Improving Cancer Care Patient Safety through Pathology Training Simulation

描述(由申请人提供)：诊断测试中不受控制的实践可变性导致了高错误率和成本飞涨。在肿瘤病理学诊断检测领域，超过70%的患者诊断检测样本存在缺陷，一个错误影响了美国每年160万被诊断为癌症的患者中超过23万人的管理。这一错误频率在过去几十年中一直保持不变。我们相信，基于模拟的医学教育(SBME)与精益质量改进方法相结合，通过从根本上改变导致不安全做法的潜在文化和流程，有可能改善癌症诊断护理。在过去的一年里，我们在科罗拉多丹佛大学(UCD)发起了一个基于解剖病理学教育的模拟实验室(PSL)的开发。将模拟培训纳入病理住院医师教育提供了几个潜在的好处：降低患者风险，消除实践的变异性，刻意实践，在离线环境中发展复杂的技能集，以渐进的责任密切监测实践，在模拟失败的环境中实践，以及在大量病例中实践，包括特别容易出错的罕见和具有挑战性的患者样本。我们假设解剖病理学精益-SBME将取代无效和过时的培训模式，并产生高技能、更少错误、专注于团队和在质量改进方面接受培训的病理学家。我们将进行一项单机构、双队列病例对照研究，将大学医院解剖病理轮换的住院医生分成两组：1)整合的Lean-SBME途径和2)传统的学徒制途径。我们将比较：1)住院医生的表现结果和2)肿瘤病理学患者在三年时间间隔内的两个区域的安全结果。我们假设，与解剖病理学传统的实习医生相比，精益-SBME实习医生将表现出更高的能力水平，通过标准化和验证的评估工具进行衡量，并且整个实施后实验室将犯更少的错误，通过标准化的质量保证工具衡量。因此，有癌症或癌症可疑体征和症状的患者将获得更安全的医疗保健，并将由于诊断测试服务的改善而改善结果。 公共卫生相关性：这项研究的公共卫生相关性主要在于科罗拉多大学医院(UCH)是该地区主要的“安全港”医院之一；服务人口中14%的家庭低于贫困水平，30%的家庭在家中不会说英语，30%-40%的家庭不是白人。我们的目标是改善这一人群的护理质量和患者安全。

DESCRIPTION (provided by applicant): Uncontrolled practice variability in diagnostic testing has contributed to high rates of error and skyrocketing costs. In the field of oncologic pathology diagnostic testing, more than 70% of patient diagnostic testing samples are defective and an error affects the management of more than 230,000 of the 1.6 million patients diagnosed with cancer annually in the United States. This error frequency has remained unchanged over the last several decades. We believe that simulation based medical education (SBME) combined with Lean methods of quality improvement has the potential to improve cancer diagnostic care by fundamentally changing the underlying culture and processes that contribute to unsafe practices. Within the past year, we initiated the development of an anatomic pathology education-based simulation laboratory (PSL) at the University of Colorado Denver (UCD). The incorporation of simulation training in pathology residency education offers several potential benefits: reduction of patient risk, elimination of practice variability, deliberate practice, development of complex skill sets in an off-line environment, close monitoring of practice with graduated responsibility, practice in environments with simulated failure, and practice with high case volume that include rare and challenging patient specimens specifically prone to error. We hypothesize that anatomic pathology Lean-SBME will replace ineffective and outdated models of training and produce pathologists who are highly skilled, make fewer errors, team-focused and trained in quality improvement. We will perform a single institution, double cohort case-control study by separating residents on the University Hospital anatomic pathology rotation into two groups: 1) an integrated Lean-SBME tract and 2) a traditional apprenticeship tract. We will compare: 1) resident performance outcomes and 2) oncologic pathology patient safety outcomes for the two tracts over a three year interval. We hypothesize that compared to anatomic pathology traditional apprenticeship residents, Lean-SBME residents will perform at higher levels of competence, measured through standardized and validated assessment tools, and the entire post-implementation laboratory will makes fewer errors, measured by standardized quality assurance tools. As a result, patients who have cancer or signs and symptoms suspicious for cancer will receive safer healthcare and will have improved outcomes as a result of improved diagnostic testing services. PUBLIC HEALTH RELEVANCE: The public health relevance of this study primarily lies in the fact that the University of Colorado Hospitals (UCH) serves as one of the major "safe harbor" hospitals in the area; the service population is comprised of 14% of families below poverty level, 30% who do not speak English at home, and 30-40% who are not white. Our goal is to improve the quality of care and patient safety in this population.