Pediatric patient safety learning laboratory to re-engineer continuous physiologic monitoring systems

项目概要/摘要 该提案的主要目标是在以下地点建立儿科患者安全学习实验室（PSLL）： 费城儿童医院（CHOP）CHOP PSLL研究人员以跨学科的方式工作， 将合作应用创新的科学方法，整合各自的学科，以实现 分析和重新设计医院和家庭生理监测系统， 信息量目前用于在医院病房和家中连续监测儿童生命体征的系统 设置生成警报，旨在警告护理人员-医院的护士和家中的父母- 需要立即注意的情况。然而，这两种系统都存在信息量低的问题， 从而造成患者安全风险，例如与重大疾病检测、诊断和 治疗这个PSLL汇集了CHOP，宾夕法尼亚大学和ECRI研究所的专业知识 在不同的领域，包括病人安全，儿科医院医学，儿科学，护理，系统 工程学，人为因素，设计，医疗器械开发，电子健康记录临床决策 支持，认知信息学，模拟和生物统计学。该项目的具体目标是（1）重新设计 监测急性护理病房住院儿童的系统，重点是减少非信息性 警报和加速护士对关键事件的反应，以及（2）重新设计监测系统 家中患有支气管肺发育不良的婴儿，重点是减少无信息的低氧血症警报 并改善临床医生对可用的纵向脉搏血氧测定数据的访问， 治疗每个目标将通过问题分析，设计，开发， 执行和评价。这个项目将使用一个基于系统工程倡议的框架 患者安全（SEIPS）模型和双重过程理论，并将采用创新的方法，如法医 事故调查、视频报警分析和现场模拟，对监控系统进行分析和评估。 最终产品将是重新设计的系统，用于医院和家庭的生理监测， 可持续儿科患者安全学习实验室在全国顶级儿童医院之一。

PROJECT SUMMARY/ABSTRACT The broad objective of this proposal is to establish a pediatric Patient Safety Learning Laboratory (PSLL) at Children’s Hospital of Philadelphia (CHOP). Working in a transdisciplinary fashion, CHOP PSLL investigators will collaboratively apply innovative scientific approaches that integrate their respective disciplines to achieve the goal of analyzing and re-engineering hospital and home physiologic monitoring systems to maximize alarm informativeness. Current systems used to continuously monitor children’s vital signs in hospital ward and home settings generate alarms intended to warn caretakers— nurses in the hospital and parents at home— of conditions that warrant their immediate attention. However, both systems suffer from low informativeness and thus pose patient safety risks such as alarm fatigue that are relevant to critical illness detection, diagnosis, and treatment. This PSLL brings together expertise from CHOP, University of Pennsylvania, and the ECRI Institute in diverse areas including patient safety, pediatric hospital medicine, neonatology, nursing, systems engineering, human factors, design, medical device development, electronic health record clinical decision support, cognitive informatics, simulation, and biostatistics. The project’s Specific Aims are (1) Re-engineer the system of monitoring hospitalized children on acute care wards, with a focus on reducing non-informative alarms and accelerating nurse responses to critical events, and (2) Re-engineer the system of monitoring infants with bronchopulmonary dysplasia at home, with a focus on reducing non-informative hypoxemia alarms and improving clinicians’ access to usable longitudinal pulse oximetry data to inform supplemental oxygen treatment. Each Aim will proceed through a stepwise process of problem analysis, design, development, implementation, and evaluation. This project will use a framework based on the Systems Engineering Initiative for Patient Safety (SEIPS) model and Dual Process Theory, and will apply innovative methods such as forensic accident investigation, video alarm analysis, and in situ simulation to analyze and evaluate monitoring systems. The end products will be redesigned systems for physiologic monitoring in hospitals and homes and a sustainable pediatric Patient Safety Learning Laboratory at one of the top children’s hospitals in the nation.