The Center for Research and Innovation in Systems Safety (CRISS) conducts basic and applied research in healthcare informatics, patient safety and clinical quality, and designs and evaluates informatics user interfaces, care processes and medical technology across Vanderbilt University Medical Center.

Directed by Matthew B. Weinger, M.D., CRISS is highly interdisciplinary and collaborative with projects spanning numerous clinical domains (from the Medical Home to the operating room) and disciplines (medicine, nursing, and pharmacy). Using a range of human factors and systems engineering, cognitive psychology, biomedical informatics, and implementation science techniques, CRISS studies performance during patient care and in realistic simulations to better understand how and why care deviates from optimal. Interventions are then designed and evaluated to improve the safety and quality of care. CRISS is actively involved in improving the user interfaces of Vanderbilt’s custom clinical information systems as well as in evaluating and redesigning processes and tools to enhance patient safety and quality care.

Focus

CRISS investigators are particularly interested in designing and evaluating medical technologies (i.e., devices and information systems) with an emphasis on the effects of the introduction of new technologies on clinical care and the use of electronically generated clinical data to identify evolving events and support decision-making. We also conduct studies to understand the causes of unexpected clinical events and how such events might be prevented.

At the conceptual level, CRISS scientists are interested in the nature of expertise, clinician-clinician communication, novel methods of information presentation, the workload and stress of individual clinicians and of teams, situational awareness, and various other intrinsic and extrinsic variables that affect performance during routine and non-routine clinical care. CRISS investigators are also interested in team communication, coordination, culture and effectiveness, human-technology interactions, adaptive problem solving, as well as individual and group performance-shaping factors, to generate practical benefits in terms of improved clinical care processes and outcomes.

History

Because of increasing scope and impact outside the operating room and across multiple healthcare domains, the Center for Perioperative Research in Quality (CPRQ), founded in 2005, was renamed in October 2010 to be the Center for Research and Innovation in Systems Safety. CRISS remains located within the Department of Anesthesiology, and is an integral part of Vanderbilt’s Institute for Medicine and Public Health (IMPH), lead by Dr. Robert Dittus. CRISS is an institution-wide resource for human factors and systems design and improvement in healthcare. The Center also subsumed the functions of Vanderbilt’s Center for Improving Patient Safety (CIPS), previously co-directed by Drs. Dittus and Weinger.

Current Activities

Active research projects include an AHRQ-funded study (Weinger, PI) which demonstrated that a simulation-based training and quality improvement intervention focused on handovers between anesthesia providers and post-anesthesia care unit (PACU) nurses significantly improved actual PACU handovers and the culture of interdisciplinary communication in the PACUs.

In a VA HSRD-funded 5-site study (Weinger, PI), CRISS faculty analyzed data from 1,000 patient cases to assess the relationship between clinician workload, the occurrence of intraoperative events, and patient major morbidity and mortality. Preliminary results show that the surgical team’s pre- and post-case workload ratings were strongly associated with reported intraoperative events.

Dr. France is completing work on an NHLBI R21 grant to model the factors that affect the ability of patients with acute coronary syndrome presenting to the emergency department to receive evidence-based care.

Dr. Miller is in the middle of a study funded by the Anesthesia Patient Safety Foundation to implement and evaluate goal-directed care protocols in the Cardiovascular ICU.

Recently, CRISS started an AHRQ-funded multicenter study (Weinger, PI) to develop and deploy standardized simulation scenarios to evaluate the competence of board-certified physicians.

Dr. Slagle and Weinger are co-investigators in an NLM-funded trial (Trent Rosenbloom, PI) to evaluate how mode of clincal documentation (handwritten note, dictation, or electronic charting) affects the patient experience as well as the quality of the resulting note.

CRISS members are also actively involved in VUMC operational initiatives in quality improvement (QI) and informatics. For example, on the QI side, CRISS faculty participate in the review and analysis of most serious clinical events at VUMC, are actively involved in a re-engineering of blood transfusion processes (which has already led to a published research paper), clinician handover improvement, and enhanced compliance with perioperative timeouts and checklists.

For VUMC informatics, CRISS faculty and staff are integrally involved in user interface design and evaluation on numerous application teams including Vanderbilt Outpatient Order Management (new system for ordering outpatient labs and diagnostic tests), StarPanel Customized Views (new method of presenting EMR data for specialists), Reliable Results Reporting (to facilitate the tracking of the status of lab results for panels of patients), and tools to support surgical timeouts, handovers and debriefings.

CRISS faculty and staff provide other CTSA/VICTR investigators with core support and guidance in theories, methods and tools related to human factors, industrial and systems engineering, user interface design and evaluation, process re-engineering, implementation science, simulation-based training and assessment, safety culture and associated survey methods, and related areas.