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Principal Investigator: Neha Neelam Goel
Organization: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Fiscal Year: 2024
Award: $187,879
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY
The goal of Dr. Neha Goel’s K23 project is to enable her to become an independent physician-investigator who
conducts research on the implementation of evidence-based care for patients with acute respiratory failure.
Building upon her strengths as a pulmonary-critical care physician and her prior training in clinical emergency
care research, Dr. Goel will transition into the next phase of her career through a well-defined training plan. The
training plan is meticulously designed to enable her to acquire requisite skills in guideline development,
implementation science methodology, and advanced statistical analyses. Her career development plan contains
focused training through conduct of a mentored research study, relevant didactic coursework, and close
mentorship from leaders in the fields of emergency and critical care medicine, and implementation science.
Dr. Goel’s ultimate research objective is to improve clinical outcomes for patients with acute respiratory failure
through the implementation of a systematically developed, evidence-based, high flow nasal oxygen (HFNO)
monitoring protocol for the emergency department (ED). In keeping with this objective, her K23 mentored
research project will focus on investigating the implementation of evidence-based protocol on HFNO use and
management for The Mount Sinai Hospital ED. HFNO use and management is a timely and important research
topic. Since the COVID-19 pandemic began, there has been a rapid increase in HFNO usage. However,
guidance on HFNO use and monitoring in the ED setting is lacking, and adverse clinical outcomes occur in the
absence of guidance. Dr. Goel’s K23 research project specific aims are to: (Aim 1) develop a pragmatic protocol
for HFNO use and management in ED setting for hypoxemic acute respiratory failure using feedback from a
national panel of multi-disciplinary experts and current evidence; (Aim 2) select implementation strategies that
address the determinants of protocol-concordant HFNO use and management, commensurate with the ED’s
capabilities, resources, and needs of its patients; and (Aim 3) examine both the implementation process for the
HFNO protocol and the applicable clinical outcomes in a pilot hybrid effectiveness-implementation study. The
completed project will include an implementation plan for HFNO management in the ED setting, and will provide
estimates of effect and sample sizes for a future R01 implementing and testing the impact of HFNO monitoring
protocols across health systems. Using the skills and preliminary data gained throughout this K23 mentored
career development project, Dr. Goel will be well positioned to become an independent physician-scientist with
R01 funding to implement and test the effectiveness of respiratory care protocols for improving patient and
process outcomes across health systems. Larger scale implementation of such interventions can help
standardized care delivery, with the ultimate goal of improving patient outcomes for more than a million acutely
ill patients presenting to EDs annually in the United States with respiratory complaints.
Terms: <Accident and Emergency department><Acute><Acute respiratory failure><Address><Adherence><Assess implementation><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Censuses><Circulatory Collapse><Clinical><Clinical Investigator><Clinical Management><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Critical Care><Critical Illness><Critically Ill><Data><Development><Development Plans><ED care><ED patient><ER care><ER patient><Effectiveness><Emergency Care><Emergency Department><Emergency Department care><Emergency Department patient><Emergency Room care><Emergency Room patient><Emergency care research><Emergency health care><Emergency healthcare><Emergency medical care><Emergency research><Emergency room><Ensure><Evidence based practice><Evidence based practice guidelines><Failure><Feedback><Focus Groups><Funding><Future><Goals><Guidelines><Health system><Hospitals><Implementation assessment><Intensive Care Units><International><Interruption><Intervention><Intervention Strategies><Intubation><Investigators><K23 Award><K23 Mechanism><K23 Program><Lung><Lung Respiratory System><Mechanical ventilation><Medicine><Mentored Patient-Oriented Research Career Development Award><Mentored Patient-Oriented Research Career Development Award (K23)><Mentors><Mentorship><Methodology><Methods><Monitor><Morbidity><Morbidity - disease rate><Nasal><Nasal Passages Nose><Nose><O element><O2 element><Outcome><Oxygen><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Phase><Physicians><Position><Positioning Attribute><Process><Process Measure><Protocol><Protocols documentation><Provider><QOC><Quality of Care><R-Series Research Projects><R01 Mechanism><R01 Program><Recommendation><Research><Research Grants><Research Personnel><Research Project Grants><Research Projects><Research Resources><Researchers><Resources><Respiratory System, Nose, Nasal Passages><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sample Size><Sampling><Scientist><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shock><Statistical Data Analyses><Statistical Data Analysis><Statistical Data Interpretation><Testing><Time Series Analysis><Training><United States><Work><Work Load><Workload><acute care><acute hypoxemic respiratory failure><acute hypoxic respiratory failure><acute onset hypoxemic respiratory failure><care delivery><care for patients><care of patients><career><career development><caring for patients><circulatory shock><clinical applicability><clinical application><cohort><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><death risk><design><designing><developmental><effectiveness testing><effectiveness/implementation hybrid study><effectiveness/implementation study><evaluate implementation><evaluation of implementation><evidence base><evidence based guidelines><evidence based recommendations><implementation evaluation><implementation process><implementation science><implementation strategy><improved><interventional strategy><mechanical respiratory assist><mechanically ventilated><mortality><mortality risk><multidisciplinary><patient oriented outcomes><pilot test><pressure><pulmonary><research study><respiratory><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><shocks><skills><standardized care><statistical analysis><strategies for implementation><ventilation>