Mentored Implementation of I-PASS for Better Handoffs and Safer Care

描述（由申请人提供）：沟通失败导致了医院中三分之二最严重的可预防不良事件。因此，提高沟通质量，特别是“交接”，已成为医疗保健研究和质量机构（AHRQ）和联合委员会的主要患者安全目标。然而，直到最近，还缺乏高质量的数据来证明移交改进工作的有效性。我们在波士顿儿童医院（Boston Children’s Hospital）进行了一个试点项目，在这个项目中，我们发现，旨在改善交接的一系列培训和流程变更干预措施的实施，与交接错误沟通的减少、住院医师工作流程的改善（减少在电脑前的时间，增加直接护理患者的时间）以及最重要的是，严重医疗差错的显著减少有关。在美国卫生与公众服务部（R18 AE000029）的资助下，我们完善并扩展了I-PASS项目，其中包括团队合作和交接培训的多模式交付（部分建立在AHRQ和国防部的TeamSTEPPS项目上）、交接模拟训练练习、口头助记器的引入、口头交接过程的变化（包括团队合作过程和环境变化）、打印交接工具。教师发展材料，以及文化变革运动。在一项9个中心的研究中，我们发现在各个站点实施I-PASS后，伤害患者的错误（可预防的不良事件）下降了34%，未遂/非有害医疗错误下降了26%。由于交接问题仍然是医院发病率和死亡率的主要来源，我们认为I-PASS的传播和实施可能对患者安全产生重要影响。医院医学学会制定了一种强有力的方法，即指导实施，已用于向全国医院广泛传播许多患者安全和质量干预措施；国家质量论坛和联合委员会授予指导实施项目2011年约翰·m·艾森伯格患者安全与质量奖，以表彰其在有效传播安全和质量护理干预措施方面取得的巨大成功。我们建议与医院医学学会（SHM）和住院儿科研究（PRIS）网络合作，采用SHM的指导实施方法，调整和实施I-PASS。我们的具体目标是：1)通过医院医学学会的指导实施计划，制定一个强有力的过程来实施和传播I- PASS；2)在32家教学医院有效实施I-PASS指导实施计划；3)建立一个工具包，通过住院儿科研究网络、医院医学学会等机构促进I-PASS的广泛传播。

DESCRIPTION (provided by applicant): Communication failures contribute to two thirds of the most serious preventable adverse events in hospitals. Improving the quality of communication, especially "handoffs," has consequently been a leading patient safety goal of the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission. Until recently, however, high-quality data demonstrating the effectiveness of handoff improvement efforts were lacking. We conducted a pilot project at Boston Children's Hospital in which we found that implementation of a bundle of training and process change interventions designed to improve handoffs was associated with reductions in handoff miscommunications, improvements in resident-physician workflow (less time at the computer, more time in direct patient care), and most importantly, a significant reduction in serious medical errors. With funding from the Department of Health and Human Services (R18 AE000029), we refined and expanded this bundle as the I-PASS program, which includes multi-modal delivery of teamwork and handoff training (built in part on AHRQ's and the Department of Defense's TeamSTEPPS program), handoff simulation training exercises, introduction of a verbal mnemonic, changes to the verbal handoff process (including teamwork process and environment changes), a printed handoff tool, faculty development materials, and a culture change campaign. In a 9-center study, we have found that following implementation of I-PASS across sites, errors that harmed patients (preventable adverse events) fell 34%, and near misses / non-harmful medical errors fell 26%. As handoff problems continue to be a major source of morbidity and mortality in hospitals, we believe that dissemination and implementation of I-PASS could have an important impact on patient safety. The Society of Hospital Medicine has developed a robust methodology, Mentored Implementation, which has been used to broadly disseminate numerous patient safety and quality interventions to hospitals nationwide; the National Quality Forum and the Joint Commission awarded the Mentored Implementation program the 2011 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality at the National Level, in recognition of its tremendous successes effectively disseminating safety and quality of care interventions. We propose to adapt and implement I-PASS in collaboration with the Society of Hospital Medicine (SHM) and the Pediatric Research in Inpatient Settings (PRIS) network, employing SHM's Mentored Implementation methodology. Our specific aims will be: 1) To develop a robust process for implementing and disseminating I- PASS through the Society for Hospital Medicine's Mentored Implementation Program; 2) To effectively enact the I-PASS Mentored Implementation Program in 32 teaching hospitals; and 3) To build a toolkit to promote widespread dissemination of I-PASS through the Pediatric Research in Inpatient Settings Network, the Society for Hospital Medicine, and beyond.