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使用现场报警模拟观察系统弹性来源
Melissa McLoone1, Meghan McNamara1, Megan A Jennings1
1Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Journal of hospital medicine
|October 9, 2023
概括
医院报警疲劳对患者安全构成风险. 这项研究使用模拟来确定临床医生如何适应关键报警,揭示了改善报警系统设计和减少患者伤害的策略.
科学领域:
- 医疗保健安全 医疗保健安全
- 系统工程 系统工程
- 临床实践 临床实践
背景情况:
- 警报疲劳导致无反应,对住院患者的安全构成重大威胁.
- 传统的安全评估侧重于罕见的故障 (安全I),忽视了日常的临床适应.
- 安全II方法强调从医疗保健系统的日常弹性中学习.
研究的目的:
- 确定临床报警系统中的弹性来源.
- 了解临床医生在现实环境中适应关键报警的情况.
- 为改善报警系统设计和患者安全提供信息.
主要方法:
- 进行了59次临床模拟临界低血量事件警报.
- 模拟发生在三级儿科医院的医疗/外科和重症监护病房.
- 收集了关于响应时间,环境观察和模拟后访谈的数据.
主要成果:
- 确定了成功响应警报的四种主要方法.
- 将这些方法映射到患者安全系统工程倡议 (SEIPS) 框架中.
- 提供了关于临床医生如何有效地管理警报事件的见解.
结论:
- 临床医生适应是减轻警报疲劳和提高患者安全的关键.
- 应用SEIPS框架域可以引导对报警系统的改进.
- 这项研究为开发更有弹性和更有效的报警管理策略提供了基础.
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