The Relation of Hospital Workload to Patient Safety

描述（申请人摘要）：对医院患者安全的担忧 已将注意力集中在不良事件和医疗差错的原因上。一 导致不良事件的可能原因是 工作量压力大时的医疗护理 活动最近媒体关注的做法，分流病人时， 医院变得过于拥挤，增加了对意外后果的担忧， 医疗保健领域的竞争加剧。这个项目将测试是否每天 医院占用率、病例复杂性和其他指标的变化 患者活动与不良事件发生率相关，控制 护士的水平。此外，由于监测不良事件是 这项研究将测试识别不良反应的替代方法， 使用电子医疗记录系统的事件。本研究将在 四家医院，三家在马萨诸塞州，一家在犹他州， 教学状况和城市/郊区位置。这项研究有两个目的。1)我们 将研究医院活动/工作量与 不良事件，控制人员配备水平。作为敏感性分析， 我们将在两个月内使用自动ADE系统测量药物不良事件（ADES）， 并重复分析。统计分析将 使用分层时间依赖性考克斯回归模型估计 不良事件的概率，以患者日为分析单位。 11)我们将开发和测试一种新的筛选方法的可行性， 使用计算机化的医院信息系统， 可在其中一家研究医院获得。目标1将对以下方面产生影响： 医院和政策制定者决定是否限制工作量， 在高工作量压力时期重新设计流程，以便 提高患者安全性。第二个可能的结果是， 用于监测不良事件和错误的具有成本效益的筛查工具。

DESCRIPTION (APPLICANT ABSTRACT): Concerns over patient safety in hospitals have focused attention on the causes of adverse events and medical errors. One possible cause leading to adverse events is the general stress placed on medical care during times of workload pressure at times of heightened patient activity. Recent media attention on the practice of diverting patients when hospitals become over-crowded adds to concerns over unintended consequences of increased competition in healthcare. This project will test whether day to day variations in hospital occupancy, case complexity, and other measures of patient activity are related to the rate of adverse events, controlling for nurse staffing levels. In addition, because monitoring adverse events is expensive, the study will test alternative methods of identifying adverse events using electronic medical record systems. The study will be performed at four hospitals, three in Massachusetts and one in Utah, representing a mix of teaching status and urban/suburban locations. The study has two aims. 1) We will examine the association between hospital activity/workload and rates of adverse events, with control for staffing levels. As a sensitivity analysis, we will measure adverse drug events (ADES) using automated ADE systems at two of the study hospitals and repeat the analyses. The statistical analyses will use stratified time-dependent Cox regression models to estimate the probability of adverse events, with the patient day as the unit of analysis. 11) We will develop and test the feasibility of a new method of screening for adverse events using a computerized hospital information system which is available at one of the study hospitals. Aim 1 will have implications for hospitals and policy makers deciding whether to limit workload, or else reengineer processes during times of high workload pressure, in order to improve patient safety. A second potential outcome will be to make available cost-effective screening tools for monitoring adverse events and errors.