Bundling Effective Resident Hand Off Practices to Improve Patient Safety

描述(由申请人提供)：卫生保健研究和质量机构和医学研究所呼吁采用改进的移交工具和流程，以解决医院中有害通信故障的高发生率。比较有效性研究(CER)已经确定了可以改善移交质量和患者安全的实践，但这些基于CER的实践在医疗中心之间的采用一直很缓慢。在波士顿儿童医院最近完成的一项试点研究中，我们发现，居民迅速采用了居民转接捆绑(RHB)，并与发现的医疗差错减少了43%相关。我们现在寻求在八个主要的儿科住院医生计划中实施RHB。RHB包括三个主要内容：1)TEAMSTEPPS培训，这是由AHRQ和国防部开发的基于证据的团队合作、领导力和沟通培训计划；2)引入标准化的口头协议和助记法，这与提高移交质量和减少医疗差错有关；以及3)引入标准化的书面/计算机化移交工具，事实证明，这些工具可以提高移交质量，并与降低不良事件发生率有关。我们将应用密集的最先进的前瞻性安全监测方法、直接观察和时间运动分析，其中每一种方法我们都在以前的研究中使用过，以评估RHB的有效性。我们还将寻求确定RHB的采用和影响被a)医院层面的因素改变的方式，包括强大的计算机系统的存在和主治医生对注销的监督；以及b)患者层面的因素，特别是传递功能限制或残疾的慢性疾病的存在，这是优先情况。为了协助在PRIS网络、IIPE和其他地方进行传播，我们将开发一个工具包，它将提供我们的调查结果摘要，并描述成功移交计划的基本组成部分。我们假设，通过将基于CER的移交干预措施捆绑在一起并通过研究和教育网络传播，我们将加快采用基于证据的移交实践，最终将显著减少医疗错误、口头和书面错误沟通，并提高全国医院的医生满意度和工作流程。 与公共卫生相关：已证明，采用经过验证的沟通策略可以降低医院内沟通失误的风险，并提高患者的安全。我们建议研究实施住院医生移交捆绑(RHB)的效果，该捆绑将包括对住院医生的团队合作培训、口头移交策略以及八个主要医疗中心的书面或计算机化移交工具。我们将严格衡量RHB对患者安全和护理流程的影响，并将研究医院因素(例如是否存在复杂的计算机系统)和患者因素(例如是否存在复杂的慢性病)如何影响跨地点采用。

DESCRIPTION (provided by applicant): The Agency for Healthcare Research and Quality and the Institute of Medicine have called for the adoption of improved handoff tools and processes to address the high incidence of harmful communication failures in hospitals. Comparative effectiveness research (CER) has identified practices that improve handoff quality and patient safety, but adoption of these CER-based practices across medical centers has been slow. In a pilot study recently completed at Children's Hospital Boston, we found that introduction of a Resident Handoff Bundle (RHB) was rapidly adopted by residents and was associated with a 43% reduction in detected medical errors. We now seek to implement the RHB in eight major pediatric residency programs. The RHB includes three major elements:1) TeamSTEPPS training, an evidence-based teamwork, leadership, and communications training program developed by AHRQ and the Department of Defense; 2) Introduction of standardized verbal protocols and mnemonics, which have been associated with improved handoff quality and reduce medical errors; and 3) Introduction of standardized written/computerized handoff tools, which have been shown to improve handoff quality and have been associated with reduced rates of adverse events. We will apply intensive state-of-the-art prospective safety surveillance methodologies, direct observation, and time motion analysis, each of which we have used in prior studies, to assess the effectiveness of the RHB. We will additionally seek to determine the manner in which the RHB's adoption and impact is modified by a) hospital-level factors, including the presence of a robust computer system and attending physician supervision of sign-out; and b) patient-level factors, especially the presence of a chronic disease that conveys functional limitations or disability, a priority condition. To assist with dissemination throughout the PRIS network, the IIPE, and beyond, we will develop a toolkit that will provide a summary of our findings and will describe the fundamental building blocks of a successful handoff program. We hypothesize that by bundling CER-based handoff interventions together and disseminating them through a research and education network, we will accelerate adoption of evidence based handoff practices which will ultimately result in significant reductions in medical errors, verbal and written miscommunications, and improved physician satisfaction and workflow in hospitals nationwide. PUBLIC HEALTH RELEVANCE: Adoption of proven communication strategies has been shown to decrease the risk of miscommunications in hospitals and improve patient safety. We propose to study the effect of implementing a Resident Handoff Bundle (RHB) that will include teamwork training for residents, verbal handoff strategies, and a written or computerized handoff tool in eight major medical centers. We will rigorously measure the effects of the RHB on patient safety and care processes, and will study how hospital factors (e.g. presence of sophisticated computer systems) and patient factors (e.g. presence of a complex chronic disease) affect adoption across sites.