Minimizing Physician Errors: Feedback of Patient Outcomes After Handoffs

描述（由申请人提供）：医疗差错是常见的，伤害患者，并增加美国每年数十亿美元的医疗保健费用。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预防它们，他们必须首先意识到它们已经发生了。这种“反馈”过程至关重要，但并不可靠。当诊断方法和治疗决定被学习时，这一缺陷的含义对医生实习生尤为重要。由于减少住院医生工作时间的规定，医生培训越来越成为轮班工作，病人的护理经常从一个医生“移交”给另一个医生。这些交接目前阻碍了许多受训者获得关于其临床决策效果的反馈，因为这些效果往往需要时间才能显现出来。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缺乏反馈的问题。我们假设，这个系统将使医生了解他们的病人移交后的结果，允许

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.