Minimizing Physician Errors: Feedback of Patient Outcomes After Handoffs

描述（由申请人提供）：医疗错误是常见的，伤害患者，并增加医疗保健成本在美国每年数十亿美元。其中许多错误是可以预防的。然而，为了让医疗保健提供者从他们的错误中吸取教训，并在未来防止他们，他们必须首先意识到他们已经发生。这种“反馈”过程至关重要，但并不可靠。这一缺陷的影响是特别重要的实习医生，当诊断方法和治疗决策的学习。由于减少住院医生工作时间的规定，医生培训越来越多地变成轮班工作，病人的护理往往从一个医生“移交”给另一个医生。目前，这些障碍阻碍了许多受训者获得关于其临床决策效果的反馈，因为这些效果通常需要时间才能显现。该项目的目标是通过在电子健康记录（EHR）中开发一个自动化的患者结果反馈系统来解决这种反馈的缺乏。我们假设，该系统将使医生能够了解他们的病人在术后的结果， 帮助他们改进决策并随着时间的推移减少错误。 拟议的项目将包括三个主要目标，以解决缺乏病人的结果反馈后，关闭。在目标1中，我们将通过测量急诊和内科实习医生在出院后查看患者病历的频率来确定问题的严重程度。在目标2中，我们将创建一组电子“触发器”，用于识别医生可能犯错误的cse。最后，在目标3中，我们将在EHR中开发和试点测试一个系统，该系统将自动为医生提供患者在出院后的结果报告。 在我们提出的研究结论，我们将创建一种方法，以提高频率和可靠性的病人结果反馈给急诊医学和内科医生实习生后，出院。如果成功，该系统将导致更准确的初步诊断和更有效的治疗决策，从而减少医疗错误。

DESCRIPTION (provided by applicant): Medical errors are common, harm patients and increase the cost of healthcare in the US by billions of dollars each year. Many of these errors are preventable. However, in order for healthcare providers to learn from their errors and prevent them in the future, they must first be aware that they have occurred. This "feedback" process is vital, but does not occur reliably. The implications of this deficiency are especially important for physician trainees, when diagnostic approaches and treatment decisions are learned. As a consequence of regulations to reduce resident work hours, physician training has increasingly become shift work and the care of patients is often "handed off" from one physician to another. These handoffs currently prevent many trainees from receiving feedback regarding the effects of their clinical decisions because these effects often take time to become evident. The objective of this project is to address this lack of feedback by developing an automated patient outcome feedback system within an electronic health record (EHR). We hypothesize that this system will enable physicians to learn the outcomes of their patients after handoffs, allowing them to improve their decision-making and reduce errors over time. The proposed project will include three main aims to address the lack of patient outcome feedback after handoffs. In Aim 1, we will establish the extent of the problem by measuring how often emergency medicine and internal medicine physician trainees currently view their patients' charts after handoffs. In Aim 2, we will create a set of electronic "triggers" that will identify cses in which physicians may have made errors. Finally, in Aim 3, we will develop and pilot test a system within an EHR that will automatically provide physicians with a report of the outcomes of their patients after handoffs. At the conclusion of our proposed studies, we will have created a methodology to improve the frequency and reliability of patient outcome feedback to emergency medicine and internal medicine physician trainees following handoffs. If successful, the system will result in more accurate initial diagnoses and more effective treatment decisions, leading to fewer medical errors.