Improving Cancer Care Patient Safety through Pathology Training Simulation

项目概要/摘要 诊断测试中不受控制的实践变异性导致了高错误率和飙升 成本在肿瘤病理诊断检测领域，70%以上的患者诊断检测 样本有缺陷，一个错误影响了160万患者中23万多人的管理 在美国每年有100人被诊断出患有癌症。这一错误频率在过去一年中保持不变。 过去几十年。我们相信，基于模拟的医学教育（SBME）结合精益 质量改进的方法有可能从根本上改善癌症诊断护理， 改变导致不安全做法的基本文化和流程。过去一年里，我们 发起了解剖病理学教育为基础的模拟实验室（PSL）的发展， 科罗拉多丹佛大学（UCD）。模拟训练在病理学住院医师培训中的应用 教育提供了几个潜在的好处：降低病人的风险，消除实践的变化，故意 实践，在离线环境中开发复杂的技能集，密切监测实践， 分级责任制，在模拟故障的环境中进行实践，并在高病例量下进行实践 其中包括罕见且具有挑战性的患者样本，特别容易出错。我们假设解剖学 病理学精益SBME将取代无效和过时的培训模式，并培养病理学家， 技能高超，错误较少，注重团队精神，并接受过质量改进方面的培训。我们将执行一个 通过对大学医院解剖学住院医师进行分离的单机构、双队列病例对照研究 病理旋转分为两组：1）集成的精益SBME道和2）传统的学徒道。 我们将比较：1）住院医师性能结局和2）肿瘤病理学患者安全性结局， 这两部电影相隔三年。我们假设，与传统的解剖病理学相比， 学徒居民，精益SBME居民将表现出更高的能力水平，通过 标准化和有效的评估工具，整个实施后实验室将使更少的 错误，由标准化的质量保证工具衡量。因此，患有癌症或症状的患者， 可疑的癌症症状将得到更安全的医疗保健，并将改善结果， 改善诊断测试服务。

Project Summary/Abstract 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 We hypothesize that anatomic pathology Lean-SBME will replace ineffective and outdated models of training and produce pathologists who are highly skilled, make fewer errors, team-focused and trained in quality improvement.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.