Improving the Safety of Care Transitions for Cardiac Surgery Patients

提高心脏手术患者护理过渡的安全性

• 批准号: 8259043
• 负责人: AYSE PINAR GURSES
• 金额: $ 13.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8259043
• 关键词: Improving; Safety; Care; Transitions; Cardiac

DESCRIPTION (provided by applicant): The purpose of this proposed career development award is to support Dr. Ayse P. Gurses, a human factors engineer, in establishing a research program that seeks to improve patient safety during transitions of care and handoffs. This award will facilitate Dr. Gurses's acquisition of additional skills and competencies in the areas of outcomes research, advanced research methods, and advanced statistical methods that are necessary for accomplishing her career goals. Moreover, the award will provide Dr. Gurses the opportunity to get mentoring from leading researchers who also have a strong track record of mentoring research scientists. The Johns Hopkins University offers an ideal environment for the proposed work, particularly because of the strong Schools of Medicine and Public Health and the strong focus on patient safety research. Increasing specialization in medicine, coupled with limited resources, has led to an increase in the number of care transitions. Unfortunately, care transitions can pose significant risks to patient safety and result in poor clinical and financial outcomes if not managed effectively. Dr. Gurses's long-term goal is to develop a care transitions improvement program that can be implemented nationally and internationally to improve patient safety. The overall objective of the proposed study is to identify the potential risks for post-operative cardiac surgery patients' safety in care transitions, and to develop methods and tools to reduce these risks. We will focus on cardiac surgery patients because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. We will focus on two processes of care: medication information management and the medical record interactions. To accomplish the overall study objective, we will first identify hazards (anything that has the potential to cause failure) that threaten post-operative cardiac surgery patients' safety in transitions of care (a) between different units in a hospital; (b) from hospital to home and to outpatient clinics. We will use both prospective and retrospective hazard identification methods. We will then conduct a prospective risk assessment of the identified hazards using the Health Care Failures Modes and Effects Analysis (HFMEA). We will conduct a separate HFMEA for each care process (e.g., medication information management); at each point of care transition (e.g., transfer from ICU to general floor). Finally, we will develop a novel; risk-analysis-informed intervention bundle and pilot test its impact on the safety of care transitions for post-operative cardiac surgery patients and on the care providers. Ineffective and poor transitions of care are a major threat to patient safety. This is especially true for patients who had cardiac surgery because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. In this study, we will identify the factors that lead to poor care transitions and unsafe care for post-operative cardiac surgery patients. We will then develop and pilot test tools and strategies to improve care transitions and the safety of post-operative cardiac surgery patients. These tools and strategies can potentially be used to improve the safety of care transitions for other patient populations in the future.

描述（由申请人提供）：该拟议职业发展奖的目的是支持人为因素工程师 Ayse P. Gurses 博士建立一项研究计划，旨在提高护理和交接过渡期间患者的安全。该奖项将有助于 Gurses 博士获得实现其职业目标所需的成果研究、先进研究方法和先进统计方法领域的额外技能和能力。此外，该奖项将为 Gurses 博士提供获得领先研究人员指导的机会，这些研究人员在指导研究科学家方面也拥有良好的记录。约翰霍普金斯大学为拟议的工作提供了理想的环境，特别是因为其强大的医学院和公共卫生学院以及对患者安全研究的高度重视。医学专业化的不断提高，加上资源有限，导致护理转换的数量增加。不幸的是，如果管理不当，护理转变可能会给患者安全带来重大风险，并导致临床和财务结果不佳。 Gurses 博士的长期目标是制定一项可以在国内和国际范围内实施的护理过渡改进计划，以提高患者的安全。拟议研究的总体目标是确定心脏手术后患者在护理过渡中安全的潜在风险，并开发降低这些风险的方法和工具。我们将重点关注心脏手术患者，因为他们疾病的复杂性和严重性以及他们需要在多种环境下接受不同医生的医疗护理。我们将重点关注两个护理过程：药物信息管理和病历交互。为了实现总体研究目标，我们将首先确定威胁心脏手术后患者在医院不同科室之间转诊时安全的危险（任何可能导致失败的因素）； (b) 从医院到家和门诊诊所。我们将使用前瞻性和回顾性危险识别方法。然后，我们将使用医疗保健失败模式和影响分析 (HFMEA) 对已识别的危害进行前瞻性风险评估。我们将为每个护理流程进行单独的 HFMEA（例如药物信息管理）；在每个护理点过渡时（例如，从 ICU 转移到普通楼层）。最后，我们将开发一部小说；基于风险分析的干预措施和试点测试其对心脏手术患者术后护理过渡安全性和护理提供者的影响。无效和不良的护理过渡是对患者安全的主要威胁。对于接受心脏手术的患者来说尤其如此，因为他们的疾病复杂且严重，并且需要在多种环境下接受不同医生的医疗护理。在这项研究中，我们将确定导致心脏手术患者术后护理过渡不佳和不安全护理的因素。然后，我们将开发和试点测试工具和策略，以改善心脏手术患者的护理过渡和安全。这些工具和策略未来有可能用于提高其他患者群体护理过渡的安全性。