Mentored Implementation of I-PASS for Better Handoffs and Safer Care

描述(由申请人提供)：在医院中，三分之二最严重的可预防的不良事件是由沟通故障造成的。因此，改善通信质量，特别是“移交”，一直是医疗保健研究和质量机构(AHRQ)和联合委员会的主要患者安全目标。然而，直到最近，还缺乏高质量的数据来证明改进移交工作的有效性。我们在波士顿儿童医院进行了一个试点项目，在该项目中，我们发现，实施一系列旨在改善移交的培训和流程更改干预措施与减少移交错误、改善住院医生工作流程(减少使用计算机的时间，更多地直接护理患者)相关，最重要的是显著减少严重医疗错误。在卫生与公众服务部(R18 AE000029)的资助下，我们将这一捆绑包改进和扩展为I-PASS计划，其中包括多模式交付团队合作和移交培训(部分基于AHRQ和国防部的TEAMSTEPPS计划)、移交模拟培训练习、引入言语助记、口头移交过程的变化(包括团队工作流程和环境变化)、印刷移交工具、教师发展材料和文化变革运动。在一项由9个中心组成的研究中，我们发现，在实施跨站点I-PASS后，伤害患者的差错(可预防的不良事件)下降了34%，差错/无害的医疗差错下降了26%。由于移交问题仍然是医院发病率和死亡率的主要来源，我们相信I-PASS的传播和实施可能会对患者的安全产生重要影响。医院医学会开发了一套可靠的方法，即指导实施，已被用于向全国各地的医院广泛传播许多患者安全和质量干预措施；国家质量论坛和联合委员会将指导实施计划授予2011年约翰·M·艾森伯格患者安全和质量创新奖，以表彰其在有效传播安全和质量护理干预措施方面取得的巨大成功。我们建议与医院医学会(SHM)和住院环境中的儿科研究(PRIS)网络合作，采用SHM的指导实施方法来适应和实施I-PASS。我们的具体目标将是：1)为实施和传播I-PASS通过医院医学会的指导实施计划制定一个强有力的程序；2)在32家教学医院有效地实施I-PASS指导实施计划；以及3)建立一个工具包，通过住院设置中的儿科研究网络、医院医学会和其他机构促进I-PASS的广泛传播。

DESCRIPTION (provided by applicant): Communication failures contribute to two thirds of the most serious preventable adverse events in hospitals. Improving the quality of communication, especially "handoffs," has consequently been a leading patient safety goal of the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission. Until recently, however, high-quality data demonstrating the effectiveness of handoff improvement efforts were lacking. We conducted a pilot project at Boston Children's Hospital in which we found that implementation of a bundle of training and process change interventions designed to improve handoffs was associated with reductions in handoff miscommunications, improvements in resident-physician workflow (less time at the computer, more time in direct patient care), and most importantly, a significant reduction in serious medical errors. With funding from the Department of Health and Human Services (R18 AE000029), we refined and expanded this bundle as the I-PASS program, which includes multi-modal delivery of teamwork and handoff training (built in part on AHRQ's and the Department of Defense's TeamSTEPPS program), handoff simulation training exercises, introduction of a verbal mnemonic, changes to the verbal handoff process (including teamwork process and environment changes), a printed handoff tool, faculty development materials, and a culture change campaign. In a 9-center study, we have found that following implementation of I-PASS across sites, errors that harmed patients (preventable adverse events) fell 34%, and near misses / non-harmful medical errors fell 26%. As handoff problems continue to be a major source of morbidity and mortality in hospitals, we believe that dissemination and implementation of I-PASS could have an important impact on patient safety. The Society of Hospital Medicine has developed a robust methodology, Mentored Implementation, which has been used to broadly disseminate numerous patient safety and quality interventions to hospitals nationwide; the National Quality Forum and the Joint Commission awarded the Mentored Implementation program the 2011 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality at the National Level, in recognition of its tremendous successes effectively disseminating safety and quality of care interventions. We propose to adapt and implement I-PASS in collaboration with the Society of Hospital Medicine (SHM) and the Pediatric Research in Inpatient Settings (PRIS) network, employing SHM's Mentored Implementation methodology. Our specific aims will be: 1) To develop a robust process for implementing and disseminating I- PASS through the Society for Hospital Medicine's Mentored Implementation Program; 2) To effectively enact the I-PASS Mentored Implementation Program in 32 teaching hospitals; and 3) To build a toolkit to promote widespread dissemination of I-PASS through the Pediatric Research in Inpatient Settings Network, the Society for Hospital Medicine, and beyond.