Effken Judith A, Brewer Barbara B, Patil Anita, Lamb Gerri S, Verran Joyce A, Carley Kathleen
University of Arizona College of Nursing, P.O. Box 210203, Tucson, AZ 85721-0203, USA.
Int J Med Inform. 2005 Aug;74(7-8):605-13. doi: 10.1016/j.ijmedinf.2005.02.003. Epub 2005 Apr 9.
As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement.
作为正在进行的一项研究的一部分，该研究旨在调查患者特征、组织特征和患者护理单元特征对安全和质量结果的影响，我们使用了一个计算建模程序OrgAhead，来模拟患者护理单元在患者安全（用药错误和跌倒）及质量结果方面的达成情况。我们利用从亚利桑那州12家医院的32个护理单元收集的数据对OrgAhead进行了调整。验证研究表明实际患者护理单元与虚拟患者护理单元之间的对应水平可接受。在本文中，我们报告了我们如何使用OrgAhead来提出关于护士长可能切实地在其患者护理单元实施的创新类型的可检验假设，以改善质量和安全结果。我们关注的是单元层面的创新，这类创新可能对管理者来说更容易实施。对于除表现最佳的护理单元（我们在该单元遇到了天花板效应）之外的所有单元，我们都能够制定出切实可行的策略，这些策略能提高虚拟单元的表现，实际单元可予以实施以改善安全和质量结果。护士长们对质量改进方面额外的决策支持反应热烈。
