Dr. Susan Moffatt-Bruce currently serves as the Chief Quality and Patient Safety Officer and Associate Dean for Clinical Affairs for Quality and Patient Safety at the Ohio State University Wexner Medical Center. Her research around Value Based Care has resulted in two AAMC Learning Health System Research Awards in the 2014 and 2015-2016 rounds. Dr. Moffatt-Bruce has led and partnered in NIH, AHA, and AHRQ funded research and was recently awarded a $4 million grant for The Institute for the Development of Environments Aligned for Patient-Safety (IDEA4PS) from the Agency of Healthcare Research and Quality. To learn more, download Dr. Moffatt-Bruce's ROCC Star Profile.
Please provide an overview of your recently AHRQ Funding work "Institute for the Development of Environments Aligned for Patient Safety (IDEA4PS). What are the core components of the project, goals, and outcome measures?
The Institute for the Development of Environments Aligned for Patient Safety (IDEA4PS) is proposed as an interdisciplinary approach to identify and explore how feedback of information can be used to inform the development of robust practices that lead to improved patient safety. Our Institute seeks to improve clinical practice by designing, testing and exploring the type and kind of information flows that result in adaptation of the health care work environment.
Stakeholder engagement, including work with clinicians, managers and patients has identified a significant chasm between what we know and how we respond, however our work is preliminary at this stage. What we do know is that the technology linked to care has created an environment where alarms have become white noise. We know that information difficult to decode in meaningful ways. The resultant information chaos has implications for patient safety. Accordingly, we have two overarching Specific Aims for this application:
Specific Aim 1: Institute Infrastructure: Develop IDEA4PS through creation of three infrastructure cores.
Core A: Administration and Implementation: will provide administrative, fiscal and management services as well as coordinate developmental activities for Institute investigators and collaborators. Additionally, and more central to the laboratory, Core A will lead the implementation and evaluation efforts that will occur as Institute innovations become ready for real-world testing.
Core B: Human Factors and Systems Engineering: will offer cross-cutting multidisciplinary design and human factors and usability expertise across all projects focused on measuring, assessing and improving the context in which practice happens.
Core C: Informatics, Analytics and Data Core: will support the linkage of data to practice through the identification of meaningful information found within the data morass, seeking to resolve the DRIP problem (Data Rich – Information Poor) by leveraging data to measure and improve outcomes.
Specific Aim 2: Research Projects: Conduct three innovative research projects designed to address patient safety issues in inpatient care.
Project 1: Telemetry and Alarms (PI: Susan Moffatt-Bruce, Emily Patterson): Focusing on the manner in which information is provided to clinicians, Project 1 will focus to the signal to noise problem experienced by clinicians, seeking to improve what engineers call the signal to noise ratio, thereby allowing clinicians to focus on meaningful events over the din of background noise, leading to an improvement in the safety and care quality.
Project 2: Surveillance Hot Spotting (PI: Courtney Herbert, Albert Lai): This project focuses specifically on hospital-acquired infections (HAIs). Despite the widespread use of EHRs, many hospitals continue to perform infection control surveillance retrospectively and often through manual review of records, which is both time-consuming and labor intensive. Project 2 proposes to explore this problem and its potential solutions by developing interfaces
that allow for the exploration of real-time results to recognize concerning trends sooner, in order to implement timely and effective interventions through the use of tools such as digital hot spotting.
Project 3: Crew Resource Management and Inpatient Portal Information (PI: Ann McAlearney, Tim Huerta): We seek to explore the impact of new information flows coming from the inpatient portal recently introduced at OSUWMC, and implement a workflow redesign process through the structure of Crew Resource Management, a proven approach focused on patient safety improvement.
IDEA4PS seeks to use systems approaches to bring together multidisciplinary teams to generate new ways of thinking with respect to the design of feedback to the environment of care in alignment with systems dynamics. Our projects are bound closely together by the costly harms associated with information problems. In focusing on information as opposed to a specific patient safety challenge, we expect to create generalizable experiential knowledge that will be invaluable in improving patient safety. Parallel to this program project grant, we are also completing work as a R01.
Please describe how the IDEA4PS will tackle the “signal to noise ratio” experienced by clinicians?
The IDEA4PS revolves around the idea that communication is the key to safe patient environments. We can only be great clinicians if we communicate. We can only be great nurses if we get the right communications. We can only be great health systems if we have open communication. To that end the IDEA4PS will work on ensuring that we are monitoring the right patients at the right time, in the right way and getting the message to the right person. The second project in the IDEA4PS will communicate patient safety events real time and allow us to focus on the patient now. Lastly, the third part of IDEA4PS is to really leverage the electronic health record so that patients can be part of their own care and we can all use teams to improve on deploying care resources where they are best served. All these projects are designed to leverage the learning health system. Everything we operationalize, we study. Everything we study, we implement. It is a great academic ecosystem!
Please describe the collaborative nature of the IDEA4PS program. Who are the key players involved?
IDEA4PS is all about communication and collaboration. In order to bring this Institute together we had to leverage every relationship and resource we had across the health system and university. We were able to engage with our human factors experts, our engineering colleagues, design experts and biomedical informatics to name just a few. There are over 20 different researchers involved in IDEA4PS and they represent over 15 different colleges and departments across The Ohio State University. To keep us all united and aligned, Dr. Ann McAlearney and Dr. Tim Huerta, both well-established health outcomes researchers in their own right, have graciously agreed to be co-directors of this institute as we continue to build capacity and engage new and innovative patient safety project.