Engineering Highly Reliable Learning Lab

 描述（由申请人提供）：“为高风险患者、转诊和测试设计高度可靠的通信和协调系统”建议建立一个工程高可靠性学习实验室（EHRLL），以提高创新能力，开发高度可靠的系统，解决在初级和专科护理交叉点造成患者安全风险的通信和协调挑战。一个五阶段的创新周期-问题分析，设计，开发，实施和评估-将推动EHRLL努力在19个哈佛附属初级保健实践及其专业护理合作伙伴中开发高度可靠的系统，这些合作伙伴每年通过140万次接触共同护理超过260，000名患者。EHRLL将包括一个行政核心和一个工程核心，以提供一个支持性的再造基础设施，该基础设施将包括一个理论驱动的、灵活的、共享的学习计划;一个由经验丰富的研究人员和外部“破坏者”组成的多学科团队;以及一个系统的方法，用于识别、设计、开发、传播和评估患者安全创新。 三个协同项目将使基于卫生系统的重新设计和设计（R&D）团队参与问题分析和动手开发，测试和实施高度可靠的闭环系统，用于高优先级的初级到专科转诊（P1初级至专科转诊）;接受手术的医疗复杂性儿童的协调系统（P2复杂围手术期护理）;以及用于具有复杂护理需求的成人新医疗状况的诊断和管理系统（P3复杂诊断和管理）。EHRLL的总体具体目标是： 目标1：建立一个共享的基础设施，包括行政/学习核心，工程核心和多学科团队，以刺激患者安全创新的系统方法; 目标二：参与三个研究项目，将系统工程应用于开发创新解决方案，以改善HIT支持的流程，并设计可推广的高度可靠的系统; 目标3：在一系列医院/社区基层医疗实践中实施和推广重新设计的系统，并测试系统在其他环境和条件下的通用性;以及 目标4：评估重新设计的系统对实践、团队、提供者和患者结果的影响，并传播研究结果、工具和资源，供全国复制。

 DESCRIPTION (provided by applicant): "Engineering Highly Reliable Communication and Coordination Systems for High Risk Patients, Referrals, and Tests" proposes to establish an Engineering High Reliability Learning Lab (EHRLL) to enhance capacity for innovation and develop highly reliable systems that address communication and coordination challenges that pose patient safety risks at the intersection of primary and specialty care. A five-stage innovation cycle-problem analysis, design, development, implementation, and evaluation-will drive EHRLL efforts to develop highly reliable systems within 19 Harvard-affiliated primary care practices and\their specialty care partners that collectively care for more than 260,000 patients through 1.4 million encounters each year. EHRLL will include an Administrative Core and an Engineering Core to provide a supportive reengineering infrastructure that will incorporate a theory-driven, flexible, shared Learning Program; a multidisciplinary team of experienced investigators and outside "Disruptors"; and a systematic approach for identifying, designing, developing, spreading, and evaluating patient safety innovation. Three synergistic projects will engage health system-based reengineering and design (R&D) teams in problem analysis and hands-on development, testing, and implementation of highly reliable closed loop systems for high priority primary to specialty referrals (P1 Primary to Specialty Referrals); coordination systems for children with medical complexity undergoing surgery (P2 Complex Perioperative Care); and diagnosis and management systems for new medical conditions in adults with complex care needs (P3 Complex Diagnosis & Management). EHRLL's Overall Specific Aims are: Aim 1: To build a shared infrastructure that comprises an Administrative/Learning Core, an Engineering Core, and multidisciplinary teams to stimulate a systematic approach for patient safety innovation; Aim 2: To engage in three research projects that will apply systems engineering to the development of innovative solutions for improving HIT-supported processes and designing highly reliable systems that are generalizable; Aim 3: To implement and spread redesigned systems across a range of hospital/community-based primary care practices and to test systems' generalizability in alternative settings and conditions; and Aim 4: To assess the impact of redesigned systems on practice, team, provider, and patient outcomes and disseminate findings, tools and resources for national replication.