Improving ED Quality and Safety by Enhancing Operations and Quality Management

描述(由申请人提供)：哈雷博士是急诊医学系的助理教授，并在西北大学医疗研究所担任二级职位。哈雷博士的长期目标是成为一名独立的调查员，主要专注于改善对急诊科(ED)患有时间敏感型疾病的患者的护理。急诊室是一个独特的医疗环境，在实现高质量的医疗服务方面面临着巨大的挑战。急诊室往往人满为患，评估许多患有未分化、时间敏感和复杂疾病的患者，无法计划、预测或有效限制寻求治疗的患者的数量和类型。哈雷博士假设，高质量的急诊室护理和患者结果包括(1)高效的操作(例如，将患者到达急诊室的时间保持在最低限度)和(2)稳健、标准化的质量管理方法(例如，自我指导的质量改进过程，旨在评估个别医院的不足之处)。运营和质量管理的差异可能在一定程度上解释了为什么类似的医院在质量指标得分和结果上差异如此之大。本项目的目标是进一步评估特定的急救系统运行质量管理特点，以确定和实施可推广的过程改进，以提高急救系统的质量和安全。在该项目中，Khare博士将重点关注急诊室的一个关键质量指标评分：急性ST段抬高心肌梗死(STEMI)患者的“经皮介入治疗时间(PCI)”质量指标评分。STEMI患者如果在90分钟内不能进行再灌注或经皮冠状动脉介入治疗，死亡率会增加。尽管有大量文献介绍了这一过程的实施，但仅有70%的时间达到了介入治疗的质量指标。有了这一奖项，哈雷博士打算获得必要的技能和知识，成为未来急诊质量和患者安全研究的全国领先者。为了实现这一目标，他将：(1)通过合并几个大型数据库来评估急诊介入治疗操作特征与急性心肌梗死死亡率之间的相关性，从而培养定量研究方法方面的技能；(2)通过使用故障模式、影响和危害性分析来发展定性研究方法方面的技能，以了解为达到最佳的介入治疗时间质量分数所必需的质量管理特征；(3)开发和实施过程改进，以解决最严重的介入治疗过程问题；以及(4)根据1、2和3的结果开发一个工具包，它将帮助医院和急救人员评估操作改进的机会，并提供一种评估和解决及时介入治疗的质量管理问题的方法。 公共卫生相关性：这项研究将填补对复杂、高度敏锐和依赖时间的过程的质量和安全性的知识和理解方面的一个重要空白--以有效的方式实现心脏病患者的救命治疗。目前，在正确的时间为正确的患者有效地提供正确的治疗，特别是为心脏病发作的患者提供优质的护理，存在着相当大的压力。为患者提供优质的医疗保健需要在急诊科进行，急诊科的环境往往过于拥挤，需要照顾患有许多复杂疾病的患者。因此，必须严格研究和加强对急诊科运作方式及其质量管理方法的评估，以便为美国人民提供最好的护理。

DESCRIPTION (provided by applicant): Dr. Khare is an Assistant Professor in the Department of Emergency Medicine and has a secondary appointment at the Institute for Healthcare Studies at Northwestern University. Dr. Khare's long-term goal is to become an independent investigator with a primary focus on improving the care for patients coming to the Emergency Department (ED) with time-sensitive diseases. The ED is a unique healthcare setting that faces significant challenges to achieving high quality care. EDs are often overcrowded, evaluate many patients with undifferentiated, time-sensitive, and complicated diseases, and cannot schedule, predict, nor effectively limit the number and types of patients seeking care. Dr. Khare hypothesizes that high quality ED care and patient outcomes involve (1) efficient operations (e.g., keeping the time a patient arrives to the ED to when they see a physician at a minimum) and (2) robust, standardized quality management approaches (e.g., self-directed quality improvement processes, aimed at evaluating an individual hospital's deficiencies). Variation in both operations and quality management may explain, in part, why similar hospitals vary so dramatically on quality indicator scores and outcomes. The objectives of this project are to further evaluate specific ED operational quality management characteristics to identify and implement generalizable process improvements to enhance quality and safety in EDs. For this project, Dr. Khare will focus on one key quality indicator score in the ED: "time-to- percutaneous intervention (PCI)" quality indicator score for acute ST-elevation myocardial infarction (STEMI) patients. Patients with STEMI have increased mortality if reperfusion or PCI is not achieved within 90 minutes. Although there is an extensive literature about implementation of this process, the time-to-PCI quality indicator is achieved only 70% of the time. With this award, Dr. Khare intends to gain the skills and knowledge necessary to become a future national leader in ED quality and patient safety research. To fulfill this goal, he will: (1) develop skills in quantitative research methods by combining several large databases to evaluate the correlation between ED operational characteristics and acute myocardial infarction mortality; (2) develop skills in qualitative research methods through the use of a Failure Mode and Effects and Criticality Analysis, to understand the quality management characteristics necessary to achieve optimal quality scores for time-to-PCI; (3) develop and implement process improvements to address the most serious time-to PCI process concerns; and (4) develop a toolkit, based on the findings of 1, 2, and 3, that will assist hospitals and EDs in assessing opportunities for operational improvement and offer an approach for assessing and resolving quality management issues for time-to-PCI. PUBLIC HEALTH RELEVANCE: This study will fill an important gap in knowledge and understanding of the quality and safety of a complex, high acuity, and time-dependent process - achieving life-saving treatments for patients with heart attacks in an efficient manner. Currently, there is considerable pressure to efficiently provide the right treatment, for the right patient, at the right time, specifically giving excellent care to patients with heart attacks. Giving excellent healthcare to patients needs to be done in the emergency department, an environment that is often overcrowded and takes care of patients with many complicated diseases. Thus, evaluation of the way emergency departments operate and their quality management approaches must be rigorously studied and enhanced to provide the best care to the American people.