Care Transitions and Teamwork in Pediatric Trauma: Implications for HIT Design

儿科创伤中的护理转变和团队合作：对 HIT 设计的影响

• 批准号: 9101954
• 负责人: AYSE PINAR GURSES
• 金额: $ 49.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9101954
• 关键词: Care; Transitions; Teamwork; Pediatric; Trauma

 DESCRIPTION (provided by applicant): Ensuring safety and quality of care as well as improving patient and family experiences have been strong drivers for health information technology (HIT) deployment. When designed and implemented well, HIT can revolutionize and improve the way clinicians and families work together. However, currently available HIT applications have made healthcare more fragmented, making it harder to coordinate care among various care team members and families; thus introducing new risks to patient safety. Our long-term goal is to develop innovative and effective concepts and techniques for the next generation of HIT-supported work systems that provide integrated, seamless, safe, and patient and family-centered care based on scientific evidence. Trauma is the leading cause of death and permanent paralysis among the pediatric population. Care transitions of critically ill patients such as trauma patients, to and from the pediatric intensive care unit (PICU) require effective teamwork among the PICU team, other teams and services (e.g., emergency department), as well as the family members. We propose to use a sociotechnical systems approach to the design of HIT that supports pediatric trauma care transitions. We will use the SEIPS 2.0, a sociotechnical systems model for healthcare, complemented by the well-known team processes framework, to ensure that our HIT design supports the cognitive work of the various trauma care team members and families. Nested within the SEIPS 2.0, we will use contextual design methodology, a six-step user-centered design process, to guide our overall design process. Our first specific aim is to describe cognitive teamwork involved in care transitions of pediatric trauma patients. We will focus on three types of care transitions: admission to PICU from emergency department, transfer from PICU to inpatient pediatric general care unit, and hospital discharge directly from PICU. The second specific aim is to develop and test design requirements for future HIT, referred to as the team-centric information technology (TACIT), that supports cognitive teamwork for enhancing safety, quality, and family-centeredness of care. The study will be conducted in three Level I pediatric trauma centers: Johns Hopkins Children's Hospital, UWHealth-American Family Children's Hospital, and the All Children's Hospital. Methods for analyzing cognitive teamwork will be diverse (i.e. contextual inquiry, interviews, focus groups) (Aim 1) and will produce a range of outputs (e.g., process maps, information flow diagrams, artifact analysis, collaboration tables, decision wheels, role network analysis) that wil be used to define the TACIT design requirements (Aim 2). Using a collaborative process among researchers and the various other stakeholders, we will develop preliminary design requirements for the TACIT mock-up and evaluate its usability. This study uses an iterative design approach; Aim 2 results will help to define additional data collection and analysis needs under Aim 1. When all Aim 1 data have been collected and analyzed, the TACIT design requirements will be finalized (Aim 2).

 描述（通过应用程序提供）：确保安全和护理质量以及改善患者和家庭经验一直是健康信息技术（HIT）部署的强大驱动力。当设计和实施良好时，HIT可以彻底改变和改善临床医生和家庭的共同努力。但是，目前可用的HIT申请使医疗保健更加分散，因此很难协调各个护理团队和家庭的护理；因此为患者安全带来了新的风险。我们的长期目标是为下一代命中的工作系统开发创新和有效的概念和技术，这些工作系统可根据科学证据提供综合，无缝，安全，患者和以家庭为中心的护理。创伤是儿科人群中死亡和永久瘫痪的主要原因。危重患者（例如创伤患者），往返儿科重症监护病房（PICU）的护理过渡需要PICU团队，其他团队和服务（例如急诊室）以及家庭成员之间的有效团队合作。我们建议使用社会技术系统方法来设计支持小儿创伤护理过渡的命中设计。我们将使用由知名团队流程框架完成的Seips 2.0，这是一种医疗保健的社会技术系统模型，以确保我们的HIT设计支持各种创伤护理团队成员和家庭的认知工作。嵌套在SEIP 2.0中，我们将使用上下文设计方法（以用户为中心的六步设计过程）来指导我们的总体设计过程。我们的第一个具体目的是描述参与小儿创伤患者护理过渡的认知团队。我们将重点关注三种类型的护理过渡：从急诊科入学，从PICU转移到住院儿科一般护理部门，以及直接从PICU出院。第二个具体目的是针对未来的热门单曲制定和测试设计要求，称为以团队为中心的信息技术（TACIT），该技术支持认知团队，以增强安全性，质量和以家庭为中心的护理。这项研究将在三级I级儿科创伤中心进行：Johns Hopkins儿童医院，UWhealth-American家庭儿童医院和所有儿童医院。分析认知团队合作的方法将为潜水员（即情境查询，访谈，焦点小组）（AIM 1），并将产生一系列输出（例如，过程映射，信息流程图，人工制品分析，协作表，决策轮，决策轮，角色网络分析），以定义TACIT设计需求（AIM 2）。利用研究人员和其他各种利益相关者之间的协作过程，我们将为默认模型制定初步设计要求并评估其可用性。这项研究采用了迭代设计方法。 AIM 2结果将有助于定义AIM 1下的其他数据收集和分析需求。在收集和分析所有AIM 1数据时，将最终确定默认设计要求（AIM 2）。