Communication Processes, Technology, and Patient Safety in Ambulatory Oncology Settings

门诊肿瘤学环境中的沟通过程、技术和患者安全 本研究的目的是描述临床医生沟通过程，沟通技术， 和不良患者事件的样本门诊化疗的做法，并检查如何这些 实践和技术影响安全的化疗施用。安全的化疗需要 临床医生之间的有效沟通，以在潜在致命事件发生前识别和管理不良事件 并发症随之而来。我们不知道在多大程度上，沟通过程，如使用脸- 在化疗实践中发生面对面的临床医生交互。利用通信技术， 流动护理可能改变工作流程，导致中断增加，这是导致用药错误的已知因素， 以及其他意想不到的后果，例如促进用药错误风险的订单输入系统。 具体目标：我们寻求：（1）表征临床医生沟通过程，沟通技术， 和不良患者事件;（2）检查临床医生沟通过程中的变化， 通信技术影响化疗提供实践;（3）评估障碍和促进因素， 安全的化疗 设计和方法：本研究将采用序贯混合方法设计，从定量分析开始， 调查之后是两部分的定性阶段。目标1的调查结果将提供详细的评估 当前的通信过程和技术的使用，我们将与以下比率相关：1）化疗- 计划治疗当天治疗延迟，2）计划外急诊科访视或 化疗期间因急性不良事件入院，和3）急诊科就诊 化疗相关的毒性在目标2中，我们将选择一个有目的的实践样本， 目标1中确定的通信流程和技术。我们将对实践进行分层， 通信技术，但与高不良事件发生率作斗争，而实践并没有很多 技术，但仍然表现良好。通过观察、临床医生跟踪和患者访谈，我们 应探讨沟通过程和技术如何影响上述不良患者事件。 在目标3中，我们将把目标1和目标2中的数据传播给实践场所的领导者和临床医生，他们将确定 安全化疗的促进者和障碍，因此我们可以为未来制定实践水平的干预措施。 试验.由于这些障碍和促进因素可能会因临床表现而异，因此我们将引出障碍， 在我们的三个不良患者事件的措施，从不同水平的性能实践的促进者。 意义：本研究将强调临床医生沟通过程和沟通的变化 技术促进或阻碍安全的化疗输送。我们提出的研究是少数几个 检查如何在不同的实践中提供护理，帮助我们为组织交付的努力提供信息 以最大限度地降低患者风险的方式进行实践。

Communication Processes, Technology, and Patient Safety in Ambulatory Oncology Settings The purpose of this study is to characterize clinician communication processes, communication technologies, and adverse patient events in a sample of ambulatory chemotherapy practices and to examine how these practices and technologies influence safe chemotherapy administration. Safe chemotherapy delivery requires effective communication among clinicians to identify and manage adverse events before potentially lethal complications ensue. We do not know the extent to which communication processes such as the use of face- to-face clinician interactions occur in chemotherapy practices. The use of communication technologies in ambulatory care may alter workflow causing increased interruptions, a known contributor to medication errors, and other unintended consequences such as order entry systems that facilitate medication error risks. Specific Aims: We seek to: (1) characterize clinician communication processes, communication technologies, and adverse patient events; (2) examine how variation in clinician communication processes and communication technologies affect chemotherapy delivery practice; and (3) assess barriers and facilitators to safe chemotherapy delivery. Design and Methods: This study will use a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from Aim 1 will provide a detailed assessment of current communication processes and use of technologies, which we will correlate with rates of: 1) chemo- therapy treatments delayed on the day of planned treatment, 2) unplanned emergency department visit or admission for acute adverse events during chemotherapy administration, and 3) emergency department visits for chemotherapy-associated toxicity. In Aim 2 we will select a purposive sample of practices with the range of communication processes and technology identified in Aim 1. We will stratify practices equipped with adequate communication technologies but struggling with high adverse event rates, and practices that do not have a lot of technologies but still perform well. Through observation, clinician shadowing, and patient interviews, we shall explore how communication processes and technology influence the adverse patient events listed above. In Aim 3 we will disseminate data from Aims 1 and 2 to leaders and clinicians in practice sites who will identify facilitators and barriers to safe chemotherapy delivery, so we can develop practice-level interventions for future testing. As these barriers and facilitators will likely vary across clinic performance, we shall elicit barriers and facilitators from practices at varying levels of performance on our three adverse patient event measures. Significance: This study will highlight how variation in clinician communication processes and communication technologies either promote or hamper safe chemotherapy delivery. Our proposed study is one of the few to examine how care is delivered across diverse practices, helping us to inform efforts to organize delivery practices in ways that minimize risks to patients.