Improving ED Quality and Safety by Enhancing Operations and Quality Management

描述（由申请人提供）：Khare博士是急诊医学系的助理教授，并在西北大学医疗保健研究所担任第二职务。Khare博士的长期目标是成为一名独立的调查员，主要关注改善急诊科（艾德）患者的护理。艾德是一个独特的医疗环境，面临着实现高质量护理的重大挑战。急诊室通常人满为患，评估许多未分化、时间敏感和复杂疾病的患者，无法安排、预测或有效限制寻求护理的患者数量和类型。Khare博士假设高质量的艾德护理和患者结果涉及（1）有效的操作（例如，将患者到达艾德的时间保持在他们最少看医生的时间）和（2）稳健的、标准化的质量管理方法（例如，自我导向的质量改进过程，旨在评估个别医院的缺陷）。运营和质量管理的差异可以部分解释为什么类似的医院在质量指标得分和结果上差异如此之大。本项目的目标是进一步评估特定的艾德操作质量管理特征，以确定和实施可推广的过程改进，以提高质量和安全的ED。在本项目中，Khare博士将重点关注艾德的一个关键质量指标评分：急性ST段抬高型心肌梗死（STEMI）患者的"经皮介入治疗（PCI）时间"质量指标评分。如果在90分钟内没有实现再灌注或PCI，STEMI患者的死亡率会增加。尽管有大量关于该过程实施的文献，但PCI时间质量指标仅在70%的时间内实现。通过这个奖项，Khare博士打算获得必要的技能和知识，成为未来艾德质量和患者安全研究的国家领导者。为了实现这一目标，他将：（1）通过结合几个大型数据库来评估艾德手术特征与急性心肌梗死死亡率之间的相关性，培养定量研究方法的技能;（2）通过使用故障模式、影响和危害性分析，培养定性研究方法的技能;了解达到PCI时间最佳质量分数所需的质量管理特征;（3）开发和实施流程改进，以解决最严重的PCI时间流程问题;以及（4）根据1、2和3的发现，开发一个工具包，帮助医院和急诊科评估操作改进的机会，并提供一种评估和解决PCI时间质量管理问题的方法。 公共卫生相关性：这项研究将填补一个重要的空白，在知识和理解的质量和安全性的一个复杂的，高敏度的，和时间依赖性的过程-实现挽救生命的治疗患者心脏病发作的有效方式。目前，有相当大的压力，有效地提供正确的治疗，为正确的病人，在正确的时间，特别是给予良好的照顾，心脏病发作的病人。为患者提供优质的医疗保健需要在急诊室完成，急诊室的环境通常过于拥挤，需要照顾患有许多复杂疾病的患者。因此，必须严格研究和加强对急诊科运作方式及其质量管理方法的评估，以便为美国人民提供最好的护理。

DESCRIPTION (provided by applicant): Dr. Khare is an Assistant Professor in the Department of Emergency Medicine and has a secondary appointment at the Institute for Healthcare Studies at Northwestern University. Dr. Khare's long-term goal is to become an independent investigator with a primary focus on improving the care for patients coming to the Emergency Department (ED) with time-sensitive diseases. The ED is a unique healthcare setting that faces significant challenges to achieving high quality care. EDs are often overcrowded, evaluate many patients with undifferentiated, time-sensitive, and complicated diseases, and cannot schedule, predict, nor effectively limit the number and types of patients seeking care. Dr. Khare hypothesizes that high quality ED care and patient outcomes involve (1) efficient operations (e.g., keeping the time a patient arrives to the ED to when they see a physician at a minimum) and (2) robust, standardized quality management approaches (e.g., self-directed quality improvement processes, aimed at evaluating an individual hospital's deficiencies). Variation in both operations and quality management may explain, in part, why similar hospitals vary so dramatically on quality indicator scores and outcomes. The objectives of this project are to further evaluate specific ED operational quality management characteristics to identify and implement generalizable process improvements to enhance quality and safety in EDs. For this project, Dr. Khare will focus on one key quality indicator score in the ED: "time-to- percutaneous intervention (PCI)" quality indicator score for acute ST-elevation myocardial infarction (STEMI) patients. Patients with STEMI have increased mortality if reperfusion or PCI is not achieved within 90 minutes. Although there is an extensive literature about implementation of this process, the time-to-PCI quality indicator is achieved only 70% of the time. With this award, Dr. Khare intends to gain the skills and knowledge necessary to become a future national leader in ED quality and patient safety research. To fulfill this goal, he will: (1) develop skills in quantitative research methods by combining several large databases to evaluate the correlation between ED operational characteristics and acute myocardial infarction mortality; (2) develop skills in qualitative research methods through the use of a Failure Mode and Effects and Criticality Analysis, to understand the quality management characteristics necessary to achieve optimal quality scores for time-to-PCI; (3) develop and implement process improvements to address the most serious time-to PCI process concerns; and (4) develop a toolkit, based on the findings of 1, 2, and 3, that will assist hospitals and EDs in assessing opportunities for operational improvement and offer an approach for assessing and resolving quality management issues for time-to-PCI. PUBLIC HEALTH RELEVANCE: This study will fill an important gap in knowledge and understanding of the quality and safety of a complex, high acuity, and time-dependent process - achieving life-saving treatments for patients with heart attacks in an efficient manner. Currently, there is considerable pressure to efficiently provide the right treatment, for the right patient, at the right time, specifically giving excellent care to patients with heart attacks. Giving excellent healthcare to patients needs to be done in the emergency department, an environment that is often overcrowded and takes care of patients with many complicated diseases. Thus, evaluation of the way emergency departments operate and their quality management approaches must be rigorously studied and enhanced to provide the best care to the American people.