Optimizing safety of mother and neonate in a mixed methods learning laboratory

描述(由申请人提供)：随着人们认识到医疗保健往往提供得很差、不足和过于昂贵而没有好处，美国对医疗保健的安全性和质量进行了越来越多的审查。在患者安全性研究中，有两个相互关联的临床领域处于萌芽阶段，即产妇和新生儿护理。由于与其他发达国家相比，美国的孕产妇和新生儿死亡率仍然较高，我们有一个令人兴奋的机会，通过包括定性研究方法、设计思维、模拟、对照试验和实施科学在内的多学科方法来推动医疗保健安全科学的发展。该项目将关注围产期护理的安全性，重点放在分娩和分娩上，这是美国住院治疗最常见的原因。从我们的方法中学到的原则也可能有助于研究医院其他领域的安全问题。因此，该项目不仅有可能为提高母亲和新生儿的安全和质量做出贡献，而且还有可能为医疗保健的一般安全科学做出贡献。我们的建议也有可能对患者的结局产生直接影响，因为研究的各个阶段必须在患者护理环境中进行。在这个拟议的项目中，我们将开展以下工作：1)建立围产期安全学习实验室，2)开发和测试最佳新生儿复苏数据显示，3)开发和测试最佳产妇数据显示，4)开发识别和防止产妇临床恶化的流程，以及5)开发最佳分娩套件的物理设计。我们的安全学习实验室将在四个相互关联的项目上开展工作：项目1：新生儿复苏的最佳交互数据显示。项目2：劳动力和分娩的最佳数据显示。项目3：提高对产妇临床恶化的认识，项目4：最佳分娩套件的物理设计。我们将通过建立安全学习实验室，汇聚产科、新生儿、护理、设计专家、工程师和家长代表，并使用模拟方法在四个项目中开发、试点和测试创新设计，扩大新生儿和孕产妇护理患者安全的知识库。

DESCRIPTION (provided by applicant): With the recognition that medical care is often poorly provided, deficient, and excessively costly without benefit, there has been increasing scrutiny on the safety and quality of healthcare in the U.S. Two interrelated clinical areas that are at a nascent stage in the study of patient safety are maternal and neonatal care. As the U.S. continues to have higher maternal and neonatal mortality compared to other developed countries, we have an exciting opportunity to advance the science of safety in healthcare with a multidisciplinary approach including qualitative research methods, design thought, simulation, controlled trials, and implementation science. This project will focus on the safety of perinatal care, with a focus on labor and delivery, which is the most common reason for hospitalization in the U.S. The principles learned from our approach may also serve to study safety issues in other areas of the hospital. Therefore, this project has the potential to not only contribute to improving safety and quality for mothers and newborns, but also contribute to the general science of safety in healthcare. Our proposal will also have the potential to have an immediate impact on patient outcomes, as stages of the research will necessarily be carried out in patient care settings. In this proposed project, we will perform work that will: 1) establish a perinatal safety learning laboratory, 2) develop and test an optimal neonatal resuscitation data display, 3) develop and test an optimal maternal data display, 4) develop a process to recognize and prevent maternal clinical deterioration, and 5) develop the optimal physical design of a labor and delivery suite. Our safety learning laboratory will perform work on four interrelated projects: Project #1: An optimal interactive data display for neonatal resuscitation. Project #2: An optimal data display for labor and delivery. Project #3: Improving recognition of maternal clinical deterioration, and Project #4: Physical design of the optimal delivery suite. We will expand the knowledge base on patient safety for neonatal and maternal care by establishing a safety learning laboratory, bringing together obstetrics, neonatology, nursing, design specialists, engineers, and parent representatives, and using simulation methodology to develop, pilot, and test innovative designs in the four projects.