Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center

Abstract

Objective: The objective of this paper is to share challenges, recommendations, and lessons learned regarding the development and implementation of a Patient Safety Learning Laboratory (PSLL) project, an innovative and complex intervention comprised of a suite of Health Information Technology (HIT) tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting at a large academic center.

Materials and methods: The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project: problem analysis, design, development, implementation, and evaluation. Implementation challenges and recommendations were derived from direct observations and the collective experience of PSLL study personnel.

Results: The PSLL intervention was implemented on 12 inpatient units during the 18-month study period, potentially impacting 12,628 patient admissions. Challenges to implementation included stakeholder engagement, project scope/complexity, technology/governance, and team structure. Recommendations to address each of these challenges were generated, some enacted during the trial, others as lessons learned for future iterative refinements of the intervention and its implementation.

Conclusion: Designing, implementing, and evaluating a suite of tools integrated within a vendor EHR to improve patient safety has a variety of challenges. Keys to success include continuous stakeholder engagement, involvement of systems and human factors engineers within a multidisciplinary team, an iterative approach to user-centered design, and a willingness to think outside of current workflows and processes to change health system culture around adverse event prevention.

Keywords: consumer health informatics; health information technology; patient safety; patient-centered care; quality improvement.

Figure 1.

Patient Safety Learning Laboratory (PSLL): EHR-Integrated Health Information Technology Tools. The Patient Safety Learning Laboratory developed tools to help patients become better informed and more involved in their care and provided clinicians with information to facilitate better and faster decisions about patient care. Patients used the interactive patient portal; a bedside display showed patient care plan information on a monitor in the patient room for patients, families and hospital staff; clinicians viewed the patient safety dashboard which contained patient data to alert hospital staff of potential patient risks. All of this was built upon the Patient SatisfActive model, a communication system that helped clinicians identify, assess, and address patient needs and expectations and helped patients and their caregivers become an active part of their care and decision-making.^,,,

Figure 2.

Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework: addressing the barriers to translation of research into practice in the Patient Safety Learning Laboratory (PSLL) study. The PSLL applied the RE-AIM framework to our overall implementation by 1) Formulating research questions from each RE-AIM component to our associated outcome measures, 2) Addressing implementation and dissemination through all phases of the research project lifecycle study-wide; and 3) Providing practical measures of how well the intervention worked in varied clinical settings.^,

Figure 3.

Implementation Lessons Learned by Project Phase. The Patient Safety Learning Laboratory projects followed the Agency for Healthcare Research and Quality Systems Design lifecycle: problem analysis, design, development, implementation, evaluation. During each project phase, the PSLL administrative core prepared for implementation and documented lessons learned.