Johns Hopkins physics lab brings systems engineering to bear on ICU safety

The Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine has partnered with the Johns Hopkins University Applied Physics Laboratory (APL) to design and deploy a set of interventions to reduce medical errors in intensive care units.

Funded by an $8.9 million grant from the Gordon and Betty Moore Foundation, the two- year project will take place at three sites: the Surgical Intensive Care Unit at Johns Hopkins Hospital (JHH); the Bayview Medical Center, a JHH-affiliated community hospital; and the University of California, San Francisco Medical Center.

Alan Ravitz, program manager for biomedical systems at APL, who is leading the lab's involvement in the initiative, says it is designed to "demonstrate that a systems approach to the management of patient care can improve both the processes of care and the outcomes of patients, and facilitate the meaningful engagement of patients and families."

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Healthcare IT has improved mortality and morbidity rates in hospitals, but the increasing use of technology has also led to challenges with regard to quality and patient safety, say Johns Hopkins officials. Studies show that at least one in every five of the estimated four million patients treated in intensive care units (ICUs) every year is harmed during their hospital stay.

These adverse events range from ICU-acquired weakness and delirium to ventilator- associated infections such as pneumonia, adult respiratory distress syndrome, blood stream infections, deep vein thrombosis and pulmonary embolus.

Noting that most medical devices commonly used in ICUs – infusion pumps, ventilator systems, defibrillators, electrocardiogram (ECG) analyzers – are not integrated or interoperable, resulting in systems that do not share data or functionality across the healthcare enterprise, Ravitz says the APL team will develop a systems approach and apply systems engineering principles and best practices to improving care and reducing adverse effects.

"Healthcare technology is grossly under-engineered," said Peter Pronovost, MD, director of the Armstrong Institute. "Devices don't talk to each other, treatments are not specified and ensured, and outcomes are largely assumed rather than measured. This project will seek to change that by enlisting systems engineers to ensure patients always get the treatments they should, by engaging patients in every aspect of their care and creating a health care system that continuously improves."

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For each type of harm, the lab will create an approach that incorporates three levels of theory: clinical epidemiology culture and supporting social structure, and organizational, team and human factors, officials say.