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：此修订项目的目标是证明在实际患者护理领域研究非常规事件 (NRE) 的价值 麻醉学。 NRE 被定义为护理人员察觉到的任何事件 提供者或熟练的观察者是不寻常的、不寻常的，或者 非典型的。 因此，NRE 代表扰动和平稳的专家流程， 可以提供对潜在系统故障的洞察，允许对过程进行研究 以及护理结果。 使用麻醉作为结构化医疗的模型 工作环境，调查人员将收集前瞻性和回顾性的 围手术期非常规事件的数据，制定有用的 对此类事件进行分类，并将其与临床结果联系起来。 这 研究将确定是否对这些因素进行了严格的描述 有助于 NRE 的发生和恢复 了解安全医疗实践与不安全医疗实践的区别。 临床经验被认为是影响疗效的主要因素 NRE 的性质和结果。 临床工作量、态势感知、生产 假设压力和人为错误是 NRE 的独立预测因素 事件和结果。 NRE过程中的直接观察和录像 实际的患者护理将提供行为任务分析和测量 工作量和态势感知。 NRE 也将通过系统识别 通过保密报告系统询问康复室的临床医生， 并通过图表筛选。 结构化面试将审查提供商 有关 NRE 意识形态、管理和决策的知识和决策过程 影响结果的因素。 包含 NRE 的录像带将由 提供商和专家。 每个 NRE 将被分类并记录在 数据库。 补充多元分析技术将测试 先验假设并描述 NRE 频率、类型和的其他预测因素 结果。 在第三年，研究人员将开始应用这些方法 麻醉后 NRE 的识别和分类 重症监护病房来描述这种方法如何推广到非 或设置。 拟议的研究，同时产生应用知识 减少医疗错误和改善临床护理的具体方法，还涉及 人类认知和专业知识本质的更基本问题。