REST-PSLL: Re-engineering Surgical Recovery and Transitions Using Technology Patient Safety Learning Laboratory

REST-PSLL：利用技术重新设计手术恢复和过渡患者安全学习实验室

• 批准号: 10768806
• 负责人: Jenna Louise Marquard
• 金额: $ 50万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10768806
• 关键词: REST; PSLL; Re; engineering; Surgical

PROJECT SUMMARY/ABSTRACT: Emergency general surgery (EGS) - accounting for 11% of US hospital admissions; over 50% of operative mortality; the highest risk, acuity, rate of complications, and cost in general surgery - particularly the subset of emergency laparotomy (EL) patients which suffer the worst EGS outcomes - is increasingly recognized as a public health crisis. While enhanced recovery programs (ERPs) have dramatically advanced pre-, intra-, and inpatient postoperative evidenced-based best practices (EBPs), ERPs have largely ignored subsequent postoperative home-based recovery. Despite certain postoperative complications occurring commonly after discharge (notably over 40% of surgical site infections [SSI]), recovery for surgical patients once discharged to home remains understudied and ripe for improvement and innovation, especially as surgical care models increasingly shift greater proportions of postoperative recovery into the home-based setting. Digital solutions for remote monitoring, patient engagement/education, and surgical prediction show promise but are used minimally for surgical recovery. We hypothesize that well-designed technology solutions for EL home- and transition-based workflows engaging diverse stakeholders will empower EL patients, their caregivers, and care teams to achieve optimal outcomes and safe recovery. The goal of REST-PSLL (Re-engineering Surgical Recovery and Transitions Using Technology Patient Safety Learning Laboratory) is to apply systems engineering approaches to co-produce innovative and scalable patient- and care team-centric solutions for EL home-based recovery. REST-PSLL has the following specific aims. Aim 1: Identify barriers and facilitators to ideal at-home recovery for patients following EL. We will engage stakeholders using the Systems Engineering for Patient Safety (SEIPS) model to identify and evaluate factors to understand barriers and facilitators of optimal care and postoperative complications with a focus on SSI. Aim 2: Iteratively design and develop new processes, tools, and technologies that help remove or reduce barriers to ideal at-home recovery. We will use swimlane diagrams to then analyze for areas of improvement to generate initial design requirements and prototypes for tools/technologies followed by iterative user-centered design to specify design requirements, develop solutions, and conduct end-user testing at our clinical sites. Aim 3: Implement and evaluate solutions in practice. Perform pilot testing and implementation, assess primary (addressing or avoiding trigger/potential issue, solution us) and secondary outcomes guided by RE-AIM framework; evaluate implementation phases guided by EPIS implementation framework to generate implementation learnings and solution revision plan(s). REST-PSLL is poised to be highly successful and impactful, highlighted by: a) anticipated learnings that can be extrapolated to other surgical populations; b) use of transdisciplinary complementary systems expertise and approaches; c) deep clinical expertise; d) patient- and caregiver- co-production; and e) expanding or optimizing existing solutions/platforms.

项目摘要/摘要： 急诊普通外科 (EGS)——占美国住院人数的 11%；超过50%的操作者 死亡;普通外科手术的风险、严重程度、并发症发生率和费用最高，尤其是 急诊剖腹手术 (EL) 患者的 EGS 结果最差 - 越来越多地被认为是 公共卫生危机。虽然强化恢复计划 (ERP) 极大地推进了术前、术中和术后恢复 住院患者术后循证最佳实践 (EBP)、ERP 在很大程度上忽略了后续的 术后居家康复。尽管某些术后并发症经常发生 出院（特别是超过 40% 的手术部位感染 [SSI]），手术患者出院后康复 家庭仍然没有得到充分研究，并且已经成熟，可以进行改进和创新，特别是作为手术护理模式 越来越多地将更大比例的术后恢复转移到家庭环境中。数字化解决方案 用于远程监控、患者参与/教育和手术预测显示出希望，但已被使用 至少用于手术恢复。我们假设精心设计的 EL 家庭和 吸引不同利益相关者的基于过渡的工作流程将增强 EL 患者、他们的护理人员和护理人员的能力 团队以实现最佳结果和安全康复。 REST-PSLL（再造外科手术）的目标 使用技术患者安全学习实验室的恢复和过渡）是应用系统 共同开发创新且可扩展的以患者和护理团队为中心的 EL 解决方案的工程方法 居家康复。 REST-PSLL 具有以下具体目标。目标 1：识别障碍和促进因素 EL 术后患者理想的在家康复方式。我们将利用系统工程吸引利益相关者 患者安全 (SEIPS) 模型，用于识别和评估因素，以了解患者安全的障碍和促进因素 重点关注 SSI 的最佳护理和术后并发症。目标2：迭代设计和开发新产品 有助于消除或减少理想家庭康复障碍的流程、工具和技术。我们将使用 泳道图，然后分析需要改进的领域，以生成初始设计要求和 工具/技术原型，然后以用户为中心的迭代设计来指定设计要求， 开发解决方案，并在我们的临床站点进行最终用户测试。目标 3：实施和评估解决方案 在实践中。进行试点测试和实施，评估主要因素（解决或避免触发/潜在的 RE-AIM 框架指导下的问题、解决方案）和次要成果；评估实施阶段 以 EPIS 实施框架为指导，生成实施学习和解决方案修订计划。 REST-PSLL 有望取得巨大成功和影响力，突出表现在：a) 预期的学习内容可以 外推至其他手术人群； b) 使用跨学科互补系统专业知识和 方法； c) 深厚的临床专业知识； d) 患者和护理人员共同生产； e) 扩展或 优化现有解决方案/平台。