# Development, Validation and Application of a Quantitative Hazard Assessment and Remediation Tool to Mitigate Risk in the Healthcare Built Environment

> **NIH AHRQ R18** · BOSTON CHILDREN'S HOSPITAL · 2021 · $390,469

## Abstract

Project Summary/Abstract
The proposal aims to develop, validate and test a standardized tool that intended to assess
latent risks in the physical healthcare environment. The Hazard Assessment and Remediation
Tool (HART) will be developed in three parts. First, the proposal will establish an intra-class
correlation coefficient (0.9) for expert raters applying the HART tool to simulated resuscitations.
Frame of reference training will be used to assess inter-rater reliability of the tool using a
separate team of raters. Second, the HART tool will be used to assess the tool's ability to
discriminate between clinical environments with various physical attributes (e.g. comparing
minimum required room size against twenty percent larger rooms) during critical clinical
interventions. Additionally, analyses will be conducted to evaluate the correlation between
HART score and completion of key clinical performance metrics (e.g. adherence to CPR
guideline of chest compressor rotations every two minutes). Lastly, the proposal aims to
develop and test a methodology to aid in the remediation of hazards in the clinical environment.
Baseline measurements from the HART tool, in conjunction with staff surveys post-simulation,
will be used to identify improvements in the trauma resuscitation environment. The HART tool
will be applied to the improved environment to determine if changes produce a more favorable
HART score. Secondary outcomes to the second and third aims of the proposal include team
communication and coordination as well as physician and nurse workload. Although pre-
construction simulation is growing in popularity, to date no standardized, quantitative, validated
tools are available to identify latent hazards in clinical environments and systems. We propose
to develop and validate a robust, quantitative tool that can be applied to clinical spaces under
design or to existing spaces to assess and remediate physical hazards.

## Key facts

- **NIH application ID:** 10147834
- **Project number:** 5R18HS025927-04
- **Recipient organization:** BOSTON CHILDREN'S HOSPITAL
- **Principal Investigator:** Catherine Allan
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $390,469
- **Award type:** 5
- **Project period:** 2018-07-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10147834

## Citation

> US National Institutes of Health, RePORTER application 10147834, Development, Validation and Application of a Quantitative Hazard Assessment and Remediation Tool to Mitigate Risk in the Healthcare Built Environment (5R18HS025927-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10147834. Licensed CC0.

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