A PBRN of a Different Color Kathleen R. Stevens, Darpan I. Patel, - - PowerPoint PPT Presentation

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A PBRN of a Different Color Kathleen R. Stevens, Darpan I. Patel, - - PowerPoint PPT Presentation

Oct 27, 2023 127 likes •352 views

A PBRN of a Different Color Kathleen R. Stevens, Darpan I. Patel, Frank Puga University of Texas Health Science Center at San Antonio Supported by NIH/NINR 1RC2NR011946 01 3RC2NR011946 01S1 3RC2NR011946 01S2 RWJF INQRI

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SLIDE 1

A PBRN of a Different Color

Kathleen R. Stevens, Darpan I. Patel, Frank Puga

University of Texas Health Science Center at San Antonio

Supported by NIH/NINR

  • 1RC2NR011946‐01
  • 3RC2NR011946‐01S1
  • 3RC2NR011946‐01S2
  • RWJF INQRI grant ID: 63510
  • UL1RR025767
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SLIDE 2

Catalysts

  • Improving our work is our work.
  • Future of healthcare calls for

interprofessional transformation for quality, safety, and value across all settings

  • Lead with evidence of ‘what works’

LABORATORY

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SLIDE 3

The ISRN includes:

– Mission – Technology infrastructure

  • Website: www.isrn.net

– Network members – Priorities – Steering Council – Coordinating Center (Base: Academic Center for Evidence-

Based Practice, University of Texas Health Science Center San Antonio)

LABORATORY

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SLIDE 4

Definition of “Improvement Science”

  • A field of research focused on healthcare and process

improvement at individual provider, microsystem, and system levels

  • Determines improvement strategies that work in

assuring effective and safe patient care

  • Related terms:
  • translational science
  • implementation science
  • evidence-based practice
  • knowledge translation
  • research utilization

LABORATORY

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SLIDE 5
  • ISRN Mission: To advance the scientific foundation for quality

improvement, safety and efficiency through transdisciplinary research addressing healthcare systems, patient- centeredness, and integration of evidence into practice.

  • Unique infrastructure for conducting improvement research—

a collaboratory for research

  • NINR/NIH-supported improvement infrastructure for a

research network.

LABORATORY

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SLIDE 6
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SLIDE 7

ISRN Research Priorities

Established national consensus on research priorities: A. Coordination and transitions of care B. High-performing clinical systems and microsystems approaches to improvement C. Evidence-based quality improvement and best practice D. Learning organizations and culture of quality and safety

LABORATORY

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SLIDE 8

LABORATORY

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SLIDE 9

A Virtual Collaboratory

Time for global collaboration. www.ISRN.net

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SLIDE 10

Improvement Science Research Network Study Guidelines

  • Network Studies are landmark studies

conducted across multiple settings

  • Rigorous design
  • “Science of team science” for virtual

collaboration

  • Co‐led by scientists and clinicians
  • Network PIs; Site PIs
  • Network members engaged in studies

LABORATORY

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SLIDE 11

BACKGROUND

  • In frontline nursing, workarounds are a

response to first order operational failures exposing patients to errors and creating inefficiencies in care. (Hassmiller)

  • Endemic shortages of nursing staff and difficult

working conditions present substantial barriers

  • n the path to improvement. (Tucker)

Small Troubles, Adaptive Responses (STAR‐2): Frontline Nurse Engagement in Quality Improvement

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SLIDE 12

Aims of STAR‐2

  • Describe first-order operational failures (defects)
  • Investigate relationships among
  • Detection of first-order operational failures
  • Organizational context, and
  • Outcomes related to quality improvement

Results will guide redesign to decrease defects

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SLIDE 13

Research Approach

  • Conduct in the ISRN “research laboratory”
  • Multisite, cross‐sectional, multivariate research
  • 14 sites, 42 med/surg units, ~840 RNs
  • 5 Pediatric Hospitals
  • Analyze data using descriptive, multivariate, and

path analysis methods

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SLIDE 14

Data Collection-Plan

  • Identical across all sites
  • Supported though Coordinating Center
  • Data aggregated via electronic database
  • Collected 10 shifts over 20 days
  • Analysis
  • Aggregate
  • Site‐Specific report
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SLIDE 15

Regulatory-IRB

  • 14 Sites

– UTHSCSA IRB – 13 Sites – Independent Review – 1 site deferred to UTHSCSA IRB

  • Approvals

– 12 Expedited (Category 7) – 2 Full Board

  • Consent

– 11 sites required documented consent – 3 documented consent not required

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SLIDE 16

Results*…..thus far

  • 8 of 14 hospitals completed to date
  • 429 RNs engaged

– 89% of expected enrollment for 8 sites

  • 2419 pocket cards submitted

– 9.7 cards per RN

  • 16,306 operational failures reported

*Analysis of 6 additional hospitals along with systems variables is currently in progress.

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SLIDE 17

50 100 150 200 250 300 350 400

Equipment Information Medication Other Physical Staffing

Frequency

Preliminary/Partial Operational Failures (mean ± SE)

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SLIDE 18

Discussion

  • Frequency of operational failures occurring in

med‐surg units

  • Frontline engagement, context, and quality

improvement

  • Satisfaction Rating: ISRN infrastructure is

effective for conducting multisite improvement research:

– Enthusiasm for engagement in rigorous research – Broad national representation – Clinical relevance – Rapid deployment – Rapid completion – Scale up and spread

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SLIDE 19

PBRN Possibilities

  • Systems thinking in primary care
  • Quality and safety
  • Culture of patient safety
  • Patient satisfaction
  • Team-based care
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SLIDE 20

Acknowledgements

  • National Institute of Nursing Research-Grand

Opportunities

  • 1RC2NR011946-01
  • 3RC2NR011946-01S1
  • 3RC2NR011946-01S2
  • RWJF INQRI grant ID: 63510
  • National Center for Research Resource Clinical and

Translational Science Award UL1RR025767

  • Site PIs at 14 hospitals across the US who became

partners in this study

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SLIDE 21

Contact Information

  • www.ISRN.net
  • ImprovementScienceResearch@ISRN.net
  • 210‐567‐1480
  • StevensK@uthscsa.edu