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: 7870683
• 负责人: AYSE PINAR GURSES
• 金额: $ 12.65万
• 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/7870683
• 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）：拟议的职业发展奖的目的是支持人为因素工程师Ayse P. Gurses博士，以建立一项研究计划，旨在在护理和交接过渡期间提高患者安全。该奖项将有助于戈尔斯博士在成果研究，高级研究方法和高级统计方法领域中获得其他技能和能力，这是实现她职业目标所必需的。此外，该奖项将为戈尔斯博士提供机会，从领先的研究人员那里获得指导，他们在指导研究科学家方面也有很强的记录。约翰·霍普金斯大学（Johns Hopkins University）为拟议工作提供了理想的环境，特别是因为医学和公共卫生的强大学校以及对患者安全研究的强烈关注。越来越多的医学专业化以及资源有限，导致了护理过渡的数量增加。不幸的是，如果没有有效管理，护理过渡会给患者的安全带来重大风险，并导致临床和财务状况不佳。 Gurses博士的长期目标是制定一项护理过渡改进计划，该计划可以在国家和国际上实施，以提高患者安全。拟议的研究的总体目的是确定术后心脏手术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。由于他们的疾病的复杂性和严重性及其在多种情况下从各种从业人员那里接受医疗服务的需求，我们将重点关注心脏手术患者。我们将重点关注两个护理过程：药物信息管理和医疗记录互动。为了实现总体研究目标，我们将首先确定威胁术后心脏手术后患者在医院不同单位之间的护理过渡（a）中的安全性的危害（任何有可能导致失败的危害）； （b）从医院到家，再到门诊诊所。我们将使用前瞻性和回顾性危害识别方法。然后，我们将使用医疗保健失败模式和效果分析（HFMEA）对确定危害进行预期的风险评估。我们将为每个护理过程（例如，药物信息管理）进行单独的HFMEA；在每个护理过渡点（例如，从ICU转移到一般地板）。最后，我们将发展一部小说。风险分析信息的干预捆绑和试点测试其对术后心脏手术患者和护理提供者的护理过渡安全性的影响。无效和不良的护理过渡是对患者安全的主要威胁。对于患有心脏手术的患者，由于其疾病的复杂性和严重性以及在多种情况下从各种从业人员接受医疗服务的需求，因此尤其如此。在这项研究中，我们将确定导致术后心脏手术患者的护理过渡和不安全护理的因素。然后，我们将开发和试行测试工具和策略，以改善护理过渡和术后心脏手术患者的安全。这些工具和策略可能有可能用于改善未来其他患者人群的护理过渡的安全性。