Improving Emergency Department Management of Adults with Sickle Cell Disease

改善成人镰状细胞病急诊科管理

基本信息

批准号：
8508193
负责人：
Paula Tanabe
金额：
$ 28.69万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8508193
关键词：
Improving Emergency Department Management Adults

项目摘要

Project Summary/Abstract This researching implementation and change while improving quality project will re-design the process of emergency department (ED) management for adults with sickle cell disease (SCD). The project will use the Failure Modes, Effects, and Criticality Analysis (FMECA)-- to identify the vulnerabilities, risks, and weak points (failures) in the systems and processes involved in using the Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), (a decision support tool developed to improve the quality of care for adults with SCD). The root causes of each failure will be identified, then re-designed. The aims for the proposed project are to (1) Conduct a proactive risk assessment, Failure Modes Effects and Criticality Analysis (FMECA) of the workflow and operational systems and processes involved in four key decisions of the EDSCANS regarding evaluation and management of SCD patients by; applying a FMECA at two academic medical centers to examine four key ED-SCANS decisions; (2) Develop and implement standardized processes and interventions for each of the four decisions of the ED-SCANS; (3) Conduct a formal program evaluation of the quality improvement implementation at each site by; (3.1) reporting process evaluation measures including implementation success, associated facilitators and barriers of process improvement interventions; and (3.2) reporting preliminary data for selected patient and clinician outcome measures to be effected by the quality improvement interventions; and (4) Develop a toolbox for dissemination and implementation of effective systems and processes to support use of the ED-SCANS in EDs at additional low resource US hospitals. Two centers will form quality improvement teams and design interventions targeted to assign correct triage scores, improve rapid, aggressive analgesic management, identify patients at high risk for severe disease or those with frequent ED management or hospitalizations, and identify medical and psychosocial referral needs for adults with SCD during an ED visit. The plan, do, study, act, rapid cycle quality improvement process will be used to rapidly assess the affect of interventions on study outcomes and allow for modifications in the interventions. A formal program evaluation will be conducted using mixed methods to evaluate the affect of the program. Clinicians will participate in semi- annual surveys to evaluate success of program implementation bi-annually, and two focus groups will be conducted at each site toward the end of the project to evaluate program success. Structured medical record review and patient interviews will be conducted to measure the affect of interventions on patient outcomes. A toolbox of protocols, educational tools, and other materials will be developed to help disseminate to other emergency departments.

项目摘要/摘要这种研究实施和变化的同时改善了质量项目将重新设计镰状细胞疾病（SCD）的急诊科（ED）管理。该项目将使用故障模式，效果和批判性分析（FMECA） - 确定脆弱性，风险和弱点（失败）在使用急诊部镰状细胞评估的系统和流程中需求和优势（ED-scans）（开发了一种决策支持工具，以提高护理质量成人SCD）。每个故障的根本原因将被识别，然后重新设计。目的拟议的项目是（1）进行主动的风险评估，失败模式的影响和关键性分析（FMECA）的工作流程和操作系统和流程参与了四个关键决策关于SCD患者评估和管理的EDSCAN；在两个处应用FMECA 学术医疗中心检查四个主要的ED扫描决定；（2）开发和实施 ED扫描的四个决策中的每个决定中的每个决策的标准化过程和干预措施；（3）进行由每个站点对质量改进实施的正式计划评估；（3.1）报告过程评估措施，包括实施成功，相关的促进者和过程障碍改进干预措施；（3.2）报告选定患者和临床医生结果的初步数据质量改善干预措施将采取的措施；（4）为传播和实施有效的系统和流程，以支持在 EDS在美国额外的低资源医院。两个中心将组成质量改进团队和设计针对性分配正确分类分数的干预措施，改善快速，积极的镇痛管理，识别患有严重疾病的高风险的患者或经常治疗或住院的患者并在ED访问期间确定患有SCD的成年人的医疗和社会心理转诊需求。计划，做，研究，ACT，快速周期质量改进过程将用于快速评估干预措施的影响在研究结果上，并允许对干预措施进行修改。正式的计划评估将是使用混合方法进行评估程序的影响。临床医生将参加半每年评估计划实施成功的年度调查，两个焦点小组将是在项目结束时在每个站点进行评估计划成功。结构化病历将进行审查和患者访谈，以衡量干预措施对患者预后的影响。一个将开发协议，教育工具和其他材料的工具箱，以帮助传播到其他急诊部门。