Just-In-Time Methods For Understanding Near-misses, Injuries & Risk Factors

描述（由申请人提供）：本研究直接响应NIOSH PAR 12-252，其特别要求提出建议，以提高我们对与职业病和伤害相关的风险和条件的理解，并通过检查健康和安全很少调查的人群来增加科学知识。这项研究的结果将为设计新的机构监测系统和干预措施提供必要的信息，以防止儿科医疗服务提供者（PHCP）的不良职业健康后果。医疗保健人员经常遇到健康和安全危害，其后果会影响员工（通过营业额、工作满意度、绩效和整体健康）、患者（通过较差的护理和安全质量）和组织（通过损失工时、赔偿要求、工作更换/培训和对组织健康/安全承诺的不良看法）。关于风险因素、未遂事故和伤害的发生率及其时间趋势的准确数据对于制定干预措施以减轻与工作有关的不良健康后果的负担至关重要。然而，研究表明，由于时间限制，不愿报告，症状自我管理，同伴压力不报告，工人赔偿程序的挫折感，受伤的“正常感”和害怕报复，医疗保健中的伤害漏报很常见。为了便于准确和 及时的伤害报告，监测系统需要得到明确的实践政策的支持，鼓励伤害报告和未遂事故，如果忽视可能会导致对工作人员和病人的伤害。近距离事故的重要性早已被纳入其他高风险行业的监控系统，如航空，核设施和军事，因为每次发生有助于了解潜在的故障模式，可能是更严重的伤害的先兆。该研究的目的是：确定PHCP之间的近距离失误和伤害的频率和类型，并评估使用实时数据收集方法作为医疗机构主动伤害监测基础的可行性。第二个目标是评估个人和工作因素与这些事件的关系。这些目标将通过以下具体目标实现：1）确定在独立儿科医院工作的PHCP经历的未遂和伤害的数量; 2）比较语音记录和传统数据收集; 3）评价基于语音记录的主动监测系统的可行性;以及4）评价个人和工作因素对未遂和伤害的关联。随机选择的PHCP将在语音记录器上记录总共1,000个两周的时间段内的未遂事件和受伤事件。通过机构监测报告的伤害将与语音记录报告进行比较，以确定低报伤害的发生率。将利用调查和重点小组来评估报告的倾向和可行性。基线和研究完成时的调查将衡量个人和工作因素及其与伤害和险些事故的关联。

DESCRIPTION (provided by applicant): This study directly responds to NIOSH PAR 12-252 which specifically requests proposals that enhance our understanding of risks and conditions associated with occupational diseases and injuries and add to scientific knowledge by examining a population whose health and safety is seldom investigated. Results from this study will provide information necessary for designing new institutional surveillance systems and interventions to prevent adverse occupational health outcomes among pediatric healthcare providers (PHCPs). Healthcare personnel routinely encounter health and safety hazards with consequences that affect the employee (through turnover, job satisfaction, performance and overall health), the patient (through poorer quality of care and safety), and the organization (through lost work-time, compensation claims, job replacement/training and poor perception of organizational commitment to health/safety). Accurate data on risk factors, the incidence of near- misses and injuries, and their time trends are essential for developing interventions to reduce the burden of work-related adverse health outcomes. However, research has shown that injury under-reporting in healthcare is common due to time constraints, reluctance to report, symptom self-management, peer pressure not to report, frustration with workers' compensation procedures, a sense of 'normalcy' of being injured and fear of reprisal. To facilitate accurate and timely injury reporting, surveillance systems need to be supported by clear practice policies encouraging injury reporting and near-misses, that if ignored may lead to harm for both staff and patients. The importance of near-misses has long been integrated in the surveillance systems of other high-risk industries such as aviation, nuclear facilities and the military because each occurrence contributes to an understanding of potential failure patterns that may be antecedents of more severe injuries. The study's objectives are to: determine the frequency and type of near-misses and injuries among PHCPs and assess the feasibility of using a real-time data collection method as the basis for active injury surveillance in healthcare organizations. A secondary objective is to assess the relationship of individual and work factors with these events. The objectives will be achieved by the following specific aims: 1) Determine the number of near-misses and injuries experienced by PHCPs working in a freestanding pediatric hospital; 2) Compare voice recording and conventional data collection; 3) Evaluate the feasibility of an active surveillance system based on voice recording; and 4) Evaluate the association of individual and work factors on near-misses and injuries. Randomly selected PHCPs will record near-misses and injuries on voice recorders for a total of 1,000 two-week periods. Injuries reported through institutional surveillance will be compared to voice-recorded reports to determine the prevalence of under-reported injuries. Surveys and focus groups will be used to assess reporting preference and feasibility. Surveys at baseline and study completion will measure individual and work factors and their associations with injuries and near-misses.