Improving Interhospital Transfer of Patients with Neurologic Emergencies

项目摘要：每年有超过230万患者经历医院间转移（IHT）， 美国的大多数IHT来自急诊科，神经系统急症（NE） 最常见的原因之一。在IHT期间，交换信息和临床医生 与患者相比，沟通通常较差，这可能导致相关的不良结局 直接入住三级医院。虽然已经针对高度时间敏感性研究了IHT， 包括创伤、急性缺血性卒中（AIS）和心肌梗死在内的疾病，很少有工作集中在 非AIS内斯，如出血性卒中、创伤性颅内出血或癫痫发作。项目的目标是 通过执行故障模式和影响，了解非AIS NE的IHT过程， 危害性分析（FMECA），用于识别、表征最高风险失效并对其进行排序。选定数量 识别的高风险故障将成为以人为本的设计应用的目标， 干预最后，申请人将使用实施框架来实施干预措施，然后 采用混合执行效果分析方法进行可行性研究， 初步成效和实施情况。该项目的总体目标是为申请人， 急诊医学医生-科学家，成为风险评估的强大方法的领导者。 医疗保健提供系统和流程，以人为本的尖端设计的应用 方法和实施科学，以提高急诊护理的质量和安全，同时提高 以病人为中心在初级导师的指导下，S。Prabhakaran，MD，MS和共同导师J. Holl，MD，MPH，A. Naidech MD、MSPH和D. McCarthy，MD，MS，申请人将利用世界一流的 西北大学的机构优势，以提高他在医疗风险评估的技能 质量和患者安全、以人为本的设计、实施科学和前瞻性研究 设计有了这些技能，申请人将成为一个独立的健康服务的理想定位 和结果研究员，专注于开发和测试新的医疗保健提供干预措施， 急诊医学这份建议书结合了一个积极主动，非常合格的候选人， 经验丰富的指导团队，以及改进护理系统和过程的新方法， 非AIS NE患者的IHT，随着晚期非AIS NE患者的区域化， 专业护理也在增加。

PROJECT ABSTRACT: More than 2.3 million patients experience an interhospital transfer (IHT) each year in the United States. Most IHTs originate from the Emergency Department and neurologic emergencies (NE) are one of the most common reasons for transfer. During IHT, exchange of information and clinician communication are often poor, which may contribute to the associated poorer outcomes compared to patients who are admitted directly to tertiary hospitals. While IHTs have been studied for highly time sensitive conditions including trauma, acute ischemic stroke (AIS), and myocardial infarction, little work has focused on non-AIS NEs, such as hemorrhagic stroke, traumatic intracranial hemorrhage, or seizures. This project seeks to gain an understanding of the IHT process for non-AIS NE by conducting a Failure Modes and Effects and Criticality Analysis (FMECA) to identify, characterize, and rank order the highest risk failures. A select number of identified high risk failures will be targets for the application of human-centered design to develop an intervention. Finally, the applicant will use an implementation framework to implement the intervention and then conduct a feasibility study using a hybrid implementation effectiveness analysis approach to assess both the preliminary effectiveness and the implementation. The overall goal of this project is for the applicant, an emergency medicine physician-scientist, to become a leader in robust methods for risk-assessment of healthcare delivery systems and processes, the application of cutting-edge human-centered design approaches, and implementation science to advance the quality and safety of emergency care while improving patient-centeredness. Under the supervision of primary mentor, S. Prabhakaran, MD, MS, and co-mentors J. Holl, MD, MPH, A. Naidech MD, MSPH, and D. McCarthy, MD, MS, the applicant will leverage the world-class institutional strengths of Northwestern University to improve his skills in risk assessment for healthcare quality and patient safety, human-centered design, implementation science, and prospective study design. With these skills, the applicant will be ideally positioned to become an independent health services and outcomes researcher, focused on the development and testing of novel healthcare delivery interventions in emergency medicine. This proposal combines a highly motivated, exceptionally qualified candidate, an experienced mentorship team, and novel methods to improve the systems and processes of care during the IHT of patients with non-AIS NE, an increasingly common healthcare practice as regionalization of advanced and specialty care increases.