Improving Interhospital Transfer of Patients with Neurologic Emergencies

项目摘要：每年有超过230万患者经历医院间转院(IHT) 美国。大多数IHTs来自急诊科，神经急诊(NE)是 这是最常见的调动原因之一。在IHT期间，与临床医生交换信息 沟通通常较差，这可能导致与患者相比预后较差。 他们被直接送入三级医院。虽然对IHTs的研究具有高度的时间敏感性 包括创伤、急性缺血性中风(AIS)和心肌梗死在内的疾病，很少有人关注 非AIS，如出血性中风、外伤性颅内出血或癫痫发作。这个项目寻求 通过进行故障模式和影响分析，了解非AIS网元的IHT过程 关键程度分析(FMECA)用于识别、表征风险最高的故障并对其进行排序。精选的数字 将成为以人为中心的设计的应用目标，以开发 干预。最后，申请者将使用实施框架来实施干预，然后 使用混合实施效果分析方法进行可行性研究，以评估 初见成效及实施情况。这个项目的总体目标是为申请者提供一个 急诊内科医生兼科学家，成为风险评估的可靠方法的领导者 医疗保健提供系统和流程，应用尖端的以人为本的设计 方法和实施科学，以提高紧急护理的质量和安全，同时改进 以病人为中心。在初级导师S.Prabhakaran，医学博士，硕士和共同导师J. Holl，MD，MPH，A.Naidech MD，MSPH和D.McCarthy，MD，MS，申请者将利用世界级的 西北大学的制度优势，以提高他的医疗保健风险评估技能 质量和患者安全、以人为本的设计、实施科学和前瞻性研究 设计。有了这些技能，申请者将处于理想的地位，成为一家独立的健康服务机构 和结果研究员，专注于开发和测试新的医疗保健提供干预措施 急救医学。这项提议结合了一位积极性很高、非常合格的候选人和 经验丰富的指导团队，以及改进护理系统和流程的新方法 非AIS NE患者的IHT，随着晚期AIS的区域化，这是一种日益常见的医疗实践 专科护理增加了。

PROJECT ABSTRACT: More than 2.3 million patients experience an interhospital transfer (IHT) each year in the United States. Most IHTs originate from the Emergency Department and neurologic emergencies (NE) are one of the most common reasons for transfer. During IHT, exchange of information and clinician communication are often poor, which may contribute to the associated poorer outcomes compared to patients who are admitted directly to tertiary hospitals. While IHTs have been studied for highly time sensitive conditions including trauma, acute ischemic stroke (AIS), and myocardial infarction, little work has focused on non-AIS NEs, such as hemorrhagic stroke, traumatic intracranial hemorrhage, or seizures. This project seeks to gain an understanding of the IHT process for non-AIS NE by conducting a Failure Modes and Effects and Criticality Analysis (FMECA) to identify, characterize, and rank order the highest risk failures. A select number of identified high risk failures will be targets for the application of human-centered design to develop an intervention. Finally, the applicant will use an implementation framework to implement the intervention and then conduct a feasibility study using a hybrid implementation effectiveness analysis approach to assess both the preliminary effectiveness and the implementation. The overall goal of this project is for the applicant, an emergency medicine physician-scientist, to become a leader in robust methods for risk-assessment of healthcare delivery systems and processes, the application of cutting-edge human-centered design approaches, and implementation science to advance the quality and safety of emergency care while improving patient-centeredness. Under the supervision of primary mentor, S. Prabhakaran, MD, MS, and co-mentors J. Holl, MD, MPH, A. Naidech MD, MSPH, and D. McCarthy, MD, MS, the applicant will leverage the world-class institutional strengths of Northwestern University to improve his skills in risk assessment for healthcare quality and patient safety, human-centered design, implementation science, and prospective study design. With these skills, the applicant will be ideally positioned to become an independent health services and outcomes researcher, focused on the development and testing of novel healthcare delivery interventions in emergency medicine. This proposal combines a highly motivated, exceptionally qualified candidate, an experienced mentorship team, and novel methods to improve the systems and processes of care during the IHT of patients with non-AIS NE, an increasingly common healthcare practice as regionalization of advanced and specialty care increases.