Development, Validation and Application of a Quantitative Hazard Assessment and Remediation Tool to Mitigate Risk in the Healthcare Built Environment

项目总结/摘要 该提案旨在开发、验证和测试一个标准化工具， 物理医疗环境中的潜在风险。危害评估和补救 工具（哈特）将分三部分开发。首先，该提案将建立一个类内 将哈特工具应用于模拟复苏的专家评估者的相关系数（0.9）。 参考框架培训将用于评估评估工具的评定者间可靠性， 独立的评分员团队。其次，哈特工具将用于评估该工具的能力， 区分具有各种物理属性的临床环境（例如， 在关键临床试验期间， 干预措施。此外，还将进行分析，以评价 哈特评分和关键临床性能指标的完成情况（例如，CPR依从性 胸部按压器每两分钟旋转一次的指南）。最后，该提案旨在 开发和测试一种方法，以帮助修复临床环境中的危害。 哈特工具的基线测量，以及模拟后的员工调查， 将被用于确定创伤复苏环境的改善。哈特工具 将应用于改善的环境，以确定是否变化产生更有利的 哈特评分。该提案第二和第三个目标的次要成果包括团队 沟通和协调以及医生和护士的工作量。虽然预- 施工仿真越来越受欢迎，迄今为止还没有标准化、定量化、有效化的 有工具可用于识别临床环境和系统中的潜在危险。我们提出 开发和验证一个强大的定量工具，可应用于临床空间， 设计或现有空间，以评估和补救物理危害。

Project Summary/Abstract The proposal aims to develop, validate and test a standardized tool that intended to assess latent risks in the physical healthcare environment. The Hazard Assessment and Remediation Tool (HART) will be developed in three parts. First, the proposal will establish an intra-class correlation coefficient (0.9) for expert raters applying the HART tool to simulated resuscitations. Frame of reference training will be used to assess inter-rater reliability of the tool using a separate team of raters. Second, the HART tool will be used to assess the tool's ability to discriminate between clinical environments with various physical attributes (e.g. comparing minimum required room size against twenty percent larger rooms) during critical clinical interventions. Additionally, analyses will be conducted to evaluate the correlation between HART score and completion of key clinical performance metrics (e.g. adherence to CPR guideline of chest compressor rotations every two minutes). Lastly, the proposal aims to develop and test a methodology to aid in the remediation of hazards in the clinical environment. Baseline measurements from the HART tool, in conjunction with staff surveys post-simulation, will be used to identify improvements in the trauma resuscitation environment. The HART tool will be applied to the improved environment to determine if changes produce a more favorable HART score. Secondary outcomes to the second and third aims of the proposal include team communication and coordination as well as physician and nurse workload. Although pre- construction simulation is growing in popularity, to date no standardized, quantitative, validated tools are available to identify latent hazards in clinical environments and systems. We propose to develop and validate a robust, quantitative tool that can be applied to clinical spaces under design or to existing spaces to assess and remediate physical hazards.