Effective Enterprise-wide Care Transitions at Discharge

出院时有效的全企业护理过渡

• 批准号: 8015782
• 负责人: Richard O. Davis
• 金额: $ 29.32万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015782
• 关键词: Effective; Enterprise; wide; Care; Transitions

DESCRIPTION (provided by applicant): Malpractice litigation related to suboptimal care transitions at discharge represents the most egregious and severe of transition mishaps. Hospitals can gain critical knowledge from these incidents to improve healthcare quality and reduce future risk of liability. Historically, conceptual frameworks describing elements of optimal care transitions have focused primarily on the discharge and the handoff. A broader conceptual framework is needed to improve patient safety. To conduct the proposed planning project, we have assembled an interdisciplinary team of research experts in care transitions, physicians, safety and quality improvement officers, nurses, and legal professionals to update the conceptual framework, develop metrics, and pilot them. The long-term goal of this project is to use qualitative analysis to develop a dashboard of key metrics to be used in real-time to alert Johns Hopkins Medicine (JHM), leaders in patient safety and quality improvement, and risk management, to suboptimal care transitions processes at discharge, which may place patients at risk for adverse events, and JHM at risk for malpractice claims. Completion of this project would represent a critical step in integration of risk management activities and patient safety efforts at JHM and in medical institutions worldwide. The Specific Aims of this planning grant are to: (SA1): Refine the existing conceptual framework for understanding suboptimal care transitions at discharge using in-depth qualitative analysis of malpractice claims and associated litigation documents; (SA2): Develop pilot metrics based on the conceptual framework developed in SA1 for monitoring quality of transitional care at discharge to improve patient safety and alert organizational leaders to events that place healthcare organizations at risk for malpractice claims; and (SA3): Test the reliability and validity of pilot metrics, and their ability to identify patient safety problems and prevent malpractice. A feasible next step would be the implementation of a national safety and risk management discharge dashboard and creation of a sophisticated risk management database combined with better defined claims coding, "real-time" data from Patient SafetyNet as an intervention strategy for effective care transitions at discharge. This new system along with patient-centered procedures, Safety Attitudes Questionnaires, patient relations, patient satisfaction surveys can help to ensure the quality and safety of care, and reduce the number of claims made against hospitals. PUBLIC HEALTH RELEVANCE: Hospital discharge represents an important transition for patients and a time of increased risk for discontinuity, miscommunication and other errors. Failures in this hand-off process can lead to adverse patient outcomes and increase health care costs. Hospital managers are unable to monitor the quality of hospital discharge, due in part to the lack of reliable indicators.

描述（由申请人提供）：与出院时的次优护理过渡相关的医疗事故诉讼是最严重和最严重的过渡事故。医院可以从这些事件中获得关键知识，以提高医疗质量并降低未来的责任风险。从历史上看，描述最佳护理过渡要素的概念框架主要集中在出院和交接上。需要一个更广泛的概念框架来提高患者安全性。为了进行拟议的规划项目，我们组建了一个跨学科的研究专家团队，包括护理过渡、医生、安全和质量改进官员、护士和法律的专业人员，以更新概念框架、制定指标并进行试点。 本项目的长期目标是使用定性分析开发一个关键指标仪表板，用于实时提醒约翰霍普金斯医学（JHM），患者安全和质量改进以及风险管理的领导者，出院时的次优护理过渡过程，这可能使患者面临不良事件的风险，并使JHM面临医疗事故索赔的风险。该项目的完成将是JHM和全球医疗机构整合风险管理活动和患者安全工作的关键一步。该规划补助金的具体目标是：（SA 1）：使用对医疗事故索赔和相关诉讼文件的深入定性分析，完善现有概念框架，以了解出院时的次优护理过渡;（SA 2）：根据SA 1中制定的概念框架制定试点指标，用于监测出院时过渡期护理的质量，以提高患者安全性，并提醒组织领导者将医疗机构置于医疗事故索赔风险中的事件;以及（SA 3）：测试试点指标的可靠性和有效性，以及它们识别患者安全问题和防止医疗事故的能力。可行的下一步是实施国家安全和风险管理出院仪表板，并创建一个复杂的风险管理数据库，结合更好定义的索赔编码，来自患者安全网的“实时”数据，作为出院时有效护理过渡的干预策略。这一新系统沿着以患者为中心的程序、安全态度调查表、患者关系、患者满意度调查，有助于确保护理质量和安全，并减少针对医院的索赔数量。 公共卫生关系：出院对患者来说是一个重要的过渡期，也是一个中断、沟通不畅和其他错误风险增加的时期。在这个交接过程中的失败可能会导致不良的患者结果，并增加医疗保健成本。 医院管理人员无法监测出院的质量，部分原因是缺乏可靠的指标。

项目成果

Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools.

从诉讼中学习：使用医疗事故索赔数据开发护理过渡规划工具。

• DOI: 10.1097/pts.0000000000000238
• 发表时间: 2020
• 期刊: Journal of patient safety
• 影响因子: 2.2
• 作者: Arbaje,AliciaI;Werner,NicoleE;Kasda,EileenM;Wu,AlbertW;Locke,CharlesFS;Aboumatar,Hanan;Paine,LoriA;Leff,Bruce;Davis,RichardO;Boonyasai,Romsai
• 通讯作者: Boonyasai,Romsai