Organizational Dynamics and Failure to Rescue After Major Surgery
组织动态和大手术后救援失败
基本信息
- 批准号:9099711
- 负责人:
- 金额:$ 15.5万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2015
- 资助国家:美国
- 起止时间:2015-07-01 至 2020-06-30
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
DESCRIPTION (provided by applicant): Every year at least 100,000 Americans die undergoing inpatient surgical procedures. Wide variation in mortality rates across hospitals suggests substantial opportunities for improvement. Payers and professional organizations are hoping that checklists, pay for performance programs, and national outcomes registries will reduce rates of surgical complications and ultimately mortality. However, recent research suggests that high mortality and low mortality hospitals are distinguished less by their complication rates than by how successfully they recognize and manage complications once they occur. Thus, minimizing "failure to rescue" (i.e., death following a major complication) may be essential in efforts to reduce surgical mortality. Successful rescue hinges on early recognition and timely management of serious complications once they occur. Focusing on the clinical deterioration of patients during the early "golden hours" of decline may yield valuable insights into how some hospitals achieve exemplary outcomes. Unfortunately, previous work does not identify actionable insights into how hospitals can improve their rescue rates. A better understanding of how interactions and relationships within hospital micro-systems could be even more crucial to improving rescue through practical and effective interventions. To explore these issues, we propose a study designed to assess such factors and to develop and implement an intervention in Michigan hospitals aimed at improving overall safety culture, communication, and rescue rates. The specific research aims are (i) to develop an in-depth understanding of the key elements, such as teamwork and communication, necessary for complication rescue; (ii) to design an intervention that promotes key elements for improving rescue; and (iii) to pilot an intervention aimed at improving hospital rescue rates. This work will shed light on how healthcare organizations can be engaged to better sense, cope with, and respond to the unexpected and changing demands presented by clinically deteriorating post-surgical patients with life-threatening complications. This project will have direct, population-level impact to inform interventions aimed at reducing mortality in surgical patients in Michigan, and ultimately elsewhere. Results from this study will also inform large payer (including CMS) and regulators (particularly JCAHO) as they set incentives and standards for enhancing the safety of inpatient surgery in the United States. Further, the research project, highly experienced multidisciplinary mentorship team, and unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate, Amir A. Ghaferi, MD, MS. The proposal includes a detailed educational plan with training that will be essential both for successful completion of this research and toward Dr. Ghaferi's career development. The training includes graduate level courses in organizational management, behavior, and theory, qualitative research methods, and implementation science. This career development award will lay the groundwork for Dr. Ghaferi to perform ongoing, innovative health services research, and to become an independent investigator and national leader in patient safety and quality improvement.
描述(由申请人提供):每年至少有10万美国人死于住院手术。各医院的死亡率差异很大,这表明有很大的改善机会。付款人和专业组织希望检查表、按绩效付费计划和国家结果登记将降低手术并发症的发生率,并最终降低死亡率。然而,最近的研究表明,高死亡率和低死亡率医院的区别与其说是并发症发生率,不如说是他们在并发症发生后识别和管理并发症的成功程度。因此,最小化“救援失败”(即,主要并发症后死亡)可能是降低手术死亡率的关键。成功的抢救取决于早期识别和及时处理严重并发症一旦发生。关注患者在早期“黄金时段”的临床恶化可能会对一些医院如何实现模范结果产生有价值的见解。不幸的是,以前的工作并没有确定医院如何提高抢救率的可行见解。更好地了解医院微观系统内的相互作用和关系对于通过实际有效的干预措施改善救援工作更为重要。为了探讨这些问题,我们提出了一项研究,旨在评估这些因素,并制定和实施干预措施,旨在提高整体安全文化,沟通和抢救率在密歇根州的医院。具体的研究目标是:(一)深入了解并发症抢救所需的关键要素,如团队合作和沟通;(二)设计一种干预措施,促进改善抢救的关键要素;以及(三)试点旨在提高医院抢救率的干预措施。这项工作将阐明医疗保健组织如何能够更好地感知,科普和应对临床恶化的手术后并发症危及生命的患者所提出的意外和不断变化的需求。该项目将产生直接的人口影响,为旨在降低密歇根州手术患者死亡率的干预措施提供信息,并最终在其他地方。这项研究的结果还将告知大型支付者(包括CMS)和监管机构(特别是JCAHO),因为他们为提高美国住院手术的安全性制定了激励措施和标准。此外,研究项目,经验丰富的多学科导师团队和无与伦比的研究环境非常适合解决候选人Amir A的职业目标和教育需求。该提案包括一个详细的教育计划与培训,这将是必不可少的成功完成这项研究和对博士Ghaferi的职业发展。培训包括组织管理,行为和理论,定性研究方法和实施科学的研究生课程。该职业发展奖将为Ghaferi博士进行持续的创新卫生服务研究奠定基础,并成为患者安全和质量改善方面的独立研究者和国家领导者。
项目成果
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