcome,1 but goes further. For example, it is well accepted that error can occur as a result of poor communication and inexperience managing the evolving medical crisis.1,2,3,4 Remarkably, this skill set, referred to as ‘crisis resource management' (CRM), is rarely taught except to anesthesiologists. 5,6,7,8 Therefore, ACES includes such strategies as: how to recognize the sick patient; mobilize assistance; work within a multidisciplinary team; and how to act preemptively while a greater chance for recovery exists. In contrast, ACLS? resuscitation typically occurs only following full cardiovascular collapse; a situation from which outcomes are often abysmal.9 As many as 98,000 Americans10 and 23,000 Canadians11 may die each year from medical errors. Although the exact numbers are debated1, 12,13,14, few deny that errors have a major effect upon patient outcome and costs. Inexperience, human fallibility and imperfect work environments mean that errors occur in all medical settings.10,11,12,13 Unfortunately, with the critically-ill, decisions are often made quickly, under stress, and with limited information. This can compound the likelihood of error precisely where consequences can be most dire. The Canadian National Steering Committee on Patient Safety outlined that medical education initiatives are essential to tackle medical errors.14 Furthermore, they recommended incorporating “simulations of high risk health-care interventions”. ACES uses Laerdal medical simulators (see below), which allow practice without patient-risk. Video playback also encourages self-awareness of strengths and weaknesses.Physicians ought to be more than just medical experts: but also communicators; collaborators; managers; advocates; scholars and professionals. These skills encompass the CanMeds objectives.15 These laudable goals can be difficult to teach using
机译：简介：急性关键事件模拟​​（ACES）程序旨在帮助获得护理重症患者所需的知识，技能和行为。方法：ACES起源于通过复苏识别出经常性缺陷，并纳入了同行评审的材料和全国范围的教师。问卷提供了人口统计学和满意度得分。我们比较了2002年和2003年的结果，以评估正在进行的修改。参与者评估和感知有用性使用5点Likert量表进行测量。多元线性回归分析确定了过去的培训是否影响了感知的有用性。结果：问卷调查显示，复苏或危机资源管理（CRM）之前的培训很少。大约一半的人以前有模拟器经验。评估显示，ACES受到好评：2002年5分中的4.38分，2003年中4.44分。修改与模拟/ CRM会议的评估显着增加相关（2002年为4.01分，而2003年为4.67分，p = 0.0004）。先前的培训对感觉到的有用性影响很小。结论：ACES是一种便携式，可修改，经过同行评审的计划，旨在改善对重症患者的护理。与会者对此进行了很好的审查。我们的结果证实，缺乏CRM培训，并且医疗模拟器获得了广泛好评。简介急性关键事件模拟​​（ACES）计划为期两天，旨在提供急性复苏必不可少的知识，技能和行为。目的是促进对重症患者的更好的护理并减少医疗错误的可能性。该手稿讨论了其设计和实现。 ACES是高级心脏病生命支持等优秀课程的补充吗？ （ACLS？）和高级创伤生命支持？ （ATLS？）。但是，它讲授了适用于任何重大疾病的策略，而不是强调仅适用于某些诊断的算法解决方案。此外，尽管许多课程都侧重于知识和程序灵活性，但ACES不仅涵盖了这些不利结果的潜在来源1，而且范围更广。例如，人们普遍认为，沟通不畅和管理不断发展的医疗危机可能会导致错误发生。1、2、3、4值得注意的是，这种技能被称为“危机资源管理”（CRM），除了麻醉师，很少有人教。 5,6,7,8因此，ACES包括以下策略：如何识别患病患者;动员援助;在多学科团队中工作;以及在有更大的恢复机会时如何先发制人。相比之下，ACLS？通常仅在完全心血管衰竭后才进行复苏。 9每年可能有多达98,000名美国人10和23,000名加拿大人11因医疗错误而死亡。尽管确切的数字尚有争议[1,2,13,14]，但很少有人否认错误会严重影响患者的治疗效果和费用。缺乏经验，人为失误和不完善的工作环境意味着在所有医疗环境中都会发生错误。10、11、12、13不幸的是，对于重病患者，决策往往是在压力之下，信息有限的情况下迅速做出的。这可能会在可能造成最严重后果的地方准确地增加出错的可能性。加拿大国家患者安全指导委员会指出，医学教育计划对于解决医学错误至关重要。14此外，他们建议纳入“模拟高风险医疗干预措施”。 ACES使用Laerdal医疗模拟器（参见下文），可以在没有患者风险的情况下进行练习。视频播放还可以鼓励人们意识到自己的长处和短处。医师不仅应该是医学专家，还应该是传播者;合作者管理人员;拥护者学者和专业人士。这些技能涵盖了CanMeds的目标。15这些值得称赞的目标可能很难使用

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