Measuring NICU Nurse Practitioner Workload in Real-time to Improve Care Quality and Patient Safety — NICHD, R01HD109303. (France) The research will improve neonatal patient safety by changing the way NICU provider workload is measured and used for workload management, organizational learning, and improvement. The project is innovative because it will use data readily accessible in electronic health records to develop a new multi-level model of workload for neonatal nurse practitioners and use this model to guide the design and development a future clinical decision support tool for provider workload management and safety improvement.
TN Department of Health: Healthcare Resiliency Program — Practice Transformation and Extension Grant. (Simmons) The purpose of this funding award is to encourage innovations in the delivery of health and healthcare services that foster improved health outcomes. This could include innovative or alternative care delivery models, enhanced care coordination, investments in technology, innovation, or partnerships which have the potential to change and improve how services are delivered, particularly with respect to minority, rural, and other traditionally underserved groups.
The ROADS Study: Reducing Overuse of Antibiotics with Decision Support — AHRQ, R01HS029331. (Williams) 4/1/23 - 1/31/28. This research seeks to reduce inappropriate antibiotic use in pediatric acute lower respiratory tract infections, the most common serious infections in childhood. Antibiotic overuse is common in this population and is associated with substantial consequences. The major goals of this proposal are to design, implement, and evaluate the effectiveness of clinical decision support tools that promote judicious use of antibiotics in children and adolescents with lower tract infections in real-world emergency and inpatient settings.
COMPACT: COMputerized PAtient-centered Collaborative Technology to support breast cancer shared decision making — AHRQ K01HS029042, following AHRQ Learning Health System Scholars (LHSS) K12HS026835. (Salwei, PI) 9/30/22 - 9/29/26. The goal of this study is to develop a team-oriented technology to support collaborative decision-making between patients, their family caregivers, and clinicians to improve personalized breast cancer treatment.
An Interoperable, Reusable and Scalable Shared Decision Aid Navigator System: Supporting the 5 Rights of Patient Shared Decision Making — AHRQ, R18HS028578. (Anders, Schilling) 9/1/22 - 8/31/25. We propose to use user-centered design methods to build and test a shared decision aid support system that addresses the patient, clinician, and system barriers to patient decision aids (PDAs) use, supports alignment with the “5 rights of clinical decision support,” and supports reusability, interoperability, and scalability.
EHR usability and usefulness, perceived missed nursing care and medication errors in critical care — AHRQ, R01HS029011. (Anders, Trinkoff) 8/1/22 - 5/31/27. We will work with the University of Maryland to further understand how the EHR impacts nursing workflow, medication errors, and nursing care. We will conduct observations, interviews and analyze this data. These will then guide a HFMEA and what-if analysis using a focus group methods and assist with data analysis and dissemination.
Realtime Measurement of Situational Workload in NICU Nurses to Improve Workload Management and Patient Safety — AHRQ, R01HS028430. (France) 5/1/22 - 2/28/26. The research will improve neonatal patient safety by changing the way nursing workload in the NICU is measured and used for workload management, organizational learning, and improvement. The project is innovative because it will use data readily accessible in electronic health records to develop a new multi-level model of workload for registered nurses and use this model to guide the design and development a future clinical decision support tool for workload management and safety improvement.
IC Ethics Core for the AIM-AHEAD Project — NIH, OT2OD032581. (Anders, Malin) 10/1/21 - 9/30/23. We will work with Consortium Members to assess needs and constraints, and pilot and test different data and computing infrastructure, tools, and governance models including data policy and organizational models.
ACTIV-6: COVID-19 Outpatient Randomized Trial to Evaluate Efficacy of Repurposed Medications — NIH/NLM. (Anders) 4/17/21 - 3/31/23. This study evaluates the effectiveness of repurposed medications in reducing symptoms of non-hospitalized participants with mild to moderate COVID-19.
CRAFT: Evaluating a Prescribing Feedback System for Acute Care Providers — VA IIR study, Federal Identifier HX003057. (Ward, PI; Anders, Co-Investigator) 10/1/20 - 9/30/24. We will develop an automated feedback system (Care Review, Assessment & Feedback Tool) for acute care providers using antibiotic and NSAID prescribing as two exemplars of the need for acute care provider feedback in the Veterans Health Administration. The goal of this study is to use machine learning to develop a human-centered design feedback system to assess and enable improvement of ED and urgent care providers’ prescribing practices.
Providing Safe Care to Older Hospitalized Patients through Discrete Event Simulation Modeling — AHRQ, R18HS025910. (Simmons, Slagle, France) 9/1/19 - 6/30/24. The PI and one Co-Investigator of this proposal have applied DES in the nursing home care setting to optimize staffing needs to provide care based on a full range of ADL care needs. The proposed study will adapt this work to the hospital setting. The resulting DES model will be used to experiment with alternative staffing models to predict potential improvements in care delivery, some of which will be implemented with care improvements confirmed by standardized observation. The primary outcome measure will be observations of the consistency of ADL care provision in areas directly associated with falls, although we will also monitor secondary outcome measures including fall risk, fall events, patient satisfaction, and other safety events (e.g., pressure ulcers). The DES model will be developed first in an ACE unit and then disseminated to two other hospital units.
Providing safe care to older hospitalized patients through discrete event simulation modeling — AHRQ, M1802896. (Simmons, PI; France and Slagle, Co-Investigators) 7/1/19 - 6/30/24.
Understanding the cognition and decision making of community anesthesiologists in their management of end-of-case neuromuscular blockade: A mixed methods study — Merck Pharmaceuticals. (Weinger) 8/29/18 - 6/30/24. This project is being conducted by the Simulation Assessment Research Group (SARG). We propose to conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizing neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases.
Recent Grants & Contracts
PRECIDENTD: PREvention of CardIovascular and DiabEtic kidNey disease in Type 2 Diabetes — PCORI subcontract from Brigham & Women’s. (Mayberry, VUMC Subcontract PI; Slagle, Salwei, Anders, Co-Investigators) 1/1/22 - 12/21/23. Primary objective is to compare rates of the total number of myocardial infarction (MI), stroke, arterial revascularization, heart failure, development of end-stage kidney disease (ESKD), kidney transplantation, and death among three possible treatments for patients with type 2 diabetes (T2D) and either established atherosclerotic cardiovascular disease (ASCVD) or at high risk for ASCVD.
PORTAL: Patient Outcome Reporting Tool for emergency medicAL services — NHLBI R34, in collaboration with ESO Inc., NIH 1R34HL155400. (Ward, PI; Anders, Co-Investigator) 9/20/21 - 5/31/24. The goal of this study is to use human-centered design to develop a feedback system for EMS providers regarding chest pain patients to which they provide care.
SPEEDe: Safety Promotion through Early Event Detection in the Elderly — NIH/NIA R01, R01AG062499. (Wright, PI; Slagle, Co-Investigator) 3/1/20 - 1/31/2024. The goal of this study is to improve the accuracy and timeliness of adverse event detection in hospitals by developing and implementing a novel Adverse Event Explorer and cutting-edge application of interactive machine learning to make the most of limited reviewer resources, thus allowing more accurate detection with less human effort.
CaPSLL: Cancer Patient Safety Learning Laboratory: preventing clinical deterioration in outpatients — AHRQ, 1R18HS026616-01. (France and Weinger, Co-PIs; Anders and Slagle, Co-Investigators) 9/28/2018 - 9/30/2022. We will partner with surgeons, oncologists, nurses, staff, and adult patients with lung and head or neck cancer recovering from and/or undergoing treatment as outpatients, and their lay caregivers, to more reliably detect and respond more effectively to unexpected clinical deterioration. We will achieve this through three Specific Aims: 1) To create and refine software tools and a predictive model for a surveillance-and-response system to prevent harm from unexpected all-cause clinical deterioration in outpatients receiving cancer treatment; 2) To create and refine processes and training that engage patients and their caregivers as active and reliable participants in detecting and reporting potential clinical deterioration. We will apply high reliability organizational (HRO) principles and theories to develop processes and training for the relevant “team” — the cancer patients, their caregivers, and the clinicians who need to respond to signals from the surveillance system; and 3) To implement in the operational environment and formally evaluate the integrated detection and response tools and processes. We hypothesize (H1) that this system will decrease the likelihood and severity of unexpected treatment events. Further, with the incorporation of a patient/family focused HRO framework, we hypothesize that the system will increase non-routine event reporting (H2) and decrease clinician response time (H3). The resulting tools, methods and predictive model will be scalable to other cancer types as well as being generalizable to other institutions and to other high-risk outpatient populations (e.g., heart failure). Project resource page.
IMPACTS: Improving Medical Performance during Acute Crises Through Simulation — AHRQ, R18HS26158. (Weinger, PI; Anders and Slagle, Co-Investigators) 7/31/2023 - 7/31/2024. This project is being conducted by the Simulation Assessment Research Group (SARG). Determining the decision-making and action strategies used by physicians to detect and manage uncommon but potentially lethal clinical events is critical to improving the “rescue” of patients from such situations. This multicenter study by physicians and experts in cognitive science will use high-fidelity simulations along with rigorous performance assessment and psychological interview methods to identify which decision-making approaches are the most successful and what aspects of the individual clinicians’ training or work processes could be modified to improve outcomes when these events occur during actual patient care. The Specific Aims are to: 1) Develop and test a unified cognitive model and taxonomy of the decision-making strategies clinicians use during critical event management; 2) Create detailed profiles of participants’ clinical practice and simulation experience; 3) Evaluate the factors affecting physicians’ critical event performance; and 4) Evaluate the relationship between simulation-based performance assessment and existing metrics of physician competence (participants’ primary board certification exam scores). On this project, we are collaborating closely with the American Board of Anesthesiologists (ABA).
HERO: Handoffs Effectiveness Research in the periOperative environments Design Studio — AHRQ-funded grant, subcontract from UTSW grant 1R13HS027769-01. (Greilich, PI; France, VUMC Subcontract PI; Weinger, Co-Investigator) 5/1/21 - 4/30/22. The goals of this study are: 1) establish a national agenda for future perioperative handoff research; 2) build capacity to support and conduct rigorous handoff research (from basic science questions to quality improvement to implementation science); and 3) elucidate the evidence gaps for and best-of-class approaches to relevant research designs and methodologies to carry out this research.
Developing and testing a user-centered ventilator weaning system for critically ill neonates — Gerber Foundation grant. (Hatch, PI; Slagle, Co-Investigator) 9/1/20 - 12/31/22. The goal of this study is to develop and test a generalizable neonatal ventilator weaning system that incorporates the best available evidence-based neonatal mechanical ventilation practices to decrease the duration of mechanical ventilation in critically ill neonates.
The role of collective mindfulness in delivering reliable and safe perioperative care to neonates — AHRQ, 1R03HS026069-01. (France, PI; Slagle, Co-Investigator) 6/1/2018 - 5/31/2020. We propose a two-year pilot study to characterize Collective Mindfulness behaviors in NICU and OR teams and to measure their impact on patient safety as measured by the incidence and severity of Non-Routine Events (NREs) during NICU-to-OR handovers and subsequent care. Our Specific Aims are to: 1) Conduct a prospective observational pilot study of NICU and OR teams to estimate the prevalence of perceived CM (i.e., self-reported using the SOS) during neonatal perioperative care; 2) Assess the concordance between expert-rated behavioral markers from the A-V recordings collected during the observational study (exhibited CM) and those teams’ self-reported SOS scores (perceived CM); and 3) Determine the relationship between perceived and/or exhibited CM and the incidence and severity of NREs occurring during neonatal perioperative care. We anticipate that knowledge gained from this study will lay the groundwork for a multi-center study on the impact of team-based HRO interventions on neonatal safety in the perioperative environment.
Risk stratification and decision support to improve care and outcomes in children with pneumonia — NIH/HIAID, R01AI125642-02. (Williams, PI; Weinger and Slagle, Co-Investigators) 2/1/2017 - 1/31/2022.
Smart-COM – scalable multi-agent adaptive resolution tools for Collaborative Outage Management — DOE, Office of Nuclear Energy University Program (NEUP) Award, DE-NE0008664. Subcontract from Virginia Tech. (Lau, PI; Anders, Site PI; Weinger and Anders, Co-Investigators) 10/1/17 - 9/30/20.
Determining and targeting reasons for low statin use to improve guideline-concordant statin therapy in high-risk patients — VA HSR7D IIR, IIR 16-072. (Virani, PI; Slagle, Co-Investigator) 7/1/2017 - 6/30/2021.
Personal health information needs and practices for maternal fetal care — AHRQ, 6R01HS024196-04. (Jackson, PI; Weinger and Anders, Co-Investigators) 8/1/2016 - 7/31/2019.
The impact of non-routine events on neonatal safety in the perioperative environment — National Institute of Child Health and Human Development (NICHD), 1R01HD086792-01. (France and Blakely PIs; Slagle and Weinger, Co-investigators) 4/4/2016 - 1/31/2020. We propose a comprehensive 4-year study of neonatal patient safety in the perioperative environment to produce the knowledge base required to inform high-impact intervention studies and guide rapid cycle quality improvement. Our Aims are to: 1a) Determine the prevalence and characteristics of NREs during the perioperative care of neonates; 1b) Delineate the relationship(s) between NREs, contributory factors, and surgical mortality and major morbidity during neonatal perioperative care; 2) Perform a comparative analysis of prospective NRE data collection with conventional event reporting methodologies within the same clinical environment; and 4) Collaborate with Primary Children’s Hospital in Salt Lake City, Utah to conduct practical pilot testing of tools and measures refined in Aims 1-3.
Designing user-centered decision support tools for chronic pain in primary care — AHRQ, R01HS023306. (Harle, PI; Anders, Co-Investigator) 9/1/2015 - 8/31/2019.
Meta-level design guidance and operator performance measures for hybrid control rooms — DOE, Nuclear Energy University Program, NE0008267. (Weinger, PI; Anders & France, Co-Investigators) 9/1/14 - 8/30/17.
Timing of inguinal hernia repair in premature infants: a randomized trial — NICHD, 1U01HD076733-04. (Blakely, PI; France and Slagle, Co-Instigators) 7/1/2014 - 6/30/2019.
Automated surveillance and intervention among patients with liver cirrhosis — VA, Merit Review Grant HX001284. (Ho & Matheny, Co-PI; Slagle & Weinger, Co-Investigators) 7/1/14 - 6/30/17.
Handover tool participatory design and educational training intervention to improve perioperative neonatal safety — FAER, Mentored Educational Grant. (Lorinc, PI; Weinger, Co-Investigator) 7/1/13 - 6/30/16.
Patient-centered Non-Routine Events (PNREs) to identify risks to best patient outcomes — PCORI, 1IP2PI000072. (Weinger, PI; Anders & Slagle, Co-Investigators) 8/1/12 - 6/31/15.
Develop usability guidelines and evaluation framework for electronic health records — NIST, SB1341-11-CN-0011. (Wiklund & Weinger, Co-PI; Weinger, Site PI) 5/1/11 - 12/30/15.