Improving Emergency Department Management of Adults with Sickle Cell Disease

描述（由申请人提供）：本研究的实施和变化，同时提高质量项目将重新设计急诊科（艾德）管理的过程中，成人镰状细胞病（SCD）。该项目将使用故障模式、影响和危害性分析（FMECA）--以确定使用急诊科镰状细胞需求和优势评估（ED-SCANS）（一种为提高成人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的漏洞、风险和弱点（故障）。将确定每个故障的根本原因，然后重新设计。拟议项目的目的是：（1）对EDSCANS关于SCD患者评估和管理的四个关键决策中涉及的工作流程和操作系统及流程进行主动风险评估、故障模式、影响和危害性分析（FMECA）;在两个学术医疗中心应用FMECA，以检查ED-SCANS的四个关键决策;（2）为ED-SCANS的四个决定中的每一个制定和实施标准化的流程和干预措施;（3）通过以下方式对每个站点的质量改进实施情况进行正式的项目评估：（3.1）报告过程评估措施，包括实施成功、相关促进因素和过程改进干预措施的障碍;和（3.2）报告质量改进干预措施影响的选定患者和临床医生结局指标的初步数据;和（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美国医院的急诊科使用ED-SCANS。两个中心将组成质量改进小组，并设计干预措施，以分配正确的分诊评分，改善快速，积极的镇痛管理，识别严重疾病的高风险患者或频繁艾德管理或住院的患者，并确定成人SCD患者在艾德访视期间的医疗和心理社会转诊需求。计划、执行、研究、行动、快速周期质量改进流程将用于快速评估干预措施对研究结局的影响，并允许对干预措施进行修改。将使用混合方法进行正式的项目评估，以评估项目的影响。临床医生将参加每半年一次的调查，以评估项目实施的成功，每半年一次，两个焦点小组将在项目结束时在每个地点进行，以评估项目的成功。将进行结构化病历审查和患者访谈，以衡量干预措施对患者结局的影响。将开发一个协议、教育工具和其他材料的工具箱，以帮助向其他紧急部门传播。 公共卫生相关性：镰状细胞病（SCD）是一种慢性疾病，具有显著的发病率和死亡率，如死亡中位年龄所反映的;男性为42岁，女性为48岁。患有SCD的人通常需要在急诊科进行护理，并且这种经历通常使患者和急诊科（艾德）临床医生都感到沮丧。拟议的项目将应用一个研究者开发的、国家卫生研究院支持的急诊科决策支持工具，指导两个急诊科的正式质量改进过程，并重新设计艾德护理过程。

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.