Realizing Improved Patient Care through Human-centered Design for Pediatric mental and behavioral health in the Emergency Department(RIPCHD.PED)

项目总结 美国大多数急诊科(ED)的设计、组织和装备都很差，无法提供 为有心理和行为健康(MBH)状况的儿童提供安全有效的护理。安全方面的担忧 在急诊室患有MBH的儿童包括护理延误，在治疗期间缺乏适当的精神咨询 探视、患者自我伤害、对他人或环境的伤害以及非自愿使用约束导致患者 和员工受伤。需要一种系统的方法来解决ED中影响MBH的许多潜在情况 患者和提供者的安全。建议的“以人为本，改善病人护理”的目的。 急诊科儿科心理和行为健康中心设计(RIPCHD.PED) 患者安全学习实验室(PSLL)是在急诊室开发和实施儿科MBH卫生工作体系， 通过将患者不必要的压力降至最低，同时改善护理，促进安全、高效和有效的护理 提供者福祉。这一PSLL将包括对少数族裔儿童及其照顾者需求的关注 以解决急诊科医疗保健服务方面的差距。此外，PSLL将把重点放在农村和 城市环境保护，以确保建议的解决方案解决环境保护系统中常见的一系列资源限制 在美国各地。来自克莱姆森大学、Prisma Health和南卡罗来纳大学的多学科团队 医学院将使用系统工程的方法进行合作，包括深入的问题分析， 设计、开发、实施和评估。该项目的具体目标包括：目标1：使用 系统工程方法，以开发共享的深入了解工作系统的促进者和 儿科MBH ED照护工作流程中的障碍，目标2：设计和发展以人为中心的工作 为急诊科的儿科MBH患者提供的系统将改善及时获得MBH护理的机会，减少不良事件 并提高ED医疗保健提供者的效率和目标3：集成、实施和评估创新 急诊室儿科MBH工作系统内的干预措施将改善ED患者和 医疗保健提供者。该团队将使用一系列方法，包括工作流分析、旅程图和 空间语法分析，以了解障碍和促进者，并确定改进的机会。一个 将使用迭代设计流程来设计和开发与物理环境、工具相关的解决方案 以及技术、任务和工作流程。这一PSLL通过关注安全与AHRQ的使命紧密结合， 有心理和行为健康的儿童的质量、公平和获得适当心理卫生保健的机会 条件。该项目将通过以下方式支持AHRQ将儿童作为优先人口的战略重点 对于AHRQ战略计划中概述的所有6个目标。此外，PSLL将重点放在服务不足的农村地区。 人口以及来自黑人和拉丁裔社区的儿童。RIPCHD.PED PSLL将是 全面努力改善急诊科儿科医疗保健工作体系。

PROJECT SUMMARY Most emergency departments (ED) in the United States are poorly designed, organized and equipped to provide safe and effective care for children with mental and behavioral health (MBH) conditions. Safety concerns for children with MBH conditions in the ED include delays in care, lack of appropriate psychiatric consults during visits, patient self-harm, harm against others or the environment, and involuntary restraint use resulting in patient and staff injury. A systems approach is needed to address the many latent conditions in the ED that impact MBH patient and provider safety. The purpose of the proposed ‘Realizing Improved Patient Care through Human- centered Design for Pediatric mental and behavioral health in the Emergency Department (RIPCHD.PED)’ patient safety learning lab (PSLL) is to develop and implement pediatric MBH health work systems in the ED that promote safe, efficient and effective care by minimizing unnecessary stressors for patients while also improving provider well-being. This PSLL will include a focus on the needs of children and their caregivers from minority communities in order to address disparities in MBH care in the ED. Further, the PSLL will focus on rural and urban EDs to ensure that proposed solutions address a range of resource constraints typically found in EDs across the US. A multidisciplinary team from Clemson University, Prisma Health and University of South Carolina School of Medicine will collaborate using a systems engineering approach involving in-depth problem analysis, design, development, implementation and evaluation. The specific aims of this project include, Aim 1: Use systems engineering methods to develop a shared in-depth understanding of the work system facilitators and barriers involved in the pediatric MBH ED caregiving workflow, Aim 2: Design and develop human-centered work systems for pediatric MBH patients in the ED that will improve access to timely MBH care, reduce adverse events and improve efficiency for ED healthcare providers and Aim 3: Integrate, implement and evaluate innovative interventions within pediatric MBH work systems in the ED that will improve outcomes for ED patients and healthcare providers. The team will use a range of methods including workflow analysis, journey mapping and space syntax analysis to understand barriers and facilitators and identify opportunities for improvement. An iterative design process will be used to design and develop solutions related to the physical environment, tools and technology and tasks and workflow. This PSLL strongly aligns with AHRQs mission by focusing on safety, quality, equity and access to appropriate mental health care for children with mental and behavioral health conditions. The project will support AHRQ’s strategic focus on children as a priority population by contributing to all 6 goals outlined in AHRQ’s strategic plan. Further, the PSLL will include a focus on underserved rural populations as well as children from Black and Latino communities. RIPCHD.PED PSLL will be the most comprehensive effort ever undertaken to improve work systems for pediatric MBH in the emergency department.