Pediatric patient safety learning laboratory to re-engineer continuous physiologic monitoring systems

项目摘要/摘要 这项提议的总体目标是在以下地点建立儿科患者安全学习实验室(PSLL) 费城儿童医院(CHOP)。以跨学科的方式工作，印章PSLL调查人员 将协作应用创新的科学方法，将各自的学科整合在一起，以实现 分析和重新设计医院和家庭生理监测系统以最大限度地提高警报的目标 信息性。目前用于在医院、病房和家中连续监测儿童生命体征的系统 设置生成警报，旨在警告照顾者-医院的护士和在家的父母- 需要他们立即注意的情况。然而，这两个系统都存在信息量低和 从而造成患者安全风险，例如与危重疾病检测、诊断和诊断相关的警报疲劳 治疗。这项PSLL汇集了CHOP、宾夕法尼亚大学和ECRI研究所的专业知识 在不同的领域，包括患者安全、儿科医院医学、新生儿、护理、系统 工程、人为因素、设计、医疗器械开发、电子健康记录临床决策 支持、认知信息学、模拟和生物统计学。该项目的具体目标是(1)重新设计 监测急性护理病房住院儿童的系统，重点是减少非信息性 警报和加快护士对危急事件的反应，以及(2)重新设计监测系统 家庭中患有支气管肺发育不良的婴儿，重点是减少无关紧要的低氧血症警报 以及改善临床医生获取可用的纵向脉搏血氧饱和度数据以通知补充氧气的情况 治疗。每个目标都将经过问题分析、设计、开发、 实施和评估。该项目将使用基于系统工程倡议的框架 针对患者安全(SEIPS)模型和双进程理论，并将应用法医等创新方法 事故调查、视频报警分析和现场模拟，以分析和评估监控系统。 最终产品将是重新设计的医院和家庭生理监测系统，以及 美国顶尖儿童医院之一的可持续儿科患者安全学习实验室。

PROJECT SUMMARY/ABSTRACT The broad objective of this proposal is to establish a pediatric Patient Safety Learning Laboratory (PSLL) at Children’s Hospital of Philadelphia (CHOP). Working in a transdisciplinary fashion, CHOP PSLL investigators will collaboratively apply innovative scientific approaches that integrate their respective disciplines to achieve the goal of analyzing and re-engineering hospital and home physiologic monitoring systems to maximize alarm informativeness. Current systems used to continuously monitor children’s vital signs in hospital ward and home settings generate alarms intended to warn caretakers— nurses in the hospital and parents at home— of conditions that warrant their immediate attention. However, both systems suffer from low informativeness and thus pose patient safety risks such as alarm fatigue that are relevant to critical illness detection, diagnosis, and treatment. This PSLL brings together expertise from CHOP, University of Pennsylvania, and the ECRI Institute in diverse areas including patient safety, pediatric hospital medicine, neonatology, nursing, systems engineering, human factors, design, medical device development, electronic health record clinical decision support, cognitive informatics, simulation, and biostatistics. The project’s Specific Aims are (1) Re-engineer the system of monitoring hospitalized children on acute care wards, with a focus on reducing non-informative alarms and accelerating nurse responses to critical events, and (2) Re-engineer the system of monitoring infants with bronchopulmonary dysplasia at home, with a focus on reducing non-informative hypoxemia alarms and improving clinicians’ access to usable longitudinal pulse oximetry data to inform supplemental oxygen treatment. Each Aim will proceed through a stepwise process of problem analysis, design, development, implementation, and evaluation. This project will use a framework based on the Systems Engineering Initiative for Patient Safety (SEIPS) model and Dual Process Theory, and will apply innovative methods such as forensic accident investigation, video alarm analysis, and in situ simulation to analyze and evaluate monitoring systems. The end products will be redesigned systems for physiologic monitoring in hospitals and homes and a sustainable pediatric Patient Safety Learning Laboratory at one of the top children’s hospitals in the nation.