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Grant Number: U18 HS11200
RFA/PA: HS00-007 - Systems Related Best Practices to Improve Patient Safety
PI Name: SELKER, HARRY
Project Title: TIPI Systems to Reduce Errors in Emergency Cardiac Care
Abstract:
SELKER, HARRY P
NEW ENGLAND MEDICAL CENTER, BOSTON MA
TIPI SYSTEMS TO REDUCE ERRORS IN EMERGENCY CARDIAC CARE
U18 HS11200-01
09/30/00
As the largest cause of morbidity and mortality in this country, acute cardiac
ischemia (ACI: which includes acute myocardial infarction AMI and unstable
angina pectoris [UAP], which can lead to AMI) is the most common serious
condition requiring emergency and acute care. Among the 7 million patients who
present to emergency departments (EDs) in this country each year with symptoms
consistent with ACI, errors are made both in ED triage and treatment. In ED
triage, in this country each year, approximately 12,000 patients with AMI and
14,000 with UAP are mistakenly sent home, which nearly doubles the expected
mortality rates for these patients and contributes to the status of missed ACI
in the ED as the largest cost category of adult malpractice claims in the US.
In ED treatment, although for ED patients with AMI, the lifesaving impact of
thrombolytic therapy is directly related to the earliness of its use, many are
not treated promptly, and about 90,000 per year are not treated at all. These
errors in triage and treatment for ACI are clinically critical to the patient
and occur on a scale that makers them public health issue, and thus present
important opportunities to reduce medical errors.
This project aims to reduce medical errors in ED triage and treatment
for ACI based on a time-insensitive predictive instrument information system
(TIPI-IS), designed to be attractive to all members of the health care system,
by providing real-time, concurrent, and retrospective decision support. This
approach rests on TIPI- capable electrocardiograph's ability to compute, for
every ED patient upon presentation, a 0-100% probability that a patient truly
has ACI, and if having an AMI, the likely outcome benefits of thrombolytic
therapy. This project will consist of a before-after time-series design to
measure the impact of the intervention with stepwise implementation. In Phase I
the system will be fully implemented at New England Medical Center (NEMC) and
revisions made to promote user-friendliness at all levels. In Phase 2, the
system will be used in the three main hospitals in the Lifespan System. In
Phase 3, Marsh USA will partner with us to distribute this system to its
insured hospitals and managed care organizations. This plan thus allows
demonstration of the usefulness of the TIPI-IS as an error reduction system,
first in a single hospital, then for a group of hospitals, and then in a sample
of health care systems nationally.
Fiscal Year: 2000
Department: TUFTS MEDICAL CENTER
Project Start: 09/15/2000
Project End: 08/31/2004
IRG: HQER
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