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

急诊科的主动风险评估：建立“安全案例”

• 批准号: 7363458
• 负责人: ROBERT L WEARS
• 金额: $ 19.73万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7363458
• 关键词: Proactive; risk; assessment; ED; Building

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.

描述（由申请人提供）：本提案有3个广泛的长期目标：1）将高危行业中使用的主动风险评估（PRA）技术扩展到医疗保健环境，2）适应为系统变更创建“安全案例”的技术（也常见于高危害行业），以卫生保健设置;和3）审查的概念，弹性工程用于补充PRA。用计算机化跟踪系统取代急诊室（ED）中的手动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。确定状态板支持患者安全或对患者构成风险的具体方式。2.在急症室进行一次PRA，以电脑状态板取代手动。由于在不同的操作条件下风险可能会有所不同，因此这将是一个阶段性的风险评估。3.根据PRA工作的结果，为该变更提供“安全案例”论证。4.为将来在卫生保健中进行此类评估提供一种可推广的方法。方法.之前对状态板认知特性的研究将用于识别对患者安全有直接影响的功能。将使用流程图技术、工作的直接观察和与艾德员工的半结构化访谈来收集系统操作的数据。这些将在社会技术PRA框架中进行分析。结果将由独立小组进行审查，以增加通用性。该项目与公共卫生有很大关系。医疗保健组织通常在流程、人员和技术方面进行重大变更（例如，开设专门的创伤或中风中心，或安装计算机化的供应商订单输入系统），但很少或根本没有对此类变更可能引起的危害进行前瞻性检查。如果PRA方法可以成功地转移到医疗保健领域，并用于在此类变更之前建立安全案例论证（并在系统的生命周期内维持这些论证），则可能会减少对患者和工作人员的意外后果，并促进有益的变更。