UT-Houston Researchers to Examine

Researchers at The University of Texas Health Science Center at Houston plan to launch in January their part of a multi-center project that will examine the complexities of emergency medicine and inefficiencies that are most likely to cause errors in the delivery of patient care.

The first phase of the five-year project, funded by a $4.7 million grant to Arizona State University (Principal Investigator Vimla L. Patel, Ph.D.) from the James S. McDonnell Foundation, is designed to study the processes underlying critical care decision-making to identify inefficiencies and weaknesses. The second phase will examine how to correct problems within the health care delivery system to reduce and prevent medical errors, reduce health care costs and increase health care quality.

Jiajie Zhang, Ph.D., the Doris L. Ross Professor and associate dean of research at The University of Texas School of Health Information Sciences at Houston, and David Robinson, M.D., research director and vice chairman of the Department of Emergency Medicine at The University of Texas Medical School at Houston, are co-investigators at the Houston site. They will conduct the research with partners at the leading institution, Arizona State University, and two other study sites, Banner Health System in Phoenix and Washington University in St. Louis.

“Our job is to understand the complexity of the emergency room setting and determine an optimal way to organize this rapidly changing, high-stress environment,” Zhang said. “Once the system is more efficient, medical errors will be reduced.”

To accomplish this, Zhang and graduate research associates will shadow health care providers in the emergency center at Memorial Hermann – Texas Medical Center. They will use their observations, along with data from the electronic medical record systems, to create a computer model of activities and human thought processes and behaviors in the emergency center. Observations will include such details of how frequently physicians access medical records, how they communicate with the nurses and pharmacists and how they prioritize the order in which patients should receive treatment.

At the Houston research site, Zhang said, the research will focus on the trauma unit, with the flexibility to expand the scope of the project to the medicine unit, the pediatric emergency center and also Lyndon B. Johnson General Hospital’s Emergency Center.

“This is an enormous task to identify and map the processes behind of emergency medicine and all the nuances of patient care,” Robinson said. “We are going to take an analytical look at how the system operates so that we’ll have a better understanding of where error comes from. Then we can make changes in the way we provide patient care.”

According to a 1999 Institute of Medicine report, an estimated 44,000 to 98,000 people die in hospitals as a result of medical errors each year in the United States. Robinson said the fast-paced environment makes emergency centers particularly vulnerable to errors, which may stem from something as simple as sloppy handwritten orders to a problem as complex as delays in patient care because of overcrowding. Most errors are corrected before there is an adverse event with patient care, Robinson said, but preventing even the slightest error is the best way to ensure patient safety.

“Error is not about blame,” Robinson said. “We need to look at the system as a whole and identify the factors that play into errors in the acute care setting.”

M. Michael Shabot, M.D., system chief medical officer at Memorial Hermann Healthcare System and adjunct professor at the UT School of Health Information Sciences, will serve as advisor to the project.

“The Memorial Hermann Healthcare System applauds the UT Health Science Center at Houston, Dr. Jiajie Zhang and Dr. David Robinson for undertaking this groundbreaking research on errors in emergency and critical care,” Shabot said. “Drs. Zhang’s and Robinson’s earlier work in this field, in conjunction with Dr. Vimla Patel of Arizona State University, is already yielding important insights into the classification, cause and prevention of medical errors, especially in emergency situations. The entire health care community, and patients most of all, will benefit from this important research.”