McGrath Susan P, Perreard Irina, Ramos Joshua, McGovern Krystal M, MacKenzie Todd, Blike George
Adv Health Care Manag. 2019 Oct 24;18. doi: 10.1108/S1474-823120190000018012.
Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information. This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.
未能成功抢救事件，即涉及因并发症导致可预防死亡的事件，是住院患者死亡率的一个重要因素。尽管几十年来已经设计并实施了许多干预措施，但这个患者安全问题仍然是大多数医院关注的首要问题。在本研究的第一部分，我们考察了一种经过深入研究且广泛采用的抢救干预措施——基于算法的患者评估工具的开发与实施情况。分析总结了在这些工具的设计和实施过程中，由于缺乏面向系统的方法，导致对患者死亡和并发症风险的理解不够理想，以及对患者病情恶化的早期识别不足。所发现的差距影响了优质患者护理的几个关键方面，包括不同护理环境之间的信息共享、支持护理团队内共享心智模型的发展，以及获取及时准确的患者信息。本章描述了如何运用几种面向系统的设计和实施活动来确立设计目标、模拟临床流程和工作流程，并创建一个可扩展的信息系统模型，以在住院环境中最大限度地发挥患者状态和风险评估工具的效益。我们讨论了基于设计活动成果的一个原型，以及实施过程中的系统层面考量。本研究还展示了将系统设计原则和实践应用于实际临床应用的有效性和影响。
