Simulation-based Training Program to Augment EMR-based Handoff Tool

描述（由申请人提供）：医疗差错是一个重大的公共卫生问题。医疗服务提供者之间的沟通不周被认为是60%的医疗错误的原因。认证组织和专家审查都呼吁努力改进和规范医疗通信，遵循在航空等其他高风险领域取得成功的模式。病人交接，特别是在高容量和高灵敏度的环境中，是病人护理系统中一个特别脆弱的点。这种交接发生在嘈杂、混乱的环境中，并以其自由形式和可变性质而闻名。在2006年全国患者安全目标中，医疗机构认证联合委员会（JCAHO）建议将移交程序标准化。我们的机构将尝试通过实施使用电子病历（EMR）的患者交接来满足JCAHO的要求。该项目的目的是整合卫生信息技术（IT）系统和基于模拟的培训，以减少急诊科（ED）环境中住院医师之间的沟通错误。最初，对实际ED交接进行为期3个月的观察将提供基线交接特征。这些数据将通过使用结构化检查表进行直接观察来收集。在引入交接工具的同时，我们将开展一个4小时的标准化患者和模型模拟培训项目，指导住院医生使用交接工具和结构化、一致沟通的基础知识。这项教育干预将在实施电子病历工具后的第1、3、5个月轮流提供给住院医师。在急诊科直接观察交接情况将持续6个月。这将允许区分培训和基于电子病历的工具对个别通信的影响。我们假设，将基于模拟的培训（包括实践和反馈）与医疗IT工具相结合将带来最大的好处，并显著减少通信错误，从而提高患者安全。本项目与卫生保健组织、认证机构和政府机构有关。沟通的一致性是减少沟通错误的必要步骤。如果要完成和保持沟通方面的改进，就必须将在职工具与强有力的培训结合起来。

DESCRIPTION (provided by the applicant): Medical error is a significant public health problem. Miscommunication between medical providers has been noted to be involved in > 60% of medical error. Accreditation organizations and expert reviews have both called for efforts to improve and standardize medical communication, following models that have been successful in other high-risk fields such as aeronautics. Patient handoffs, particularly in high-volume and high-acuity settings, are a particularly vulnerable point in the patient care system. Such handoffs occur in noisy, chaotic settings and are notable for their free-form and variable nature. In the National Patient Safety Goals for 2006, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recommended standardization of handoff procedures. Our institution will attempt to satisfy JCAHO's request by implementing a patient handoff that uses the electronic medical record (EMR). The aim of this project is to integrate health information technology (IT) systems and simulation-based training to reduce communication errors between resident physicians in an emergency department (ED) setting. Initially, a 3-month observation of actual ED handoffs will provide baseline handoff characteristics. This data will be collected by direct observation using a structured checklist. Concurrent with the introduction of the handoff tool, we will conduct a 4-hour standardized patient and mannequin simulation-based training program to instruct residents in both the use of the handoff tool and the fundamentals of structured, consistent communication. This educational intervention will be offered to residents rotating in the 1st, 3rd, and 5th months after the implementation of the EMR tool. Direct observation of handoffs in the ED will continue for 6 months. This will allow discrimination of the effect of the training and the EMR-based tool on communications individually. We hypothesize that the combination of simulation-based training (with practice and feedback) and a health IT tool will provide the greatest benefit and result in significantly fewer communications errors, therefore increasing patient safety. This project is relevant to health care organizations, accreditation bodies, and governmental bodies. Consistency in communication is a necessary step to reduce communication error. Integration of on-the-job tools with robust training is necessary if improvement in communication is to be accomplished and maintained.