Patient Safety Learning Laboratory: Making Acute Care More Patient-Centered (PSLL)

The Brigham and Women's Hospital (BWH) Patient Safety Learning Laboratory (PSLL) focuses on developing health information technology (HIT) tools to engage patients, family, and professional care team members in reliable identification, assessment, and reduction of patient safety threats in real-time, before they manifest in actual harm.

The Brigham and Women's Hospital (BWH) Patient Safety Learning Laboratory (PSLL) will develop systems approaches to integrating health information technology (HIT), stakeholder engagement mechanisms, and process design/engineering methods focused on patient safety, development and enhancement of tools, health care system interventions, and translation into practice. The three technological toolkits to be developed as part of the Patient Safety Learning Laboratory (PSLL) are:1) Patient-centered Fall Prevention Toolkit which aims to engage patients and their family caregivers in the design of HIT tools to prevent patient falls and related injuries during an acute hospitalization; 2) Patient Safety Checklist Tool to improve patient safety and quality outcomes, provider efficiency, and team communication; and 3) MySafeCare Patient Safety Reporting System which aims to iteratively develop and evaluate the impact of a patient safety reporting system on patient safety and fosters a health system focused on collaborative learning. The Brigham and Women's Patient Safety Learning Laboratory (BWH PSLL) will establish a vibrant learning ecosystem of health services, informatics, and systems engineering researchers, collaborating with patients and family for evolving and applying these approaches to adverse event prevention in hospitalized patients. In addition, a Systems Engineering, Usability, and Integration (SEUI) Core will leverage health systems engineering approaches to develop and provide a system-wide methodology to aid in the successful implementation and improvement of Health Information Technology (HIT) tools and a model known as the Patient SatisfActive® will be developed, tested, and refined to create a culture of patient- and family-centered care.

Central Line-Associated Bloodstream Infection (CLABSI), Venous Thromboembolism, Patient Fall, Catheter-Associated Infection, Severe Hypoglycemia, Opioid-Related Severe Adverse Drug Event, Hospital Acquired Pressure Ulcer, Adverse Drug Event, Severe Hospital Acquired Delerium, Rapid Response Related to Arrhythmia

Patients and providers on hospital care units where the PSLL patient safety health information technology tools are implemented, during the interventional phase of a stepped wedge randomized trial design.

Patients on hospital care units where the PSLL patient safety health information technology tools have been implemented or are to be implemented, but are not during the usual care phase of a stepped wedge randomized trial design.

Hospitalizations with the presence of any of the following: Patient Falls with Injury, Severe Hypoglycemia, Inpatient or post hospitalization venous thromboembolism, catheter associated urinary tract infection (CAUTI), Central Line Associated Blood Stream Infection (CLABSI), Opioid related severe adverse drug event, hospital acquired pressure ulcer, severe hospital acquired delirium, rapid response related to arrhythmia

Patient Falls/ Mobility: % patient days of patients at fall risk due to a gait disturbance on sedatives

Patient Falls/ Mobility:% pt-days of patients at fall risk due to a gait disturbance without Physical Therapy consult order

Processes of care: % patient-days of patients at fall risk due to a gait disturbance without Physical Therapy consult order

Glucose Control: % patients with diabetes or hyperglycemia with orders for basal and nutritional insulin

Processes of care: % patients with diabetes or hyperglycemia with orders for basal and nutritional insulin

Venous thromboembolism (VTE): % pt-days with appropriate prophylaxis ordered based on risk and contraindications

Processes of care: % patient-days with appropriate prophylaxis ordered based on risk and contraindications

Venous thromboembolism (VTE):% pt-days with appropriate prophylaxis administered based on risk and contraindications

Processes of care: % pt-days with appropriate prophylaxis administered based on risk and contraindications

Pain Control:% pt-days with opioids administered and no Richmond Agitation-Sedation Scale (RASS) score recorded

Processes of care: % pt-days with opioids administered and no Richmond Agitation-Sedation Scale (RASS) score recorded

Antibiotic Management: % patient-days with patients on broad-spectrum gram-positive and broad-spectrum gram-negative antibiotics for > 72 hours

Processes of care: % pt-days with patients on broad-spectrum gram-positive and broad-spectrum gram-negative antibiotics for > 72 hours

Processes of care: % patient-days of high risk patients without any telemetry bottom page 5 mock tables

Bowel Regimen:% patient-days where on opioids, no bowel movement 2 or more days, and no bowel regimen administered

Processes of care: % patient-days where on opioids, no bowel movement 2 or more days, and no bowel regimen administered

Pain Control: proportion of hospitalizations with opioid induced depression of consciousness or respiration

Safety Outcomes: proportion of hospitalizations with opioid induced depression of consciousness or respiration

Safety Outcomes: proportion of patients on opioids who had rapid response, code blue, ICU transfer, Bipap, mechanical ventilation

Pain Control: proportion of hospitalizations of patients on opioids with any opioid-related Adverse Drug Event

Safety Outcomes: proportion of hospitalizations of patients on opioids with any opioid-related Adverse Drug Event

Pressure Ulcers: proportion of hospitalizations with pressure ulcer worsening in stage from admission to discharge

Safety outcomes: proportion of hospitalizations with hospital-acquired pressure ulcer worsening in stage from admission to discharge

Provider perceptions of safety, communication based on Agency for Healthcare Research and Quality (AHRQ) patient safety climate survey

perceived teamwork climate on hospital care units based on Agency for Healthcare Research and Quality (AHRQ) patient safety climate survey

Patient and caregiver perceptions of how well clinical team kept them safe based on Patient Activation Measure (PAM 13)

Other Clinical Outcomes: Proportion of hospitalizations with cardio-respiratory code or rapid response

Patient Satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Dykes PC, Burns Z, Adelman J, Benneyan J, Bogaisky M, Carter E, Ergai A, Lindros ME, Lipsitz SR, Scanlan M, Shaykevich S, Bates DW. Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA Netw Open. 2020 Nov 2;3(11):e2025889. doi: 10.1001/jamanetworkopen.2020.25889.