Improving Emergency Department Management of Adults with Sickle Cell Disease

描述（由申请人提供）：本研究实施和改进质量的项目将重新设计成人镰状细胞病（SCD）急诊科（ED）管理流程。该项目将使用失效模式、影响和关键性分析（FMECA）来识别使用急诊科镰状细胞需求和优势评估（ED-SCANS）所涉及的系统和流程中的漏洞、风险和弱点（失败），（一种决策支持工具，旨在提高成人SCD的护理质量）。每个故障的根本原因将被确定，然后重新设计。建议项目的目的是：(1)对EDSCANS关于评估和管理SCD患者的四项关键决策所涉及的工作流程和操作系统和过程进行前瞻性风险评估、失效模式影响和关键分析（FMECA）；在两个学术医疗中心应用FMECA来检查ed - scan的四个关键决定；(2)为ED-SCANS的四项决策制定和实施标准化的流程和干预措施；(3)对各现场的质量改进实施情况进行正式的程序评价；（3.1）报告过程评价措施，包括过程改进干预措施的实施成功、相关的促进因素和障碍；（3.2）报告通过质量改进干预措施影响的选定患者和临床医生结果测量的初步数据；(4)开发一个工具箱，用于传播和实施有效的系统和流程，以支持在其他资源匮乏的美国医院的急诊科使用ed - scan。两个中心将组成质量改进小组，设计干预措施，以分配正确的分诊分数，改善快速、积极的镇痛管理，识别严重疾病高风险患者或频繁急诊管理或住院的患者，并确定急诊期间SCD成人患者的医疗和心理社会转诊需求。计划、实施、研究、行动、快速循环质量改进过程将用于快速评估干预措施对研究结果的影响，并允许对干预措施进行修改。将使用混合方法进行正式的计划评估，以评估计划的影响。临床医生将参加半年一次的调查，以评估项目实施的成功与否，每两年一次。在项目结束时，将在每个地点进行两个焦点小组，以评估项目的成功与否。将进行结构化的医疗记录审查和患者访谈，以衡量干预措施对患者预后的影响。将开发一个包含协议、教育工具和其他材料的工具箱，以帮助传播到其他急诊科。

DESCRIPTION (provided by applicant): This researching implementation and change while improving quality project will re-design the process of emergency department (ED) management for adults with sickle cell disease (SCD). The project will use the Failure Modes, Effects, and Criticality Analysis (FMECA) -- to identify the vulnerabilities, risks, and weak points (failures) in the systems and processes involved in using the Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), (a decision support tool developed to improve the quality of care for adults with SCD). The root causes of each failure will be identified, then re-designed. The aims for the proposed project are to (1) Conduct a proactive risk assessment, Failure Modes Effects and Criticality Analysis (FMECA) of the workflow and operational systems and processes involved in four key decisions of the EDSCANS regarding evaluation and management of SCD patients by; applying a FMECA at two academic medical centers to examine four key ED-SCANS decisions; (2) Develop and implement standardized processes and interventions for each of the four decisions of the ED-SCANS; (3) Conduct a formal program evaluation of the quality improvement implementation at each site by; (3.1) reporting process evaluation measures including implementation success, associated facilitators and barriers of process improvement interventions; and (3.2) reporting preliminary data for selected patient and clinician outcome measures to be effected by the quality improvement interventions; and (4) Develop a toolbox for dissemination and implementation of effective systems and processes to support use of the ED-SCANS in EDs at additional low resource US hospitals. Two centers will form quality improvement teams and design interventions targeted to assign correct triage scores, improve rapid, aggressive analgesic management, identify patients at high risk for severe disease or those with frequent ED management or hospitalizations, and identify medical and psychosocial referral needs for adults with SCD during an ED visit. The plan, do, study, act, rapid cycle quality improvement process will be used to rapidly assess the affect of interventions on study outcomes and allow for modifications in the interventions. A formal program evaluation will be conducted using mixed methods to evaluate the affect of the program. Clinicians will participate in semi-annual surveys to evaluate success of program implementation bi-annually, and two focus groups will be conducted at each site toward the end of the project to evaluate program success. Structured medical record review and patient interviews will be conducted to measure the affect of interventions on patient outcomes. A toolbox of protocols, educational tools, and other materials will be developed to help disseminate to other emergency departments. PUBLIC HEALTH RELEVANCE: Sickle cell disease (SCD) is a chronic disease with significant morbidity and mortality as reflected by the median age of death; 42 for males, and 48 for females. Persons with SCD often require care in an emergency department and this experience is often frustrating for both the patient and emergency department (ED) clinician. The proposed project will apply an investigator developed, NIH supported, emergency department decision support tool, to guide a formal quality improvement process at two emergency departments, and re- design the process of ED care.