Workload, Workforce, and Quality of Care in Pediatric Hospitals

项目总结/摘要 在这项研究计划中，我们研究了工作负荷的动态方面， 劳动力和儿童医院的护理质量，并寻求解决方法 在医院测量利用率的问题，特别是在一般儿科护理环境中。我们 采用多学科方法来理解患者流量的复杂性， 应用循证管理和运筹学，了解能力如何 可能与医院环境中的需求/需要相匹配， 这关系到所提供护理的质量、安全性、有效性和效率。成果 将为卫生服务研究人员，医院领导， 监管机构和培训计划，以掌握劳动力的具体不平衡- 工作量匹配导致效率低下或护理质量降低。 初步工作的重点是制定和验证住院病人的管理措施， 工作量、劳动力和选定的质量终点（例如，住院时间衍生物、药物治疗 错误、安全事件和再入院）。目标1将完成 初步研究，以确定用于确定动态的行政数据的准确性 工作量，劳动力和护理质量的措施，在学术儿童医院。目的2 将确定与住院时间、再入院相关的工作量和劳动力因素， 一般儿科诊断的儿童用药错误。今后的工作旨在 制定预测规则，并审查业务战略，以防止或应对 工作量和劳动力不匹配，以优化质量和安全。最终目的 帮助临床医生和管理员优化工作量-劳动力平衡， 儿科医院设置，以实现安全，有效，高效，及时，以病人为中心， 对住院儿童的公平照顾。

Project Summary/Abstract In this research plan, we examine associations between dynamic aspects of workload, workforce, and quality of care at children's hospitals and seek to address methodological problems of measuring utilization at hospitals, particularly in a general pediatric care setting. We adopt a multidisciplinary approach to understanding the complex nature of patient flow by applying evidence-based management and operations research to understanding how capacity may be matched to demand/need in a hospital setting and the consequences of imbalance in this relationship for quality, safety, effectiveness and efficiency of care delivered. The outcomes of this project will provide valuable tools for health services researchers, hospital leadership, regulatory agencies, and training programs to grasp the specific imbalances of workforce- workload matching that result in inefficiency or reduced quality of care. Preliminary work has focused on developing and validating administrative measures of inpatient workload, workforce, and selected quality endpoints (e.g., length of stay derivatives, medication errors, safety events, and readmissions). Aim 1 will complete the validation outlined in preliminary studies to determine the accuracy of administrative data used to determine dynamic measures of workload, workforce, and quality of care at an academic children's hospital. Aim 2 will identify workload and workforce factors associated with length of stay, readmission, and medication errors for children with common general pediatrics diagnoses. Future work aims to develop a prediction rule and examine operational strategies to prevent or respond to periods of workload and workforce mismatch in order to optimize quality and safety. The ultimate purpose of this project is to help clinicians and administrators optimize workload-workforce balance in the pediatric hospital setting to achieve safe, effective, efficient, timely, patient-centered, and equitable care for hospitalized children.