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The ����ֱ�� University Applied Physics Laboratory (APL) will partner with the ����ֱ�� Medicine (JHM) Armstrong Institute for Patient Safety and Quality to design, implement and deploy an integrated set of interventions to reduce medical errors in intensive care units. The project is funded by an $8.9 million grant from the San Francisco-based Gordon and Betty Moore Foundation.

The grant — the first award in a new $500 million, 10-year Patient Care Program designed to eliminate preventable harms that patients experience in the hospital — will fund a two-year demonstration project at three sites: the Surgical Intensive Care Unit at ����ֱ�� Hospital (JHH); the Bayview Medical Center, a JHH-affiliated community hospital; and the University of California, San Francisco Medical Center.

“We will 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,” says Alan Ravitz, of APL’s Research and Exploratory Development Department, who is leading APL’s involvement in the project.

While sophisticated health care technology has improved mortality and morbidity rates in hospitals, the increasing use of these innovations has also resulted in patient safety and care quality challenges. Studies show that at least one in every five of the estimated four million patients treated in intensive care units every year is harmed during their hospital stay. These adverse events range from ICU-acquired weakness and delirium to ventilator-associated infections like pneumonia, adult respiratory distress syndrome, bloodstream infections, deep vein thrombosis and pulmonary embolus.

A significant problem is that the 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 health care enterprise, says Ravitz.

The team will develop a systems approach and apply systems engineering principles and best practices — hallmarks of APL’s capability — to improving care and reducing a variety of negative effects, not only those that harm the patient physically but also those that can damage the dignity and respect of patients and their families. For each type of harm, they will create an approach that incorporates three levels of theory: clinical epidemiology culture and supporting social structure, and organizational, team and human factors.

In addition to managing the project, APL — which will receive roughly $3.2 million of the grant — will lead the systems engineering component, including the incorporation of human factors engineering to ensure that technologies developed support improving patient outcomes and enhance the effectiveness and efficiency of clinicians.

“Health care technology is grossly under-engineered,” said Peter Pronovost, M.D., 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.”

“Improvements in patient care will be more significant and lasting if patients and their families are actively engaged — especially if we reconfigure clinical processes, care teams and technology into an integrated whole to focus on patient safety,” said the Moore Foundation’s George Bo-Linn, M.D., the chief program officer for the Patient Care Program.

APL and ����ֱ�� Medicine have collaborated on other health care improvement projects that employed a systems engineering approach: an effort to improve the design and operations of medical treatment facilities and a safety initiative aimed at improving the safety of infusion pumps. In fact, the ����ֱ�� Systems Institute — based at the Whiting School of Engineering — provided the research and development funding, as well as the technical oversight, for the development phase of this project, says APL’s Mo Dehghani, the director of the Systems Institute.

“Through these efforts, we’ve learned key lessons that we intend to apply to the patient safety ICU demonstration project,” says Ravitz. “System devices need to be more tightly integrated with the larger IT enterprise and more aligned with workflow and the needs of the patient and family to reduce the risks inherent in the design of some the medical devices.”

Work on the new effort is scheduled to start this fall.