Development, Validation and Application of a Quantitative Hazard Assessment and Remediation Tool to Mitigate Risk in the Healthcare Built Environment

项目摘要/摘要 该提案旨在开发、验证和测试一个标准化工具，旨在评估 身体保健环境中的潜在风险。危害评估和补救措施 工具(HART)将分三部分开发。首先，该提议将建立一个阶级内部 专家评分员将HART工具应用于模拟复苏的相关系数(0.9)。 将使用参照系培训来评估该工具在评分者之间的可靠性 独立的评分员团队。其次，HART工具将用于评估该工具的能力 区分具有各种物理属性的临床环境(例如，比较 在危重临床期间要求的最小房间大小与较大房间的20% 干预措施。此外，还将进行分析以评估两者之间的相关性 HART评分和关键临床表现指标的完成情况(例如，坚持心肺复苏 胸部压缩机每两分钟旋转一次的指南)。最后，该提案旨在 开发和测试一种方法，以帮助补救临床环境中的危险。 HART工具的基线测量，结合模拟后的工作人员调查， 将用于确定创伤复苏环境的改善情况。HART工具 将应用于改善的环境，以确定变化是否会产生更有利的 哈特得分。提案第二个和第三个目标的次要成果包括团队 沟通和协调以及医生和护士的工作量。尽管之前- 施工模拟越来越流行，到目前为止还没有标准化的、定量的、验证的 可以使用工具来识别临床环境和系统中的潜在危险。我们建议 开发并验证可应用于临床空间的可靠、量化工具 设计或现有空间，以评估和补救物理危害。

Project Summary/Abstract The proposal aims to develop, validate and test a standardized tool that intended to assess latent risks in the physical healthcare environment. The Hazard Assessment and Remediation Tool (HART) will be developed in three parts. First, the proposal will establish an intra-class correlation coefficient (0.9) for expert raters applying the HART tool to simulated resuscitations. Frame of reference training will be used to assess inter-rater reliability of the tool using a separate team of raters. Second, the HART tool will be used to assess the tool's ability to discriminate between clinical environments with various physical attributes (e.g. comparing minimum required room size against twenty percent larger rooms) during critical clinical interventions. Additionally, analyses will be conducted to evaluate the correlation between HART score and completion of key clinical performance metrics (e.g. adherence to CPR guideline of chest compressor rotations every two minutes). Lastly, the proposal aims to develop and test a methodology to aid in the remediation of hazards in the clinical environment. Baseline measurements from the HART tool, in conjunction with staff surveys post-simulation, will be used to identify improvements in the trauma resuscitation environment. The HART tool will be applied to the improved environment to determine if changes produce a more favorable HART score. Secondary outcomes to the second and third aims of the proposal include team communication and coordination as well as physician and nurse workload. Although pre- construction simulation is growing in popularity, to date no standardized, quantitative, validated tools are available to identify latent hazards in clinical environments and systems. We propose to develop and validate a robust, quantitative tool that can be applied to clinical spaces under design or to existing spaces to assess and remediate physical hazards.