Providing Safe Care to Older Hospitalized Patients through Discrete Event Simulation Modeling

通过离散事件模拟建模为老年住院患者提供安全护理

• 批准号: 10192697
• 负责人: SANDRA F SIMMONS
• 金额: $ 38.99万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192697
• 关键词: Providing; Safe; Care; Older; Hospitalized

Project Summary Many hospital patients, particularly older patients, are dependent on staff for assistance with activities of daily living (ADL) such as walking and toileting. Assistance with these activities is time-consuming for staff, and evidence suggests that ADL assistance is not consistently provided in hospitals. This inconsistent ADL care is often associated with adverse events, particularly falls, with 30-60% of hospital falls related to patients’ attempts to use the bathroom. There is evidence that consistent toileting and mobility assistance can prevent falls, but barriers related to staffing and the complex hospital work environment make it difficult to provide this care consistently in daily acute care practice. The National Academy of Medicine has identified a systems-engineering approach called Discrete Event Simulation (DES) as a method to improve the quality and efficiency of health care. This approach has been used for decades in other industries and more recently applied to healthcare settings. Discrete Event Simulation mathematically models multiple work parameters that define a care setting, such as the time to provide an episode of care, and predicts the ability of staff within that setting to provide care at different points in time based on other competing demands and care requirements. Sensitivity and predictive analyses can be used to examine how changes to the system, such as different staff schedules or order of care routines, affect and improve care delivery thus facilitating more efficient management. This investigative team has applied DES to the nursing home setting to identify staffing needs to provide care based on a range of resident ADL dependencies and staffing resources. However, this DES methodology has not been applied to the acute care setting, where many older patients need similar ADL care services and also are at risk for falls. Thus, the purpose of the proposed study is to apply DES to the hospital setting focused on units that care for large numbers of older patients with ADL dependencies. This study will produce a novel technology that hospital providers may use to efficiently manage medical units by experimenting with innovative approaches to improve ADL care prior to more expensive efforts to implement and test interventions in actual practice. This technology will be first developed and tested in an Acute Care for the Elderly (ACE) unit. However, the degree to which the model accurately describes care in two other diverse hospital units will be tested in preparation for disseminating the model to other units and hospitals via a web-based simulation tool.

项目摘要 许多医院患者，尤其是老年患者，都依赖于工作人员的帮助 日常生活（ADL），例如步行和厕所。这些活动的协助对员工来说是耗时的， 证据表明，医院并未始终提供ADL援助。这个不一致的ADL 护理通常与不良事件有关，尤其是跌倒，其中30-60％的医院跌倒与患者有关 尝试使用浴室。有证据表明一致的厕所和流动援助可以防止 跌倒，但与人员配备和复杂的医院工作环境有关的障碍使得很难提供此事 每天的急性护理实践中始终如一的护理。 美国国家医学院已经确定了一种系统工程方法，称为离散 事件模拟（DES）是提高医疗保健质量和效率的方法。这种方法有 离散事件 仿真数学对定义护理设置的多个工作参数进行建模，例如 提供护理的一集，并预测该环境中员工在不同点提供护理的能力 及时根据其他竞争要求和护理要求。敏感性和预测分析可以是 用于检查系统的变化（例如不同的员工时间表或护理程序顺序）如何影响系统的变化 并改善护理服务，从而支持更有效的管理。 这个调查团队已将DES应用于护士家庭环境，以确定人员的需求 根据ADL依赖性和人员配备资源的一系列居民提供护理。但是，这个des 方法学尚未应用于急性护理环境，许多老年患者需要类似的ADL护理 服务，也有跌倒的风险。这是拟议的研究的目的是将DES应用于医院 设置专注于照顾大量ADL依赖性患者的单位。 这项研究将生产出医院提供者可能用来有效管理的新技术 医疗单位通过尝试创新的方法来改善ADL护理，然后再昂贵 在实际实践中实施和测试干预措施的努力。该技术将首先开发和测试 在对老年人（ACE）单位的急性护理中。但是，模型准确描述了护理的程度 在其他两个不同的医院单位中，将进行测试，以准备将模型传播到其他单位和 通过基于Web的仿真工具进行医院。