Improving the Safety of Care Transitions for Cardiac Surgery Patients

描述(由申请人提供)：这项拟议的职业发展奖的目的是支持人为因素工程师Ayse P.Gurses博士建立一个研究计划，寻求在护理和移交过渡期间改善患者的安全。这一奖项将促进Gurses博士在成果研究、先进研究方法和先进统计方法领域获得更多技能和能力，这些都是实现她的职业目标所必需的。此外，该奖项将为古尔塞斯博士提供机会，让他获得顶尖研究人员的指导，这些研究人员在指导研究科学家方面也有很好的记录。约翰霍普金斯大学为拟议的工作提供了理想的环境，特别是因为有强大的医学院和公共卫生学院，以及对患者安全研究的强烈关注。医学的日益专业化，加上有限的资源，导致了护理过渡的数量增加。不幸的是，如果不进行有效管理，护理过渡可能会对患者的安全构成重大风险，并导致不良的临床和财务结果。Gurses博士的长期目标是开发一个可以在国内和国际上实施的护理过渡改进计划，以提高患者的安全。这项拟议研究的总体目标是确定心脏手术后患者在护理过渡过程中的潜在风险，并开发降低这些风险的方法和工具。我们将重点关注心脏手术患者，因为他们的疾病复杂和严重，他们需要在多个环境下接受不同医生的医疗护理。我们将重点介绍两个护理过程：药物信息管理和病历交互。为了实现总体研究目标，我们将首先确定在以下过渡过程中威胁心脏手术后患者安全的危险(任何可能导致失败的危险)：(A)医院不同单元之间的过渡；(B)从医院到家庭和门诊诊所的过渡。我们将使用前瞻性和追溯性危险识别方法。然后，我们将使用医疗保健失败模式和影响分析(HFMEA)对已识别的危险进行前瞻性风险评估。我们将为每个护理流程(例如，药物信息管理)进行单独的HFMEA；在每个护理过渡点(例如，从ICU转移到普通楼层)。最后，我们将开发一种新颖的、风险分析知情的干预捆绑，并初步测试其对心脏手术后患者和护理提供者过渡护理的安全性的影响。无效和糟糕的护理过渡是对患者安全的主要威胁。对于接受心脏手术的患者尤其如此，因为他们的疾病复杂和严重，他们需要在多个环境中接受不同从业者的医疗护理。在这项研究中，我们将确定导致心脏手术后患者护理过渡不佳和不安全护理的因素。然后，我们将开发和试点测试工具和战略，以改善心脏手术后患者的护理过渡和安全性。这些工具和策略可能在未来用于提高其他患者群体的护理过渡的安全性。

DESCRIPTION (provided by applicant): The purpose of this proposed career development award is to support Dr. Ayse P. Gurses, a human factors engineer, in establishing a research program that seeks to improve patient safety during transitions of care and handoffs. This award will facilitate Dr. Gurses's acquisition of additional skills and competencies in the areas of outcomes research, advanced research methods, and advanced statistical methods that are necessary for accomplishing her career goals. Moreover, the award will provide Dr. Gurses the opportunity to get mentoring from leading researchers who also have a strong track record of mentoring research scientists. The Johns Hopkins University offers an ideal environment for the proposed work, particularly because of the strong Schools of Medicine and Public Health and the strong focus on patient safety research. Increasing specialization in medicine, coupled with limited resources, has led to an increase in the number of care transitions. Unfortunately, care transitions can pose significant risks to patient safety and result in poor clinical and financial outcomes if not managed effectively. Dr. Gurses's long-term goal is to develop a care transitions improvement program that can be implemented nationally and internationally to improve patient safety. The overall objective of the proposed study is to identify the potential risks for post-operative cardiac surgery patients' safety in care transitions, and to develop methods and tools to reduce these risks. We will focus on cardiac surgery patients because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. We will focus on two processes of care: medication information management and the medical record interactions. To accomplish the overall study objective, we will first identify hazards (anything that has the potential to cause failure) that threaten post-operative cardiac surgery patients' safety in transitions of care (a) between different units in a hospital; (b) from hospital to home and to outpatient clinics. We will use both prospective and retrospective hazard identification methods. We will then conduct a prospective risk assessment of the identified hazards using the Health Care Failures Modes and Effects Analysis (HFMEA). We will conduct a separate HFMEA for each care process (e.g., medication information management); at each point of care transition (e.g., transfer from ICU to general floor). Finally, we will develop a novel; risk-analysis-informed intervention bundle and pilot test its impact on the safety of care transitions for post-operative cardiac surgery patients and on the care providers. Ineffective and poor transitions of care are a major threat to patient safety. This is especially true for patients who had cardiac surgery because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. In this study, we will identify the factors that lead to poor care transitions and unsafe care for post-operative cardiac surgery patients. We will then develop and pilot test tools and strategies to improve care transitions and the safety of post-operative cardiac surgery patients. These tools and strategies can potentially be used to improve the safety of care transitions for other patient populations in the future.