Improving Cancer Care Patient Safety through Pathology Training Simulation

项目摘要/摘要 诊断测试中不受控制的实践可变性导致了高错误率和暴涨 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160万名患者中超过23万人的管理 在美国，每年都会被诊断出患有癌症。该错误频率在过去几年中保持不变 持续了几十年。我们认为，基于模拟的医学教育(SBME)与精益管理相结合 质量改进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。在过去一年中，我们 发起建立以解剖病理学教育为基础的模拟实验室(PSL) 科罗拉多大学丹佛分校。模拟训练在病理科实习中的应用 教育提供了几个潜在的好处：降低患者风险，消除实践的可变性， 实践，在离线环境中开发复杂的技能集，密切监控实践 分级负责，在模拟失败的环境中实践，在大案例量中实践 这包括特别容易出错的罕见和具有挑战性的患者样本。我们假设解剖学上的 病理精益-SBME将取代无效和过时的培训模式，并培养出 技能高，错误少，专注于团队，接受过质量改进方面的培训。我们将表演一场 大学医院居民分离的单机构、双队列病例对照研究 病理旋转分为两组：1)综合Lean-SBME途径和2)传统学徒制途径。 我们将比较：1)住院医生的表现结果和2)肿瘤病理患者的安全结果 这两个地区相隔三年。我们假设与传统的解剖病理学相比 学徒制住院医生，精益-SBME住院医生将表现出更高的能力水平，通过 标准化和经验证的评估工具，整个实施后实验室将减少 误差，由标准化的质量保证工具测量。因此，患有癌症或体征的患者 疑似癌症的症状将得到更安全的医疗保健，并将因 改进诊断检测服务。

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 We hypothesize that anatomic pathology Lean-SBME will replace ineffective and outdated models of training and produce pathologists who are highly skilled, make fewer errors, team-focused and trained in quality improvement.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