Bundling Effective Resident Hand Off Practices to Improve Patient Safety

描述（由申请人提供）：医疗保健研究和质量机构和医学研究所呼吁采用改进的切换工具和流程，以解决医院中有害通信故障的高发生率。比较有效性研究（CER）已经确定了提高交接质量和患者安全的实践，但在医疗中心采用这些基于CER的实践一直很慢。在波士顿儿童医院最近完成的一项试点研究中，我们发现，引入住院医师汉密顿捆绑（RHB）迅速被住院医师采用，并与检测到的医疗错误减少43%相关。我们现在寻求在八个主要的儿科住院医师项目中实施RHB。RHB包括三个主要要素：1）TeamSTEPPS培训，这是由AHRQ和国防部开发的基于证据的团队合作，领导力和沟通培训计划; 2）引入标准化的口头协议和助记符，这与提高交接质量和减少医疗错误有关;以及3）引入标准化的书面/计算机化的移交工具，这已经被证明可以改善切换质量并且与降低的不良事件发生率相关联。我们将应用我们在先前研究中使用的最先进的前瞻性安全性监测方法、直接观察和时间运动分析，以评估RHB的有效性。此外，我们还将寻求确定RHB的采用和影响通过以下因素进行修改的方式：a）医院层面的因素，包括存在强大的计算机系统和主治医生对签出的监督;和B）患者层面的因素，特别是存在传达功能限制或残疾的慢性疾病（优先条件）。为了协助在整个PRIS网络，IIPE，和超越传播，我们将开发一个工具包，将提供我们的研究结果的摘要，并将描述一个成功的切换程序的基本组成部分。我们假设，通过将基于CER的交接干预措施捆绑在一起，并通过研究和教育网络传播，我们将加速采用基于证据的交接实践，最终将导致医疗错误，口头和书面错误沟通的显着减少，并提高全国医院的医生满意度和工作流程。 公共卫生相关性：采用行之有效的沟通策略已被证明可以降低医院中错误沟通的风险，并提高患者安全。我们建议研究的影响，实施居民汉密顿捆绑（RHB），将包括居民的团队合作培训，口头移交策略，并在八个主要的医疗中心的书面或计算机化的移交工具。我们将严格衡量RHB对患者安全和护理流程的影响，并将研究医院因素（例如，复杂的计算机系统的存在）和患者因素（例如，复杂的慢性疾病的存在）如何影响跨站点的采用。

DESCRIPTION (provided by applicant): The Agency for Healthcare Research and Quality and the Institute of Medicine have called for the adoption of improved handoff tools and processes to address the high incidence of harmful communication failures in hospitals. Comparative effectiveness research (CER) has identified practices that improve handoff quality and patient safety, but adoption of these CER-based practices across medical centers has been slow. In a pilot study recently completed at Children's Hospital Boston, we found that introduction of a Resident Handoff Bundle (RHB) was rapidly adopted by residents and was associated with a 43% reduction in detected medical errors. We now seek to implement the RHB in eight major pediatric residency programs. The RHB includes three major elements:1) TeamSTEPPS training, an evidence-based teamwork, leadership, and communications training program developed by AHRQ and the Department of Defense; 2) Introduction of standardized verbal protocols and mnemonics, which have been associated with improved handoff quality and reduce medical errors; and 3) Introduction of standardized written/computerized handoff tools, which have been shown to improve handoff quality and have been associated with reduced rates of adverse events. We will apply intensive state-of-the-art prospective safety surveillance methodologies, direct observation, and time motion analysis, each of which we have used in prior studies, to assess the effectiveness of the RHB. We will additionally seek to determine the manner in which the RHB's adoption and impact is modified by a) hospital-level factors, including the presence of a robust computer system and attending physician supervision of sign-out; and b) patient-level factors, especially the presence of a chronic disease that conveys functional limitations or disability, a priority condition. To assist with dissemination throughout the PRIS network, the IIPE, and beyond, we will develop a toolkit that will provide a summary of our findings and will describe the fundamental building blocks of a successful handoff program. We hypothesize that by bundling CER-based handoff interventions together and disseminating them through a research and education network, we will accelerate adoption of evidence based handoff practices which will ultimately result in significant reductions in medical errors, verbal and written miscommunications, and improved physician satisfaction and workflow in hospitals nationwide. PUBLIC HEALTH RELEVANCE: Adoption of proven communication strategies has been shown to decrease the risk of miscommunications in hospitals and improve patient safety. We propose to study the effect of implementing a Resident Handoff Bundle (RHB) that will include teamwork training for residents, verbal handoff strategies, and a written or computerized handoff tool in eight major medical centers. We will rigorously measure the effects of the RHB on patient safety and care processes, and will study how hospital factors (e.g. presence of sophisticated computer systems) and patient factors (e.g. presence of a complex chronic disease) affect adoption across sites.