Assessing Risk in Ambulatory Medication Use after Hospital Transitions

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Description (provided by the applicant): The purpose of this proposed career development award is to support Dr. Tosha Wetterneck, a general internal medicine physician, in establishing a research program that seeks to improve the safety of patient care during transitions from hospital to primary care. This award will facilitate Dr. Wetterneck's acquisition of advanced research competencies in human factors engineering techniques and provide for individual and group mentoring from accomplished researchers with a proven track record of mentoring physician scientists. The University of Wisconsin-Madison offers an ideal environment for the proposed work because of the strong Departments of Industrial and Systems Engineering, Population Health Sciences and Medicine, the established interdepartmental collaborations and the long history of healthcare systems engineering research. Transitions of care are increasingly common and are a source of errors and patient harm due to failures in information exchange. During the period of this training grant, Dr. Wetterneck will conduct research in which the long-term goal is to determine the safest medication information process during transitions of care from hospital to primary care to inform intervention strategies that reduce the potential for patient harm by preventing errors and supporting the detection and correction of the errors that do occur. Importantly, this research is performed from the primary care provider perspective. In order to determine intervention strategies, it is imperative that the system risks are identified through prospective risk assessment. The risk assessment must consider the contributions of the organization, environment humans (clinician and patient), technology and tools and the tasks performed. We propose to use failure modes and effects analysis and fault tree analysis of the medication information management process to assess system risks. We also propose to identify the mechanisms by which errors that do occur during hospital transitions are detected and corrected - the process of error recovery. This complementary approach to identify error risks and recovery will lead to the development of robust systems of care that both prevent errors from occurring and recover from the errors that do occur.