Elucidating Non-Routine Events Arising from Interhospital Transfers

阐明院间转移引起的非常规事件

• 批准号: 10749448
• 负责人: Michael J. Ward
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749448
• 关键词: Academic Medical Centers; Accident and Emergency department; Accounting; Acute; Acute myocardial infarction; Address; Admission activity; Adverse event; Area; Award; Cardiology; Caring; Categories; Clinical; Collection; Communication; Community Healthcare; Computational algorithm; Data; Data Collection; Detection; Deterioration; Development; Documentation; Education; Elderly; Emergency Care; Emergency Medicine; Emergency Situation; Emergency department visit; Engineering; Environment; Evaluation; Event; Failure; Family; Family member; Feasibility Studies; Floor; Foundations; Future; Health Information System; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hour; Human; Incidence; Informatics; Information Systems; Injury; Institution; Intervention; Interview; Length of Stay; Literature; Manuals; Medical Records; Medical center; Medicine; Methods; Modeling; Natural Language Processing; Outcome; Patients; Perioperative; Population; Process; Provider; Psyche structure; Qualifying; Qualitative Methods; Qualitative Research; Records; Reporting; Research; Resources; Safety; Sampling; Scanning; Science; Services; Severities; Site; Surveys; System; Tennessee; Text; Time; Training; Veterans; Work; acute care; biomedical informatics; care costs; care episode; clinical care; clinical center; clinical predictors; cost; data exchange; data quality; design; digital imaging; experience; field study; high risk; hospital readmission; implementation intervention; implementation science; improved; informatics tool; innovation; medical specialties; novel; open source; optical character recognition; patient safety; prevent; programs; rapid detection; skills; stroke patient; structured data; tool

Veterans experienced more than 3 million emergency department visits in 2021 and nearly one-third of these are in non-VA settings. Non-VA emergency care is the single largest contributor to community care with an estimated $500 million in monthly costs. Interhospital transfers are used either to repatriate Veterans during acute episodes of care or to provide access specialty care (e.g., cardiology) should such skilled services not be available at the initial hospital. However, such transfers are burdensome for Veterans and their families, and are associated with worsened clinical outcomes. The field of Human Factors Engineering uses system science to examine what may contribute to suboptimal clinical outcomes through the evaluation of “Non-Routine Events.” These are sub-optimal deviations from the standards of care or unexpected events that are identified through validated surveys of staff, clinicians, and patients. In this pilot application, we seek to advance the study of Non-Routine Events (NREs) through their application to interhospital transfers from VA and non-VA emergency departments. We will use validated surveys of NREs along with transfer documentation to study transfers for evidence of NREs. Finally, in order to automate NRE data collection, we seek to train an optical character recognition and natural language processing informatics cool, “MIRROR EHR,” to extract data of NRE components from scanned medical records for Veterans who experienced interhospital transfers. Guided by the principles of high reliability, our innovative pilot proposal directly addresses multiple ORD-wide and HSR&D priority areas including Access to Care, Quality & Safety, and Healthcare Informatics by using cross-cutting methods of Health Systems Engineering to study interhospital transfers and addressing data quality and how to integrate non-VA data. This work addresses a major legislative priority of the MISSION Act to address the quality and safety of non-VA emergency care. The Specific Aims are: 1) Examine Non-Routine Events arising from interhospital transfers of Veterans; 2) Identify NREs in transferring hospital clinical documentation amongst Veterans experiencing interhospital transfer; and 3) Demonstrate the feasibility of the MIRROR EHR informatics tool to collect and categorize data that are indicators of NREs. The team is uniquely qualified to accomplish these Aims, with expertise in systems science, human factors engineering, biomedical informatics, implementation science, qualitative methods, and acute hospital-based care (emergency and hospital medicine). The institutional environment at the VA Tennessee Valley Healthcare System and Vanderbilt University Medical Center is outstanding, including the Geriatric Research, Education and Clinical Center (GRECC), a site for VA Quality Scholars, an innovative qualitative research center; nationally ranked graduate programs in the relevant fields of study; and the national CTSA coordinating center. This application will conduct necessary pilot work to evaluate the feasibility of NRE data collection arising from interhospital transfers from both VA and non-VA settings using validated NRE surveys. This is a highly innovative proposal to advance the methods of safety science and biomedical informatics designed to improve the quality and safety for Veterans experiencing care transitions in the form of interhospital transfers. Should this work prove feasible, we plan to use these pilot data to prepare a larger Merit award application to evaluate NREs in interhospital transfers and to develop interventions to mitigate their potential harm of Veterans.

退伍军人在2021年经历了超过300万的急诊室访问，其中几乎三分之一 在非VA设置中。非VA紧急护理是通过 估计每月费用为5亿美元。院间转移用于遣返退伍军人 急性护理或提供访问专业护理（例如心脏病学）的急性服务不应是 可在最初的医院获得。但是，这种转移对退伍军人及其家人来说是负担重的， 与恶劣的临床结果有关。人为因素工程领域使用系统科学 通过评估“非列表 事件。“这些是远离护理标准或已确定的意外事件的最佳选择 通过经过验证的员工，临床医生和患者的调查。 在此试点申请中，我们试图通过其申请来进步非列表事件（NRE） 从弗吉尼亚州和非VA急诊室进行了院间转移。我们将使用已验证的NRES调查 以及转移文档以研究转移以获取NRE的证据。最后，为了自动化NRE 数据收集，我们寻求培训光学特征识别和自然语言处理信息 酷，“镜子EHR”，以从扫描的医疗记录中提取NRE组件的数据 经历了院间转移。 在高可靠性原则的指导下，我们的创新飞行员提案直接解决了多个ORD范围的问题 以及HSR＆D的优先领域，包括使用护理，质量与安全以及医疗保健信息学。 卫生系统工程的横切方法研究医院间转移和纠正数据 质量以及如何整合非VA数据。这项工作涉及《任务法》的主要立法优先事项 解决非VA紧急护理的质量和安全性。具体目的是：1）检查非列表 由退伍军人的医院间转移引起的事件； 2）确定转移医院临床的NRE 经历了院间转移的退伍军人之间的文件； 3）证明了 镜像EHR信息工具，以收集和分类为NRE的指标的数据。 该团队具有实现这些目标的独特资格，并具有系统科学，人为因素的专业知识 工程，生物医学信息，实施科学，定性方法和急性医院 护理（紧急和医院医学）。田纳西州田纳西河谷医疗保健的机构环境 系统和范德比尔特大学医学中心非常出色，包括老年研究，教育 和临床中心（GRECC），一个创新的定性研究中心VA质量学者的地点； 在相关研究领域的全国性研究生课程；以及国家CTSA协调中心。 该应用程序将进行必要的试点工作，以评估NRE数据收集的可行性 使用经过验证的NRE调查从VA和非VA设置进行了院间转移。这是一个高度 创新的建议，以推进旨在改善的安全科学和生物医学信息的方法 以院间转移形式进行护理过渡的退伍军人的质量和安全。应该 这项工作证明是可行的，我们计划使用这些试验数据来准备更大的优点奖励申请以评估 医院间转移的NRE，并制定干预措施以减轻退伍军人的潜在危害。