Proactive risk assessment in the ED: Building the 'safety case'

描述（由申请人提供）：本提案有3个广泛的长期目标：1)将在高危险行业中使用的主动风险评估（PRA）技术扩展到医疗保健环境中，2)将为系统变更创建“安全案例”的技术（在高危险行业中也很常见）应用到医疗保健环境中；3)研究弹性工程的概念，用于补充PRA。用计算机跟踪系统取代急诊科的手动状态板的案例将被用作该项目的“试验台”。因此，该项目的具体目标是：1。确定状态委员会支持患者安全或对患者构成风险的具体方式。2. 进行预先评估，以取代电子部门的手动状态板。由于风险在不同的操作条件下可能会有所不同，因此这将是一个分阶段的风险评估。3. 根据PRA工作的结果，为这一变化提出一个“安全案例”。4. 制定一种可推广的方法，以便今后在卫生保健领域开展此类评估。方法。先前对状态板认知特性的研究将用于识别对患者安全有直接影响的功能。过程绘图技术、直接观察工作和与教育署职员的半结构化面谈将用于收集系统运作的数据。这些将在社会技术PRA框架中进行分析。结果将由独立评审小组进行评审，以增加普遍性。该项目与公共卫生有重大关系。卫生保健组织通常在流程、人员和技术方面做出重大改变（例如，开设专门的创伤或中风中心，或安装计算机化的医疗服务提供者订单输入系统），但很少或根本没有对这些改变可能引起的危害进行前瞻性检查。如果PRA方法能够成功地应用到医疗保健领域，并在此类变化之前用于建立安全案例论证（并在系统的整个生命周期中维持这些论证），那么可能会减少对患者和工作人员的意外后果，并促进有益的变化。

DESCRIPTION (provided by the applicant): There are 3 broad, long-term objectives for this proposal: 1) to extend the techniques of proactive risk assessment (PRA) used in high hazard industries into a health care setting, 2) to adapt the technique of creating a 'safety case' for a system change (also common in high hazard industries) to a health care setting; and 3) to examine the concepts of resilience engineering for use in supplementing a PRA. The case of replacing manual status boards in emergency departments (EDs) with computerized tracking systems will be used as a 'test bed' for the project. The specific aims of the project therefore are: 1. To identify the specific ways in which the status board supports patient safety, or poses risks to patients. 2. To conduct a PRA for replacing manual with computer-based status boards in EDs. Because risks may vary under different operating conditions, this will be a phased risk assessement. 3. To produce a 'safety case' argument for that change based on the results of the PRA exercise. 4. To produce a generalizable methodology for conducting such assessments in health care in the future. Methods. Prior work on the cognitive properties of the status board will be used to identify functionality with direct implications for patient safety. Process mapping techniques, direct observations of work and semistructured interview with ED staff will be used to gather data on system operations. These will be analyzed in a sociotechnical PRA framework. The results will be independently reviewed panel to increase generality. The project has substantial relevance to public health. Health care organizations commonly make major changes in processes, people and technology (eg, opening specialized trauma or stroke centers, or installing computerized provider order entry systems) with little or no prospective examination of the hazards that may be induced by such changes. If PRA methods can be successfully transported to health care and used to build safety case arguments prior to such changes (and to maintain those arguments over the life of the system), unintended consequences for patients and staff may be reduced, and beneficial change facilitated.