The Safety Integration Stakeholders (SAINTS) program to integrate worker and patient safety in Oregon rural hospitals

项目总结/摘要 COVID-19疫情凸显了工人与病人安全之间密不可分的联系。然而大多数 医院对病人或工人的安全有不同的措施。一个恰当的例子是安全的病人处理 和流动性（SPHM），其中大多数计划由员工健康和安全实施， 与其他质量或患者安全部门协调。这种脱节是重要的，因为不利的 和昂贵的结果，如病人福尔斯或工人的病人协助伤害有重叠的风险因素， 必须一起解决。一个有希望的应对措施是通过一个整合利益相关者的计划， 包括有影响力的一线工作人员，以解决患者福尔斯和患者辅助的重叠风险因素 受伤我们的初步研究在俄勒冈州的一家乡村医院预先测试了一项综合安全计划， 在改善领先指标和减少患者辅助损伤方面证明了12个月的有效性 rates.该计划有四个主要组成部分：1）病人和工人安全利益相关者的参与; 2)社会网络分析（SNA）的创新应用，以确定同行公认的安全领导者 而不是自我或主管提名的工人，他们可能没有影响力来实现变革; 3） 培训利益相关者的安全领导，以及4）实施质量改进（QI）周期，以减少 安全隔栏.基于这些有希望的结果，我们计划建立一个新的可扩展的干预措施， 严格的多医院试验。本提案的目的是进行一项随机分组对照试验， 六家农村医院，以评估名为“安全整合”的安全计划的有效性和过程 利益攸关方（圣徒）。我们将检验中心假设，即相对于通常的实践控制， 随机分配到圣徒计划的医院将降低患者福尔斯和患者- 协助受伤12个月后，该计划结束。理由是，圣徒计划将积极 通过确定和培训关键参与者，以促进环境，行政， 和与SPHM相关的教育预防措施。我们提出两个目标：目标1：确定圣徒的 有效减少患者福尔斯和患者辅助损伤的重叠风险因素。有效性将 通过调查住院部工作人员对患者协助伤害和患者福尔斯跌倒的风险因素来确定， 基线、项目启动后6个月和实施结束后12个月（主要 端点）。该试验的动力是检测领先指标的变化，但我们也将研究滞后效应 关于患者福尔斯、患者辅助伤害、报告系统中的条目和员工流动率的发生率。 目标2：确定圣徒计划产生的安全预防措施。鉴于半结构化 设计，我们将进行多方法的过程评估，以确定在何种程度上该计划是 是否按计划交付，是否导致采取预防措施。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic accentuated the inextricable link between worker and patient safety. Yet most hospitals have separate initiatives for either patient or worker safety. A case in point is safe patient handling and mobility (SPHM), where most programs are implemented by Employee Health and Safety without coordination with other quality or patient safety departments. This disconnect is significant because adverse and costly outcomes such as patient falls or workers’ patient-assist injuries have overlapping risk factors that must be addressed together. One promising response is through a program that integrates stakeholders, including influential front-line workers, to address overlapping risk factors for patient falls and patient-assist injuries. Our preliminary research pre-tested an integrated safety program at a rural hospital in Oregon that demonstrated 12-month effectiveness in improving leading indicators and reduction of patient-assist injury rates. The program had four main components: 1) the involvement of patient and worker safety stakeholders; 2) the innovative application of Social Network Analysis (SNA) to identify peer-recognized safety leaders instead of self- or supervisor-nominated workers who may not have the influence required to effect change; 3) training stakeholders on safety leadership, and 4) implementation of quality improvement (QI) cycles to reduce safety barriers. Based on these promising results, we plan to build a new scalable intervention to be tested in a rigorous multi-hospital trial. The objective of this proposal is to conduct a cluster randomized controlled trial in six rural hospitals to evaluate the effectiveness and process of a safety program titled Safety Integration Stakeholders (SAINTS). We will test the central hypothesis that relative to usual practice controls, the three hospitals randomly assigned to the SAINTS program will have reduced risk factors for patient falls and patient- assist injuries 12 months after the end of the program. The rationale is that the SAINTS program will positively impact outcomes by identifying and training key players on strategies to boost environmental, administrative, and educational precautions relevant to SPHM. We propose two aims: Aim 1: Determine the SAINTS' effectiveness in reducing overlapping risk factors for patient falls and patient-assist injuries. Effectiveness will be determined by surveying in-patient unit workers on risk factors for patient-assist injuries and patient falls at baseline, six months after program initiation, and 12 months after the end of implementation (primary endpoint). The trial is powered to detect changes in leading indicators, but we will also examine lagging effects on the incidence rates of patient falls, patient-assist injuries, entries in reporting systems, and staff turnover. Aim 2: Identify safety precaution measures produced by the SAINTS program. Given the semi-structured design, we will conduct a multi-method process evaluation to identify the extent to which the program was delivered as planned and if it led to the adoption of preventative measures.