Care Transitions and Teamwork in Pediatric Trauma: Implications for HIT Design

 描述(由申请人提供)：确保安全和护理质量以及改善患者和家庭体验一直是卫生信息技术(HIT)部署的强大驱动因素。如果设计和实施得当，HIT可以彻底改变和改善临床医生和家庭合作的方式。然而，目前可用的HIT应用程序使医疗保健更加分散，使协调不同护理团队成员和家庭之间的护理变得更加困难；从而给患者安全带来了新的风险。我们的长期目标是为下一代HIT支持的工作系统开发创新和有效的概念和技术，以科学证据为基础，提供集成、无缝、安全和以患者和家庭为中心的护理。创伤是儿科人口死亡和永久瘫痪的主要原因。危重病人(如创伤病人)往返儿科重症监护室(PICU)的护理过渡需要PICU团队、其他团队和服务(如急诊科)以及家属之间有效的团队合作。我们建议使用社会技术系统方法来设计支持儿科创伤护理过渡的HIT。我们将使用SEIPS 2.0，这是一种医疗保健的社会技术系统模型，并辅之以著名的团队流程框架，以确保我们的HIT设计支持各种创伤护理团队成员和家庭的认知工作。嵌套在SEIPS 2.0中，我们将使用情景设计方法，这是一个以用户为中心的六步设计过程，以指导我们的整体设计过程。我们的第一个具体目标是描述儿童创伤患者护理过渡过程中的认知团队合作。我们将重点关注三种类型的护理过渡：从急诊科进入PICU，从PICU转到住院的儿科普通护理单元，以及从PICU直接出院。第二个具体目标是开发和测试未来HIT的设计要求，称为以团队为中心的信息技术(默契)，它支持认知团队合作，以提高安全、质量和以家庭为中心的护理。这项研究将在三个一级儿科创伤中心进行：约翰·霍普金斯儿童医院、华盛顿大学健康-美国家庭儿童医院和所有儿童医院。分析认知团队合作的方法将是多样化的(即背景调查、访谈、焦点小组)(目标1)，并将产生一系列的输出(例如，流程图、信息流图、人工制品分析、协作表、决策轮、角色网络分析)，用于确定默示的设计要求(目标2)。利用研究人员和其他不同利益相关者之间的协作过程，我们将为默示模型制定初步设计要求，并评估其可用性。本研究采用迭代设计方法；目标2的结果将有助于确定目标1下的额外数据收集和分析需求。当收集和分析了所有目标1的数据后，将最终确定默示的设计要求(目标2)。

 DESCRIPTION (provided by applicant): Ensuring safety and quality of care as well as improving patient and family experiences have been strong drivers for health information technology (HIT) deployment. When designed and implemented well, HIT can revolutionize and improve the way clinicians and families work together. However, currently available HIT applications have made healthcare more fragmented, making it harder to coordinate care among various care team members and families; thus introducing new risks to patient safety. Our long-term goal is to develop innovative and effective concepts and techniques for the next generation of HIT-supported work systems that provide integrated, seamless, safe, and patient and family-centered care based on scientific evidence. Trauma is the leading cause of death and permanent paralysis among the pediatric population. Care transitions of critically ill patients such as trauma patients, to and from the pediatric intensive care unit (PICU) require effective teamwork among the PICU team, other teams and services (e.g., emergency department), as well as the family members. We propose to use a sociotechnical systems approach to the design of HIT that supports pediatric trauma care transitions. We will use the SEIPS 2.0, a sociotechnical systems model for healthcare, complemented by the well-known team processes framework, to ensure that our HIT design supports the cognitive work of the various trauma care team members and families. Nested within the SEIPS 2.0, we will use contextual design methodology, a six-step user-centered design process, to guide our overall design process. Our first specific aim is to describe cognitive teamwork involved in care transitions of pediatric trauma patients. We will focus on three types of care transitions: admission to PICU from emergency department, transfer from PICU to inpatient pediatric general care unit, and hospital discharge directly from PICU. The second specific aim is to develop and test design requirements for future HIT, referred to as the team-centric information technology (TACIT), that supports cognitive teamwork for enhancing safety, quality, and family-centeredness of care. The study will be conducted in three Level I pediatric trauma centers: Johns Hopkins Children's Hospital, UWHealth-American Family Children's Hospital, and the All Children's Hospital. Methods for analyzing cognitive teamwork will be diverse (i.e. contextual inquiry, interviews, focus groups) (Aim 1) and will produce a range of outputs (e.g., process maps, information flow diagrams, artifact analysis, collaboration tables, decision wheels, role network analysis) that wil be used to define the TACIT design requirements (Aim 2). Using a collaborative process among researchers and the various other stakeholders, we will develop preliminary design requirements for the TACIT mock-up and evaluate its usability. This study uses an iterative design approach; Aim 2 results will help to define additional data collection and analysis needs under Aim 1. When all Aim 1 data have been collected and analyzed, the TACIT design requirements will be finalized (Aim 2).