The Safety Integration Stakeholders (SAINTS) program to integrate worker and patient safety in Oregon rural hospitals

项目摘要/摘要 新冠肺炎疫情凸显了工人和患者安全之间的千丝万缕的联系。然而，大多数 医院对病人或工作人员的安全有不同的倡议。安全处理病人就是一个很好的例子 和移动性(SPHM)，其中大多数计划是由员工健康和安全部门实施的，没有 与其他质量或患者安全部门协调。这种脱节是严重的，因为 而代价高昂的后果，如患者摔倒或工作人员的患者辅助伤害，都有重叠的风险因素， 必须一起解决。一个有希望的回应是通过一个整合利益相关者的计划， 包括有影响力的一线工作人员，以解决患者跌倒和患者协助的重叠风险因素 受伤。我们的初步研究预先测试了俄勒冈州一家乡村医院的综合安全计划 在改善领先指标和减少患者辅助伤害方面显示出12个月的有效性 费率。该计划有四个主要组成部分：1)患者和工人安全利益相关者的参与； 2)创新应用社交网络分析(SNA)来识别同行认可的安全领导者 而不是自我或主管提名的工人，他们可能没有实施变革所需的影响力；3) 对利益相关者进行安全领导培训，以及4)实施质量改进(QI)周期，以减少 安全屏障。基于这些有希望的结果，我们计划构建一种新的可扩展干预措施，并在 严格的多医院试验。这项建议的目标是在#年进行一项整群随机对照试验 六家乡村医院将评估名为安全集成的安全计划的有效性和流程 利益相关者(圣徒)。我们将检验中心假设，相对于通常的实践控制，三个 随机分配到圣徒计划的医院将减少患者跌倒和患者- 在计划结束12个月后协助受伤人员。理由是圣徒计划将积极地 通过确定和培训关键参与者的战略来促进环境、行政、 以及与SPHM相关的教育预防措施。我们提出了两个目标：目标1：确定圣徒的 在减少患者跌倒和患者辅助伤害的重叠危险因素方面的有效性。有效性将 通过调查住院病房工作人员的患者辅助损伤和患者跌倒的风险因素来确定 基线、方案启动后6个月和实施结束后12个月(主要 端点)。这项试验是为了检测领先指标的变化，但我们也将检查滞后效应 关于患者跌倒、患者辅助伤害、报告系统中的条目和员工流动率的发生率。 目标2：确定圣徒计划制定的安全预防措施。在给定半结构化的 设计时，我们将进行多方法过程评估，以确定该计划被 如果按计划交付，并导致采取预防措施。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic accentuated the inextricable link between worker and patient safety. Yet most hospitals have separate initiatives for either patient or worker safety. A case in point is safe patient handling and mobility (SPHM), where most programs are implemented by Employee Health and Safety without coordination with other quality or patient safety departments. This disconnect is significant because adverse and costly outcomes such as patient falls or workers’ patient-assist injuries have overlapping risk factors that must be addressed together. One promising response is through a program that integrates stakeholders, including influential front-line workers, to address overlapping risk factors for patient falls and patient-assist injuries. Our preliminary research pre-tested an integrated safety program at a rural hospital in Oregon that demonstrated 12-month effectiveness in improving leading indicators and reduction of patient-assist injury rates. The program had four main components: 1) the involvement of patient and worker safety stakeholders; 2) the innovative application of Social Network Analysis (SNA) to identify peer-recognized safety leaders instead of self- or supervisor-nominated workers who may not have the influence required to effect change; 3) training stakeholders on safety leadership, and 4) implementation of quality improvement (QI) cycles to reduce safety barriers. Based on these promising results, we plan to build a new scalable intervention to be tested in a rigorous multi-hospital trial. The objective of this proposal is to conduct a cluster randomized controlled trial in six rural hospitals to evaluate the effectiveness and process of a safety program titled Safety Integration Stakeholders (SAINTS). We will test the central hypothesis that relative to usual practice controls, the three hospitals randomly assigned to the SAINTS program will have reduced risk factors for patient falls and patient- assist injuries 12 months after the end of the program. The rationale is that the SAINTS program will positively impact outcomes by identifying and training key players on strategies to boost environmental, administrative, and educational precautions relevant to SPHM. We propose two aims: Aim 1: Determine the SAINTS' effectiveness in reducing overlapping risk factors for patient falls and patient-assist injuries. Effectiveness will be determined by surveying in-patient unit workers on risk factors for patient-assist injuries and patient falls at baseline, six months after program initiation, and 12 months after the end of implementation (primary endpoint). The trial is powered to detect changes in leading indicators, but we will also examine lagging effects on the incidence rates of patient falls, patient-assist injuries, entries in reporting systems, and staff turnover. Aim 2: Identify safety precaution measures produced by the SAINTS program. Given the semi-structured design, we will conduct a multi-method process evaluation to identify the extent to which the program was delivered as planned and if it led to the adoption of preventative measures.