Taylor April M, Chuo John, Figueroa-Altmann Ana, DiTaranto Susan, Shaw Kathy N
The Children's Hospital of Philadelphia, USA.
Jt Comm J Qual Patient Saf. 2013 Sep;39(9):396-403. doi: 10.1016/s1553-7250(13)39053-9.
A unit-based Patient Safety Leadership Walkrounds (PSWR) model was deployed in six medical/surgical units at The Children's Hospital of Philadelphia to identify patient safety issues in the clinical microsystem. Specific objectives of PSWR were to (1) provide a forum for frontline staff to freely report and discuss patient safety problems with unit local leaders, (2) improve teamwork and communication within and across units, and (3) develop a supportive environment in which staff and leaders brainstorm on potential solutions.
Baseline data collection and discussion with leaders and staff from the pilot units were used to create a standard set of safety tools and questions. Through multiple Plan-Do-Study-Act cycles, safety tools and questions were refined, while the process of walkrounds in each of the six pilot units was customized.
Leaders in all six pilot units indicated that PSWR helped them to uncover previously unidentified safety concerns. Top-impact areas included nurse-medical team relationship, work-flow flaws, equipment defects, staff education, and medication safety. The project engaged 149 individuals across all disciplines, including 33 physicians, and entailed 34 PSWR in its first year. Information from these pilot units initiated safety changes that spread across multiple units, with identification of hospital-wide quality and patient safety issues.
For participating units, the PSWR process is a situational awareness tool that helps management periodically assess new or unresolved vulnerabilities that may affect safety and care quality on the unit. Unit-based PSWR help identify safety concerns at the microsystem level while improving communication about safety events across units and to hospital leaders in the macrosystem.
基于单位的患者安全领导巡视（PSWR）模型在费城儿童医院的六个内科/外科科室中展开，以识别临床微观系统中的患者安全问题。PSWR的具体目标是：（1）为一线工作人员提供一个论坛，以便他们与科室当地领导自由报告和讨论患者安全问题；（2）改善科室内部和科室之间的团队合作与沟通；（3）营造一个支持性环境，让工作人员和领导共同集思广益，探讨潜在的解决方案。
通过收集试点科室领导和工作人员的基线数据并进行讨论，创建了一套标准的安全工具和问题。经过多个计划-执行-研究-改进循环，对安全工具和问题进行了完善，同时对六个试点科室各自的巡视流程进行了定制。
所有六个试点科室的领导均表示，PSWR帮助他们发现了此前未被识别的安全隐患。影响最大的领域包括护士与医疗团队的关系、工作流程缺陷、设备缺陷、工作人员培训以及用药安全。该项目让包括33名医生在内的149名各学科人员参与其中，第一年进行了34次PSWR。来自这些试点科室的信息引发了安全变革，这些变革在多个科室蔓延开来，同时识别出了全院范围的质量和患者安全问题。
对于参与的科室而言，PSWR流程是一种态势感知工具，有助于管理层定期评估可能影响科室安全和护理质量的新的或未解决的薄弱环节。基于科室的PSWR有助于在微观系统层面识别安全隐患，同时改善各科室之间以及与宏观系统中医院领导之间关于安全事件的沟通。
