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Improving Emergency Department Management of Adults with Sickle Cell Disease

改善成人镰状细胞病急诊科管理

基本信息

批准号：
8508193
负责人：
Paula Tanabe
金额：
$ 28.69万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8508193
关键词：
Improving Emergency Department Management Adults

项目摘要

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.

项目总结/摘要本研究在质量改进项目的实施与变革过程中，成人镰状细胞病（SCD）的急诊科（艾德）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、风险和弱点使用急诊科镰状细胞评估所涉及的系统和过程中的（故障）需求和优势（ED-SCANS），（一个决策支持工具，旨在提高护理质量，成人SCD）。将确定每个故障的根本原因，然后重新设计。的目标，建议的项目是（1）进行积极的风险评估，故障模式影响和危害性分析（FMECA）的工作流程和业务系统和过程中涉及的四个关键决策， EDSCANS关于SCD患者的评估和管理，通过在两个学术医疗中心检查四个关键ED-SCANS决定;（2）制定和实施（3）为ED-SCANS的四个决定中的每一个决定制定标准化的流程和干预措施; 通过以下方式对每个现场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质量改进措施的影响;（4）开发工具箱，传播和实施有效的系统和程序，以支持在以下方面使用ED-SCANS：其他低资源美国医院的急诊室。两个中心将组成质量改进小组，干预措施旨在分配正确的分诊评分，改善快速、积极的镇痛管理，识别严重疾病高风险患者或频繁接受艾德治疗或住院治疗的患者，并在艾德就诊期间确定成人SCD患者的医疗和心理社会转诊需求。计划，做，研究、行动、快速周期质量改进过程将用于快速评估干预措施的影响并允许对干预措施进行修改。正式的项目评估将使用混合方法进行评估该计划的影响。临床医生将参加半- 每年两次进行年度调查，以评估方案执行的成功情况，在项目结束时在每个地点进行，以评估项目是否成功。结构化病历将进行审查和病人访谈，以衡量干预措施对病人结果的影响。一将开发一套协议、教育工具和其他材料，以帮助向其他急诊室。