Improving Cancer Care Patient Safety through Pathology Training Simulation

描述（由申请人提供）：诊断测试中不受控制的实践可变性导致了高错误率和飙升的成本。在肿瘤病理诊断检测领域，超过70%的患者诊断检测样本存在缺陷，在美国每年160万确诊癌症患者中，一个错误影响了超过23万患者的治疗。在过去的几十年里，这个错误频率保持不变。我们认为，基于模拟的医学教育（SBME）与质量改进的精益方法相结合，有可能从根本上改变导致不安全做法的潜在文化和流程，从而改善癌症诊断护理。在过去的一年里，我们在科罗拉多大学丹佛分校（UCD）建立了一个基于解剖病理学教育的模拟实验室（PSL）。在病理学住院医师教育中纳入模拟训练有几个潜在的好处：降低患者风险，消除实践变异性，有意识的实践，在离线环境中发展复杂的技能，密切监测实践与分级责任，在模拟失败的环境中实践，以及在高病例量的实践中，包括罕见和具有挑战性的患者标本，特别是容易出错。我们假设，解剖病理学精益- sbme将取代无效和过时的培训模式，并培养出高技能、犯更少错误、团队关注和质量改进培训的病理学家。我们将进行一项单机构、双队列病例对照研究，将大学医院解剖病理学轮转的住院医生分为两组：1)综合精益中小企业组和2)传统学徒组。我们将比较：1)住院医生的表现结果和2)肿瘤病理患者的安全结果，这两个领域在三年的间隔。我们假设，通过标准化和有效的评估工具来衡量，与传统的解剖病理学实习医师相比，Lean-SBME实习医师将表现出更高的能力水平，并且整个实施后的实验室将减少错误，通过标准化的质量保证工具来衡量。因此，患有癌症或疑似癌症的体征和症状的患者将获得更安全的医疗保健，并且由于诊断测试服务的改进，结果将得到改善。

DESCRIPTION (provided by applicant): Uncontrolled practice variability in diagnostic testing has contributed to high rates of error and skyrocketing costs. In the field of oncologic pathology diagnostic testing, more than 70% of patient diagnostic testing samples are defective and an error affects the management of more than 230,000 of the 1.6 million patients diagnosed with cancer annually in the United States. This error frequency has remained unchanged over the last several decades. We believe that simulation based medical education (SBME) combined with Lean methods of quality improvement has the potential to improve cancer diagnostic care by fundamentally changing the underlying culture and processes that contribute to unsafe practices. Within the past year, we initiated the development of an anatomic pathology education-based simulation laboratory (PSL) at the University of Colorado Denver (UCD). The incorporation of simulation training in pathology residency education offers several potential benefits: reduction of patient risk, elimination of practice variability, deliberate practice, development of complex skill sets in an off-line environment, close monitoring of practice with graduated responsibility, practice in environments with simulated failure, and practice with high case volume that include rare and challenging patient specimens specifically prone to error. We hypothesize that anatomic pathology Lean-SBME will replace ineffective and outdated models of training and produce pathologists who are highly skilled, make fewer errors, team-focused and trained in quality improvement. We will perform a single institution, double cohort case-control study by separating residents on the University Hospital anatomic pathology rotation into two groups: 1) an integrated Lean-SBME tract and 2) a traditional apprenticeship tract. We will compare: 1) resident performance outcomes and 2) oncologic pathology patient safety outcomes for the two tracts over a three year interval. We hypothesize that compared to anatomic pathology traditional apprenticeship residents, Lean-SBME residents will perform at higher levels of competence, measured through standardized and validated assessment tools, and the entire post-implementation laboratory will makes fewer errors, measured by standardized quality assurance tools. As a result, patients who have cancer or signs and symptoms suspicious for cancer will receive safer healthcare and will have improved outcomes as a result of improved diagnostic testing services. PUBLIC HEALTH RELEVANCE: The public health relevance of this study primarily lies in the fact that the University of Colorado Hospitals (UCH) serves as one of the major "safe harbor" hospitals in the area; the service population is comprised of 14% of families below poverty level, 30% who do not speak English at home, and 30-40% who are not white. Our goal is to improve the quality of care and patient safety in this population.