Engineering Safe Care Journeys for Vulnerable Older Adults

项目摘要/摘要 人口老龄化与日益复杂的护理需求相结合，产生了一个重大挑战 用于医疗保健服务系统。老年患者在患者安全问题和医疗保健方面的风险很高- 相关伤害，特别是在急诊科(ED)和医院接受护理时。我们的 该项目的重点是65岁以上被诊断为跌倒或疑似尿路的脆弱老年患者 ED(AHRQ优先人群)的感染(UTI)。这些患者经历了一系列的患者安全 问题，如反复摔倒、诊断和用药错误(例如，不必要地使用抗生素或药物 增加跌倒风险)，与制动相关的静脉血栓栓塞症，以及与医疗保健相关的 感染(如艰难梭菌)。 我们由工程师、卫生服务研究人员、护士、医生和药剂师组成的跨学科团队将 与UW Health合作，UW Health是一家拥有学术和社区ED的大型医疗系统，以创建和 在向急诊室提交报告后，评估支持老年人安全旅行的护理系统。按顺序 为了让老年人在从急诊室开始的旅程中安全过渡，我们建议创造一个‘病人安全 将提供错误检测和恢复的机会，以预测患者的安全问题 旅行的后续步骤，以及改善沟通和协调。 我们将使用SEIPS(患者安全系统工程倡议)模型作为概念框架 用于解决老年人经历的多个患者安全问题和医疗保健相关伤害 在他们的关怀之旅中。我们将采用参与式以人为本的设计方法来实施5- AHRQ RFA中描述的STEP方法(问题分析、设计、开发、实施和 评估)。这将涉及建立一个多学科干预实施小组(IIT)， 来自(1)患者/护理人员的代表，(2)来自急诊科、医院和SNF的临床医生和工作人员，(3)UW Health 利益相关者；(4)研究人员。 我们将评估患者安全护照对最常见和相互关联的患者的影响 老年人在跌倒、VTE、诊断和用药错误以及 哈斯。根据SEIPS模式，评估将评估护理过程和结果(EHR数据)， 患者和照顾者的观点(调查和访谈)，以及急诊室、医院和SNF的观点 临床医生和工作人员(调查和焦点小组)。 我们将开发一个跨学科的PSLL，旨在为脆弱的患者设计安全护理之旅， 包括老年人。我们的PSLL将建立在工程学之间长期而强大的研究合作基础上 以及威斯康星大学麦迪逊分校的健康科学，这导致了 威斯康星州医疗系统工程研究所(WIHSE)于2017年成立。

Project Summary/Abstract The combination of the aging population with increasingly complex care needs produces a major challenge for the healthcare delivery system. Older patients are at high risk for patient safety issues and healthcare- associated harm, especially when receiving care in the Emergency Department (ED) and the hospital. Our project focuses on vulnerable older patients over 65 who are diagnosed with fall or suspected urinary tract infection (UTI) in the ED (AHRQ priority population). These patients experience a range of patient safety issues, such as repeated falls, diagnostic and medication errors (e.g. unnecessary use of antibiotics or drugs that increase fall risk), venous thromboembolism related to immobilization, and healthcare-associated infections (e.g., C-difficile). Our transdisciplinary team of engineers, health services researchers, nurses, physicians and pharmacists will collaborate with UW Health, a large health system with both academic and community EDs, to create and evaluate a system of care that supports the safe journey of older adults after presentation to the ED. In order for older adults to transition safely in their journey that begins in the ED, we propose to create a `patient safety passport' that will provide opportunities for error detection and recovery, for anticipating patient safety issues in the subsequent steps of the journey, and for improving communication and coordination. We will use the SEIPS (Systems Engineering Initiative for Patient Safety) model as the conceptual framework for addressing multiple patient safety issues and healthcare-associated harm experienced by older adults during their care journey. We will apply a participatory human-centered design approach to implement the 5- step methodology described in the AHRQ RFA (problem analysis, design, development, implementation and evaluation). This will involve the creation of a multidisciplinary Intervention Implementation Team (IIT) with representatives from (1) patients/caregivers, (2) clinicians and staff from ED, hospital and SNF, (3) UW Health stakeholders, and (4) researchers. We will evaluate the impact of the patient safety passport on the most frequent and inter-related patient safety issues experienced by older adults in the domains of fall, VTE, diagnostic and medication errors, and HAIs. In line with the SEIPS model, the evaluation will assess care process and outcomes (EHR data), the perspective of patients and caregivers (survey and interviews), and the perspective of ED, hospital and SNF clinicians and staff (survey and focus groups). We will develop a transdisciplinary PSLL aimed at engineering safe care journeys for vulnerable patients, including older adults. Our PSLL will build on long-standing, strong research collaboration between engineering and the health sciences at the University of Wisconsin-Madison, which led to the official launch of the Wisconsin Institute for Healthcare Systems Engineering (WIHSE) in 2017.