The Relation of Hospital Workload to Patient Safety

简介(申请人摘要)：医院对病人安全的关注 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对 工作压力大的时候的医疗护理 活动。最近媒体对分流病人的做法的关注 医院人满为患加剧了人们对艾滋病意外后果的担忧 医疗保健领域的竞争加剧。这个项目将每天测试是否 医院占有率、病例复杂性和其他指标的变化 患者的活动与不良事件的发生率有关，控制 护士人员配备水平。此外，因为监测不良事件是 这项研究耗资巨大，将测试识别不良反应的替代方法 使用电子病历系统的活动。这项研究将在 四家医院，三家在马萨诸塞州，一家在犹他州，代表着 教学状况和城市/郊区位置。这项研究有两个目的。1)我们 将审查医院活动/工作量与 不良事件，并控制人员配备水平。作为敏感性分析， 我们将使用自动ADE系统在两个月内测量不良药物事件(ADE) 研究医院，并重复分析。统计分析将 使用时间依赖的分层COX回归模型估计 不良事件发生的概率，以患者日为分析单位。 我们将开发和测试一种新的筛查方法的可行性 使用计算机化医院信息系统的不良事件 可在其中一家研究医院购买。目标1将对 医院和政策制定者决定是限制工作量，还是 在工作负载压力大的时候重新设计流程，以便 提高患者安全。第二个潜在的结果将是 用于监测不良事件和错误的经济高效的筛查工具。

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.