The Family Input for Quality and Safety (FIQS) Study

摘要 在医院中，患者安全不良事件发生率仍然居高不下。对于儿童，不良事件为1.5-2 是成人住院患者的两倍（40.0 vs. 25.1 harm/100次入院）。父R 01提案 使用未开发的安全性事件报告来源-住院儿科患者和家属 患者-评估儿科安全事件的流行病学; 错误报告系统;预防儿科用药错误的方法;以及学习的发展 卫生系统，以解决住院儿科安全。我们基于移动的电话的方法，家庭输入， 质量和安全（FIQS），是与家庭和临床医生合作开发的，并在一个 儿科医疗外科单位，与参与者和工作人员的热情参与。这一目标 建议在其他医院测试该方法的同时，解决以下目标中先前工作的严格性 单位（例如，ICU、血液肿瘤科）和安全网医院。目的1：描述安全性事件的变化 使用家庭和患者生成的安全性报告跨护理环境和人群（N~ 6，500名参与者; N~3000份FIQS报告）。这将使用实时移动的电话工具来确定家庭和 按医院环境、医疗复杂性、语言、卫生技术素养和患者 和家庭成员的人口统计数据。拟议的行政补充将支持职业生涯 为未来的拉丁裔医生，研究员，迈特加西亚女士的发展，以改善护理拉丁裔患者， 通过严谨和创新的研究。候选人是美国公民，其父母没有收到 高中以上学历。Garcia女士将领导一项定性研究，以更好地引出 在初步研究中发现不常报告事件的Latinx患者和家属。目标2：比较 FIQS报告，以临床医生生成的报告记录在事件报告和病历中。这将 采用混合方法，量化每个来源的重叠和独特事件的数量，并使用 定性分析，以描述每个来源所涵盖的独特领域。目标3：评估改进 合作的重点是将家庭和病人报告问题纳入安全工作。拟议 研究在其范式转变概念模型方面具有创新性：1）患者参与的质量改进，2） 它使用移动的电话技术来收集真实的时间数据，以及3）它使用改进的协作来 制定强有力的实施策略，将家庭和患者报告纳入安全工作。的 拟议研究的贡献将是对多个家庭和患者安全报告的描述。 两种不同卫生系统中的住院患者类型;家庭和患者安全报告与 检测不良事件的其他方法;以及交叉设置实施工具和策略， 将家庭和患者安全报告纳入护理。这些贡献将是重要的，因为它们是 实施和评估潜在的新方法以提高儿科住院患者安全性的关键步骤。

Abstract Adverse patient safety event rates remain stubbornly high in hospitals. For children, adverse events are 1.5-2 times more common than in adult inpatients (40.0 vs. 25.1 harms/100 admissions). The parent R01 proposal uses an untapped source of safety event reporting—patients and family members of hospitalized pediatric patients—to assess the epidemiology of pediatric safety events; strengths and limitations of current methods of error reporting systems; methods to prevent pediatric medication errors; and the development of learning health systems to address inpatient pediatric safety. Our mobile phone-based approach, Family Input for Quality and Safety (FIQS), was developed in partnership with families and clinicians, and was pilot-tested on a pediatric medical-surgical unit, with enthusiastic engagement from participants and staff. The objectives of this proposal are to address the rigor of prior work in the following aims, while testing the approach in other hospital units (e.g., ICU, hematology-oncology) and in a safety net hospital. Aim 1: Describe variations in safety events across care settings and populations using family- and patient-generated safety reports (N~6,500 participants; N~3000 FIQS Reports). This will use the real-time mobile phone tool to determine differences in family and patient safety reports by hospital setting, medical complexity, language, health technology literacy, and patient and family-member demographics. The proposed administrative supplement will support the career development for a future Latinx physician-researcher, Ms. Maite Garcia, to improve care for Latinx patients and families through rigorous and innovative research. The candidate is a US citizen whose parents did not receive post-secondary high school degrees. Ms. Garcia will lead a qualitative study to better elicit safety events in Latinx patients and families, who were found to report events infrequently in the pilot study. Aim 2: Compare FIQS reports to clinician-generated reports documented in incident reports and in the medical record. This will employ mixed-methods, quantifying the number of overlapping and unique events from each source, and using qualitative analysis to describe unique domains covered in each source. Aim 3: Evaluate an improvement collaborative focused on incorporating family and patient reports issues into safety efforts. The proposed research is innovative in its paradigm-shifting conceptual model of 1) patient-engaged quality improvement, 2) its use of mobile phone technologies to gather real time data, and 3) its use of an improvement collaborative to develop robust implementation strategies for incorporating family and patient reports into safety efforts. The contribution of the proposed research will be a description of family and patient safety reports across multiple types of inpatient settings in two diverse health systems; a comparison of family and patient safety reports to other methods of detecting adverse events; and cross-setting implementation tools and strategies to incorporate family and patient safety reports into care. These contributions will be significant because they are key steps in implementing and evaluating a potential new approach to improving pediatric inpatient safety.