Acute Care Learning Laboratory - Reducing Threats to Diagnostic Fidelity in Critical Illness

项目摘要/摘要 尽管人们认识到诊断错误和延误是可预防的死亡的主要原因 在美国，在减少这种已知杀手造成的死亡后果方面进展甚微。尽管有一种 大量文献概述了原因，有效的战略导致了有意义的 诊断误差率和延迟率的降低尚未付诸实践。这至少在一定程度上是 由于侧重于医疗团队角色的实施不力，未能将 临床环境中组织和系统流程的复杂性。这项建议是 独特新颖，将混合方法研究方法与系统工程研究相结合 了解导致诊断错误和延迟的多种因素的相互作用的方法。这个 从这种整体方法中获得的知识将在学习实验室内使用，以告知 设计、开发、评估和改进诊断错误和延迟的解决方案。“控制塔” 将作为现场学习实验室的中转站，并将建在一个完善的临床实验室之上 信息学基础设施和医院环境开放创新和实践变革。具体地说，使用 这种创新的方法，我们将评估学习实验室干预的有效性 新发危重病患者的诊断错误和延误。通过以下方式制定的干预措施 “控制塔”有可能与多种实践共享，并适用于各种临床 环境。

Project Summary/Abstract Despite the recognition that diagnostic errors and delays are a major contributor to preventable deaths in the USA, little progress has been made to reduce mortality outcomes from this known killer. Although there is a considerable body of literature outlining contributing causes, an effective strategy leading to a meaningful reduction in diagnostic error and delay rates has not made its way into practice. This has, at least in part, been due to ineffective implementation that has focused on the healthcare team's role and has failed to incorporate the complexity of the organizational and systems processes within the clinical environment. This proposal is unique and novel and combines mixed-methods research approaches with systems engineering research approaches to understand the interplay of the multiple factors contributing to diagnostic error and delay. The knowledge gained from this holistic approach will then be used within the learning laboratory to inform the design, development, evaluation, and refinement of the solutions to diagnostic error and delay. “Control Tower” will be the staging ground for the in situ learning laboratory and will be built on top of a well-established clinical informatics infrastructure and hospital environment open to innovation and practice change. Specifically, using this innovative approach we will evaluate the effectiveness of learning laboratory interventions on the rate of diagnostic error and delay in patients with emerging critical illness. The interventions developed through “Control Tower” have the potential to be shared with multiple practices and adapted to a variety of clinical environments.