Providing Safe Care to Older Hospitalized Patients through Discrete Event Simulation Modeling

通过离散事件模拟建模为老年住院患者提供安全护理

• 批准号: 10192697
• 负责人: SANDRA F SIMMONS
• 金额: $ 38.99万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192697
• 关键词: Providing; Safe; Care; Older; Hospitalized

Project Summary Many hospital patients, particularly older patients, are dependent on staff for assistance with activities of daily living (ADL) such as walking and toileting. Assistance with these activities is time-consuming for staff, and evidence suggests that ADL assistance is not consistently provided in hospitals. This inconsistent ADL care is often associated with adverse events, particularly falls, with 30-60% of hospital falls related to patients’ attempts to use the bathroom. There is evidence that consistent toileting and mobility assistance can prevent falls, but barriers related to staffing and the complex hospital work environment make it difficult to provide this care consistently in daily acute care practice. The National Academy of Medicine has identified a systems-engineering approach called Discrete Event Simulation (DES) as a method to improve the quality and efficiency of health care. This approach has been used for decades in other industries and more recently applied to healthcare settings. Discrete Event Simulation mathematically models multiple work parameters that define a care setting, such as the time to provide an episode of care, and predicts the ability of staff within that setting to provide care at different points in time based on other competing demands and care requirements. Sensitivity and predictive analyses can be used to examine how changes to the system, such as different staff schedules or order of care routines, affect and improve care delivery thus facilitating more efficient management. This investigative team has applied DES to the nursing home setting to identify staffing needs to provide care based on a range of resident ADL dependencies and staffing resources. However, this DES methodology has not been applied to the acute care setting, where many older patients need similar ADL care services and also are at risk for falls. Thus, the purpose of the proposed study is to apply DES to the hospital setting focused on units that care for large numbers of older patients with ADL dependencies. This study will produce a novel technology that hospital providers may use to efficiently manage medical units by experimenting with innovative approaches to improve ADL care prior to more expensive efforts to implement and test interventions in actual practice. This technology will be first developed and tested in an Acute Care for the Elderly (ACE) unit. However, the degree to which the model accurately describes care in two other diverse hospital units will be tested in preparation for disseminating the model to other units and hospitals via a web-based simulation tool.

项目摘要 许多医院的病人，特别是老年病人，在活动中依赖工作人员的帮助。 日常生活(ADL)的一部分，如散步和如厕。协助这些活动对工作人员来说是很耗时的， 有证据表明，医院并没有始终如一地提供ADL帮助。此不一致的ADL 护理通常与不良事件有关，特别是跌倒，30%-60%的医院跌倒与患者的 试图用洗手间。有证据表明，持续的如厕和行动辅助可以防止 瀑布，但与人员配备有关的障碍和复杂的医院工作环境使其难以提供 在日常急诊护理实践中始终如一地进行护理。 美国国家医学科学院已经确定了一种名为离散的系统工程方法 事件模拟(DES)作为一种提高医疗质量和效率的方法。这种方法具有 在其他行业使用了几十年，最近应用于医疗保健设置。离散事件 模拟对定义护理环境的多个工作参数进行数学建模，例如 提供一集护理，并预测在该环境中的工作人员在不同时间点提供护理的能力 根据其他相互竞争的需求和护理要求及时提供服务。敏感度和预测性分析 用于检查对系统的更改，如不同的员工时间表或护理程序顺序，如何影响 并改善护理提供，从而促进更有效的管理。 该调查小组已将DES应用到疗养院环境中，以确定人员需求 提供基于一系列常驻ADL依赖关系和人力资源的护理。然而，这是DES 方法论尚未应用于急性护理环境，在那里许多老年患者需要类似的ADL护理 服务，也有跌倒的风险。因此，拟议研究的目的是将DES应用于医院 环境侧重于照顾大量患有ADL依赖的老年患者的单位。 这项研究将产生一种新的技术，医院提供者可以使用它来有效地管理 医疗单位通过试验创新方法，在更昂贵的情况下改善ADL护理 努力在实际实践中实施和测试干预措施。这项技术将首先进行开发和测试 在一家急性老年护理(ACE)病房。然而，该模型准确描述护理的程度 将在另外两个不同的医院单位进行测试，为向其他单位传播这一模式做准备 医院通过一个基于网络的模拟工具。