Improving ED Quality and Safety by Enhancing Operations and Quality Management

简介（由申请人提供）：Dr. Khare是美国西北大学急诊医学系的助理教授，并在美国西北大学医疗保健研究所兼职。Dr. Khare的长期目标是成为一名独立的研究者，主要致力于改善就诊于急诊科（ED）的时间敏感型疾病患者的护理。急诊科是一个独特的医疗保健环境，面临着实现高质量护理的重大挑战。急诊科往往人满为患，需要评估许多未分化、时间敏感和复杂疾病的患者，无法安排、预测，也无法有效限制求诊患者的数量和类型。Dr. Khare假设，高质量的急诊科护理和患者的治疗结果包括：(1)高效的操作（例如，将患者到达急诊科的时间保持在最短的时间内）和(2)稳健、标准化的质量管理方法（例如，旨在评估单个医院缺陷的自我指导的质量改进过程）。运营和质量管理的差异可能部分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。本计划的目的是进一步评估机电工程部的具体运作质量管理特征，以确定和实施可推广的过程改进，以提高机电工程部的质量和安全。在这个项目中，Dr. Khare将重点关注ED中的一个关键质量指标评分：急性st段抬高型心肌梗死（STEMI）患者的“经皮介入时间（PCI）”质量指标评分。如果在90分钟内不能实现再灌注或PCI， STEMI患者的死亡率会增加。尽管有大量关于该过程实施的文献，但达到pci质量指标的时间仅为70%。有了这个奖项，Dr. Khare打算获得必要的技能和知识，成为ED质量和患者安全研究的未来国家领导者。为了实现这一目标，他将：(1)通过结合多个大型数据库来评估急诊科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的技能；(2)通过使用失效模式、影响和临界性分析，发展定性研究方法的技能，了解实现pci时间最佳质量分数所需的质量管理特征；(3)开发和实施流程改进，以解决最严重的PCI流程问题；(4)根据第1、2和3条的发现，开发一个工具包，帮助医院和急诊科评估运营改进的机会，并提供一种评估和解决pci时间质量管理问题的方法。

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.