Improving Emergency Department Management of Adults with Sickle Cell Disease

项目摘要/摘要 这一研究、实施和改进质量工程的过程将重新设计 成人镰状细胞病(SCD)的急诊科管理。该项目将使用 故障模式、影响和危害性分析(FMECA)--识别漏洞、风险和薄弱环节 (故障)使用急诊部镰刀单元评估所涉及的系统和流程 需求和优势(ED-SCANS)(为提高护理质量而开发的决策支持工具 成人SCD)。将找出每个失败的根本原因，然后重新设计。该计划的目标 建议的项目是：(1)进行前瞻性风险评估、故障模式、影响和危害性 分析(FMECA)四个关键决策中涉及的工作流程和运营系统及流程 关于SCD患者评估和管理的EDSCANS；应用FMECA在2 学术医学中心将审查四项关键的电子扫描决定；(2)制定和实施 电子扫描的四项决定的标准化程序和干预措施；(3)开展 通过以下方式对每个现场的质量改进实施进行正式计划评估；(3.1)报告过程 评价措施，包括执行成功、相关的促进者和进程障碍 改善干预措施；以及(3.2)报告选定患者和临床医生结果的初步数据 将由质量改进干预措施实施的措施；以及(4)开发工具箱 传播和实施有效的系统和程序，以支持电子扫描在#年的使用 EDS在额外的低资源美国医院。两个中心将组成质量改进团队和设计 有针对性的干预措施是分配正确的分诊评分，改善快速、积极的止痛管理， 确定患有严重疾病的高风险患者或那些经常接受急诊治疗或住院的患者， 并在急诊期间确定成年SCD患者的医疗和心理社会转诊需求。计划，做， 将使用研究、行动、快速循环质量改进过程来快速评估干预措施的效果 关于研究结果，并允许对干预措施进行修改。正式的计划评估将是 采用混合方法对项目实施效果进行评价。临床医生将参加半决赛 每两年进行一次年度调查，以评估方案执行的成功情况，两个重点小组将是 在项目接近尾声时在每个地点进行，以评估计划的成功。结构化病历 将进行回顾和患者访谈，以衡量干预措施对患者结局的影响。一个 将开发礼仪工具箱、教育工具和其他材料，以帮助向其他人传播 急诊科。

Project Summary/Abstract 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.