Realizing Improved Patient Care through Human-centered Design for Pediatric mental and behavioral health in the Emergency Department(RIPCHD.PED)

项目摘要 美国的大多数急诊科（艾德）的设计、组织和设备都很差， 为患有精神和行为健康（MBH）疾病的儿童提供安全有效的护理。安全性问题 在艾德患有MBH的儿童包括护理延误， 访视、患者自我伤害、对他人或环境的伤害以及非自愿约束使用导致患者 员工受伤。需要一种系统方法来解决艾德中影响MBH的许多潜在条件 患者和供应商的安全。提出的“通过人类实现改善患者护理”的目的- 急诊科儿科心理和行为健康中心设计（RIPCHD.PED） 患者安全学习实验室（PSLL）是在艾德开发和实施儿科MBH卫生工作系统， 通过最大限度地减少患者不必要的压力，促进安全、高效和有效的护理，同时改善 提供者的福祉。该PSLL将重点关注来自少数民族的儿童及其照顾者的需求， 社区，以解决在医疗保健护理的差距在ED。此外，PSLL将侧重于农村和 城市ED，以确保提出的解决方案解决了ED通常存在的一系列资源限制 在美国各地。来自克莱姆森大学、Prisma Health和南卡罗来纳州大学的多学科团队 医学院将采用系统工程方法进行合作，涉及深入的问题分析， 设计、开发、实施和评价。该项目的具体目标包括：目标1： 系统工程方法，以发展对工作系统促进者的共同深入理解， 儿科MBH艾德治疗工作流程中涉及的障碍，目标2：设计和开发以人为本的工作 艾德儿科MBH患者的系统，将改善及时获得MBH护理的机会，减少不良事件 提高艾德医疗服务提供者的效率，目标3：整合、实施和评估创新 艾德儿科MBH工作系统中的干预措施，将改善艾德患者的结局， 医疗保健提供者。该团队将使用一系列方法，包括工作流程分析、旅程映射和 空间语法分析，以了解障碍和促进因素，并确定改进的机会。一个 迭代设计过程将用于设计和开发与物理环境、工具 技术、任务和工作流程。该PSLL通过关注安全，与AHRQs的使命高度一致， 精神和行为健康儿童获得适当精神卫生保健的质量、公平性和机会 条件该项目将通过促进下列活动，支持阿富汗人权问题咨询委员会将儿童作为优先人口的战略重点： AHRQ战略计划中概述的所有6个目标。此外，PSLL还将重点关注服务不足的农村地区， 这是一个很好的解决办法，包括黑人和拉丁裔社区的儿童。RIPCHD.PED PSLL将是最 为改善急诊科儿科MBH的工作系统所做的全面努力。

PROJECT SUMMARY Most emergency departments (ED) in the United States are poorly designed, organized and equipped to provide safe and effective care for children with mental and behavioral health (MBH) conditions. Safety concerns for children with MBH conditions in the ED include delays in care, lack of appropriate psychiatric consults during visits, patient self-harm, harm against others or the environment, and involuntary restraint use resulting in patient and staff injury. A systems approach is needed to address the many latent conditions in the ED that impact MBH patient and provider safety. The purpose of the proposed ‘Realizing Improved Patient Care through Human- centered Design for Pediatric mental and behavioral health in the Emergency Department (RIPCHD.PED)’ patient safety learning lab (PSLL) is to develop and implement pediatric MBH health work systems in the ED that promote safe, efficient and effective care by minimizing unnecessary stressors for patients while also improving provider well-being. This PSLL will include a focus on the needs of children and their caregivers from minority communities in order to address disparities in MBH care in the ED. Further, the PSLL will focus on rural and urban EDs to ensure that proposed solutions address a range of resource constraints typically found in EDs across the US. A multidisciplinary team from Clemson University, Prisma Health and University of South Carolina School of Medicine will collaborate using a systems engineering approach involving in-depth problem analysis, design, development, implementation and evaluation. The specific aims of this project include, Aim 1: Use systems engineering methods to develop a shared in-depth understanding of the work system facilitators and barriers involved in the pediatric MBH ED caregiving workflow, Aim 2: Design and develop human-centered work systems for pediatric MBH patients in the ED that will improve access to timely MBH care, reduce adverse events and improve efficiency for ED healthcare providers and Aim 3: Integrate, implement and evaluate innovative interventions within pediatric MBH work systems in the ED that will improve outcomes for ED patients and healthcare providers. The team will use a range of methods including workflow analysis, journey mapping and space syntax analysis to understand barriers and facilitators and identify opportunities for improvement. An iterative design process will be used to design and develop solutions related to the physical environment, tools and technology and tasks and workflow. This PSLL strongly aligns with AHRQs mission by focusing on safety, quality, equity and access to appropriate mental health care for children with mental and behavioral health conditions. The project will support AHRQ’s strategic focus on children as a priority population by contributing to all 6 goals outlined in AHRQ’s strategic plan. Further, the PSLL will include a focus on underserved rural populations as well as children from Black and Latino communities. RIPCHD.PED PSLL will be the most comprehensive effort ever undertaken to improve work systems for pediatric MBH in the emergency department.