Improving Emergency Department Management of Adults with Sickle Cell Disease

改善成人镰状细胞病急诊科管理

• 批准号: 8152067
• 负责人: Paula Tanabe
• 金额: $ 28.95万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8152067
• 关键词: Improving; Emergency; Department; Management; Adults

DESCRIPTION (provided by applicant): This researching implementation and change while improving quality project will re-design the process of emergency department (ED) management for adults with sickle cell disease (SCD). The project will use the Failure Modes, Effects, and Criticality Analysis (FMECA) -- to identify the vulnerabilities, risks, and weak points (failures) in the systems and processes involved in using the Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), (a decision support tool developed to improve the quality of care for adults with SCD). The root causes of each failure will be identified, then re-designed. The aims for the proposed project are to (1) Conduct a proactive risk assessment, Failure Modes Effects and Criticality Analysis (FMECA) of the workflow and operational systems and processes involved in four key decisions of the EDSCANS regarding evaluation and management of SCD patients by; applying a FMECA at two academic medical centers to examine four key ED-SCANS decisions; (2) Develop and implement standardized processes and interventions for each of the four decisions of the ED-SCANS; (3) Conduct a formal program evaluation of the quality improvement implementation at each site by; (3.1) reporting process evaluation measures including implementation success, associated facilitators and barriers of process improvement interventions; and (3.2) reporting preliminary data for selected patient and clinician outcome measures to be effected by the quality improvement interventions; and (4) Develop a toolbox for dissemination and implementation of effective systems and processes to support use of the ED-SCANS in EDs at additional low resource US hospitals. Two centers will form quality improvement teams and design interventions targeted to assign correct triage scores, improve rapid, aggressive analgesic management, identify patients at high risk for severe disease or those with frequent ED management or hospitalizations, and identify medical and psychosocial referral needs for adults with SCD during an ED visit. The plan, do, study, act, rapid cycle quality improvement process will be used to rapidly assess the affect of interventions on study outcomes and allow for modifications in the interventions. A formal program evaluation will be conducted using mixed methods to evaluate the affect of the program. Clinicians will participate in semi-annual surveys to evaluate success of program implementation bi-annually, and two focus groups will be conducted at each site toward the end of the project to evaluate program success. Structured medical record review and patient interviews will be conducted to measure the affect of interventions on patient outcomes. A toolbox of protocols, educational tools, and other materials will be developed to help disseminate to other emergency departments. PUBLIC HEALTH RELEVANCE: Sickle cell disease (SCD) is a chronic disease with significant morbidity and mortality as reflected by the median age of death; 42 for males, and 48 for females. Persons with SCD often require care in an emergency department and this experience is often frustrating for both the patient and emergency department (ED) clinician. The proposed project will apply an investigator developed, NIH supported, emergency department decision support tool, to guide a formal quality improvement process at two emergency departments, and re- design the process of ED care.

描述(由申请人提供)：这项研究、实施和改变，同时提高质量，将重新设计成人镰状细胞病(SCD)急诊科(ED)管理流程。该项目将使用故障模式、影响和危害性分析(FMECA)--在使用急诊部镰刀细胞需求和优势评估(ED-SCANS)(为提高成人SCD护理质量而开发的决策支持工具)所涉及的系统和流程中识别脆弱性、风险和薄弱环节(故障)。将找出每个失败的根本原因，然后重新设计。拟议项目的目标是(1)通过以下方式对EDSCANS关于SCD患者评估和管理的四项关键决策中涉及的工作流程和操作系统和过程进行积极的风险评估、故障模式影响和危害性分析(FMECA)；在两个学术医学中心应用FMECA以审查四项关键的电子扫描决策；(2)为电子扫描的四项决策中的每一项制定和实施标准化流程和干预措施；(3)通过以下方式对每个地点的质量改进实施情况进行正式计划评估；(3.1)报告流程评估措施，包括实施成功、相关的促进者和流程改进干预措施的障碍；以及(3.2)报告将受质量改进干预措施影响的选定患者和临床医生结果措施的初步数据；以及(4)开发一个工具箱，用于传播和实施有效的系统和流程，以支持在其他低资源的美国医院的急诊科使用电子扫描。两个中心将组成质量改进团队并设计有针对性的干预措施，以分配正确的分诊评分，改进快速、积极的止痛药管理，识别严重疾病的高风险患者或频繁进行急诊管理或住院的患者，并在急诊期间确定患有SCD的成年人的医疗和心理社会转诊需求。计划、执行、研究、行动、快速循环质量改进过程将用于快速评估干预措施对研究结果的影响，并允许对干预措施进行修改。将使用混合方法进行正式的计划评估，以评估计划的影响。临床医生将参加半年一次的调查，每两年评估一次计划实施的成功，并在项目结束时在每个地点进行两个焦点小组，以评估计划的成功。将进行结构化的病历审查和患者访谈，以衡量干预措施对患者结局的影响。将开发一个工具箱，其中包括礼仪、教育工具和其他材料，以帮助向其他急救部门传播。 公共卫生相关性：镰状细胞病(SCD)是一种慢性疾病，发病率和死亡率显著，由死亡年龄中位数反映；男性为42岁，女性为48岁。SCD患者通常需要在急诊科接受治疗，这一经历对患者和急诊科(ED)临床医生来说通常都是令人沮丧的。拟议的项目将应用一个由NIH支持的调查员开发的急诊科决策支持工具，以指导两个急诊科的正式质量改进过程，并重新设计急诊护理的过程。