The purpose of this proposed career development award is to support Dr. Ayse P. Gurses, a human factors engineer, in establishing a research program that seeks to improve patient safety during transitions of care and handoffs. This award will facilitate Dr. Gurses's acquisition of additional skills and competencies in the areas of outcomes research, advanced research methods, and advanced statistical methods that are necessary for accomplishing her career goals. Moreover, the award will provide Dr. Gurses the opportunity to get mentoring from leading researchers who also have a strong track record of mentoring research scientists. The Johns Hopkins University offers an ideal environment for the proposed work, particularly because of the strong Schools of Medicine and Public Health and the strong focus on patient safety research. Increasing specialization in medicine, coupled with limited resources, has led to an increase in the number of care transitions. Unfortunately, care transitions can pose significant risks to patient safety and result in poor clinical and financial outcomes if not managed effectively. Dr. Gurses's long-term goal is to develop a care transitions improvement program that can be implemented nationally and internationally to improve patient safety. The overall objective of the proposed study is to identify the potential risks for post-operative cardiac surgery patients'safety in care transitions, and to develop methods and tools to reduce these risks. We will focus on cardiac surgery patients because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. We will focus on two processes of care: medication information management and the medical record interactions. To accomplish the overall study objective, we will first identify hazards (anything that has the potential to cause failure) that threaten post-operative cardiac surgery patients'safety in transitions of care (a) between different units in a hospital;(b) from hospital to home and to outpatient clinics. We will use both prospective and retrospective hazard identification methods. We will then conduct a prospective risk assessment of the identified hazards using the Health Care Failures Modes and Effects Analysis (HFMEA). We will conduct a separate HFMEA for each care process (e.g., medication information management);at each point of care transition (e.g., transfer from ICU to general floor). Finally, we will develop a novel;risk-analysis-informed intervention bundle and pilot test its impact on the safety of care transitions for post-operative cardiac surgery patients and on the care providers. Ineffective and poor transitions of care are a major threat to patient safety. This is especially true for patients who had cardiac surgery because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. In this study, we will identify the factors that lead to poor care transitions and unsafe care for post-operative cardiac surgery patients. We will then develop and pilot test tools and strategies to improve care transitions and the safety of post-operative cardiac surgery patients. These tools and strategies can potentially be used to improve the safety of care transitions for other patient populations in the future.

Public Health Relevance

Ineffective and poor transitions of care are a major threat to patient safety. This is especially true for patients who had cardiac surgery because of the complexity and severity of their illnesses and their needs for receiving medical care from various practitioners in multiple settings. In this study, we will identify the factors that lead to poor care transitions and unsafe care for post-operative cardiac surgery patients. We will then develop and pilot test tools and strategies to improve care transitions and the safety of post-operative cardiac surgery patients. These tools and strategies can potentially be used to improve the safety of care transitions for other patient populations in the future.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01HS018762-04
Application #
8474725
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2010-08-01
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
4
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Nasarwanji, Mahiyar F; Badir, Aysel; Gurses, Ayse P (2016) Standardizing Handoff Communication: Content Analysis of 27 Handoff Mnemonics. J Nurs Care Qual 31:238-44
Marsteller, Jill A; Wen, Mei; Hsu, Yea-Jen et al. (2015) Safety Culture in Cardiac Surgical Teams: Data From Five Programs and National Surgical Comparison. Ann Thorac Surg 100:2182-9
Peterson, Susan M; Gurses, Ayse P; Regan, Linda (2014) Resident to resident handoffs in the emergency department: an observational study. J Emerg Med 47:573-9
Murphy, David J; Pronovost, Peter J; Lehmann, Christoph U et al. (2014) Red blood cell transfusion practices in two surgical intensive care units: a mixed methods assessment of barriers to evidence-based practice. Transfusion 54:2658-67
Ant Ozok, A; Wu, Huijuan; Garrido, Melissa et al. (2014) Usability and perceived usefulness of Personal Health Records for preventive health care: a case study focusing on patients' and primary care providers' perspectives. Appl Ergon 45:613-28
Carayon, Pascale; Wetterneck, Tosha B; Rivera-Rodriguez, A Joy et al. (2014) Human factors systems approach to healthcare quality and patient safety. Appl Ergon 45:14-25
Holden, Richard J; Carayon, Pascale; Gurses, Ayse P et al. (2013) SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 56:1669-86
Gurses, Ayse P; Ozok, A Ant; Pronovost, Peter J (2012) Time to accelerate integration of human factors and ergonomics in patient safety. BMJ Qual Saf 21:347-51
Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura et al. (2012) Using human factors engineering to improve patient safety in the cardiovascular operating room. Work 41 Suppl 1:1801-4
Thompson, David A; Kass, Nancy; Holzmueller, Christine et al. (2012) Variation in local institutional review board evaluations of a multicenter patient safety study. J Healthc Qual 34:33-9

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