Proactive risk assessment in the ED: Building the 'safety case'

描述(由申请人提供)：本提案有3个广泛的长期目标：1)将高风险行业中使用的前瞻性风险评估(PRA)技术扩展到医疗保健环境中；2)将为系统变化(在高风险行业中也很常见)创建“安全案例”的技术应用于医疗保健环境；以及3)检查用于补充PRA的复原力工程的概念。用计算机化的跟踪系统取代急诊科人工状态板的情况将被用作该项目的“试验台”。因此，该项目的具体目标是：1.确定状态委员会支持患者安全或对患者构成风险的具体方式。2.在电子病床进行以计算机为基础的状态板取代人工的PRA。由于不同运行条件下的风险可能不同，这将是一个分阶段的风险评估。3.根据PRA工作的结果，为这一改变提出“安全理由”论据。4.制定一种可推广的方法，以便今后在卫生保健方面进行此类评估。方法：研究方法。先前关于状态板认知属性的工作将用于确定对患者安全有直接影响的功能。将使用流程映射技术、直接观察工作情况和与教育署工作人员的半结构化面谈来收集有关系统运行的数据。这些将在社会技术PRA框架中进行分析。结果将由独立评审小组进行审查，以增加一般性。该项目与公共卫生有很大的相关性。卫生保健组织通常在流程、人员和技术方面进行重大更改(例如，开设专门的创伤或中风中心，或安装计算机化的提供者订单录入系统)，而很少或根本不对此类更改可能引发的危险进行前瞻性检查。如果PRA方法可以成功地传输到医疗保健，并用于在此类更改之前建立安全案例论点(并在系统的整个生命周期中保持这些论点)，则可能会减少对患者和工作人员的意外后果，并促进有益的改变。

DESCRIPTION (provided by the applicant): There are 3 broad, long-term objectives for this proposal: 1) to extend the techniques of proactive risk assessment (PRA) used in high hazard industries into a health care setting, 2) to adapt the technique of creating a 'safety case' for a system change (also common in high hazard industries) to a health care setting; and 3) to examine the concepts of resilience engineering for use in supplementing a PRA. The case of replacing manual status boards in emergency departments (EDs) with computerized tracking systems will be used as a 'test bed' for the project. The specific aims of the project therefore are: 1. To identify the specific ways in which the status board supports patient safety, or poses risks to patients. 2. To conduct a PRA for replacing manual with computer-based status boards in EDs. Because risks may vary under different operating conditions, this will be a phased risk assessement. 3. To produce a 'safety case' argument for that change based on the results of the PRA exercise. 4. To produce a generalizable methodology for conducting such assessments in health care in the future. Methods. Prior work on the cognitive properties of the status board will be used to identify functionality with direct implications for patient safety. Process mapping techniques, direct observations of work and semistructured interview with ED staff will be used to gather data on system operations. These will be analyzed in a sociotechnical PRA framework. The results will be independently reviewed panel to increase generality. The project has substantial relevance to public health. Health care organizations commonly make major changes in processes, people and technology (eg, opening specialized trauma or stroke centers, or installing computerized provider order entry systems) with little or no prospective examination of the hazards that may be induced by such changes. If PRA methods can be successfully transported to health care and used to build safety case arguments prior to such changes (and to maintain those arguments over the life of the system), unintended consequences for patients and staff may be reduced, and beneficial change facilitated.