Unexpected Clinical Events: Impact on Patient Safety

意外临床事件：对患者安全的影响

• 批准号: 7090352
• 负责人: MATTHEW BRET WEINGER
• 金额: $ 3.79万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-27 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7090352
• 关键词: anesthesia complication; anesthesiology; clinical research; health care facility information system; health care personnel performance; health care service; health science research; health services research tag; hospital patient care; hospital personnel; human subject; longitudinal human study; outcomes research

DESCRIPTION: The goal of this revised project is to demonstrate the value of studying non-routine events (NRE) during actual patient care in the field of anesthesiology. An NRE is defined as any event that is perceived by care providers or skilled observers to be unusual, out of the ordinary, or atypical. NRE thus represents perturbations and smooth expert processes and may provide insight into potential system faults, allowing study of process as well as outcome of care. Using anesthesia as a model of a structured medical work environment, the investigators will collect prospective and retrospective data on non-routine events in the perioperative period, develop a useful classification of such events, and relate them to clinical outcomes. This research will ascertain whether rigorous characterization of the factors contributing to the occurrence of, and recovery from, NRE facilitates understanding what distinguishes safe versus unsafe medical practice. Clinical experience is hypothesized to be a principal factor influencing the nature and outcome of NRE. Clinical workload, situation awareness, production pressure and human error are hypothesized to be independent predictors of NRE incidents and outcome. Direct observation and video taping of NRE during actual patient care will provide behavioral task analysis and measurement of workload and situation awareness. NRE will also be identified by systematic query of clinicians in the recovery room, by a confidential reporting system, and by chart screening. Structured interviews will examine providers knowledge and decision processes with regard to NRE ideology, management and factors influencing outcome. NRE-containing video tapes will be reviewed by providers and by experts. Each NRE will be categorized and logged in a database. Complementary multivariate analysis techniques will test the a priori hypotheses and delineate other predictors of NRE frequency, type, and outcome. In year 3 the investigators will begin to apply these methodologies of identification and categorization of NRE in the post-anesthesia and intensive care units to delineate how this approach will generalize to a non- OR setting. The proposed studies, while yielding applied knowledge of specific ways to reduce medical error and improve clinical care, also address more fundamental issues of human cognition and the nature of expertise.

描述：该修订项目的目的是证明在实际患者护理领域的实际患者护理期间研究非列表事件的价值 麻醉学。 NRE定义为任何护理所感知的事件 提供者或熟练的观察者是不寻常的，与众不同的，或者 非典型。 因此，NRE代表了扰动和流畅的专家流程，并且 可能会洞悉潜在的系统故障，从而将过程研究为 以及护理的结果。 使用麻醉作为结构化医疗的模型 工作环境，调查人员将收集潜在的回顾性 有关围手术期非列表事件的数据，开发有用的 这些事件的分类，并将其与临床结果相关联。 这 研究将确定是否严格表征因素 促进NRE的发生和恢复的促进 了解区分安全与不安全的医疗实践的原因。 临床经验被认为是影响的主要因素 NRE的自然和结果。 临床工作量，情况意识，生产 压力和人为错误被认为是NRE的独立预测指标 事件和结果。 直接观察和录制了NRE 实际的患者护理将提供行为任务分析和测量 工作量和情况意识。 NRE也将通过系统识别 通过机密报告系统的恢复室中临床医生的查询， 并通过图表筛选。 结构化访谈将检查提供者 关于NRE意识形态，管理和的知识和决策过程 影响结果的因素。 含NRE的录像带将由 提供者和专家。 每个NRE将被分类和登录 数据库。 互补的多元分析技术将测试A 先验假设，并描述NRE频率，类型和 结果。 在第三年级，调查人员将开始采用这些方法 在麻醉后的NRE识别和分类和分类 重症监护部门，以描绘这种方法将如何推广到非 - 或设置。 拟议的研究，同时对 减少医疗错误并改善临床护理的特定方法，也解决 人类认知和专业知识本质的更根本问题。