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： 紧急通用外科手术（例如） - 占美国医院入院的11％；超过50％的手术 死亡;一般手术中的最高风险，敏锐度，并发症发生率和成本 - 特别是 遭受最严重的EGS结局的紧急剖腹手术（EL）患者越来越被认为是 公共卫生危机。虽然增强的恢复计划（ERP）具有明显的先进的预性，内部和 住院术后基于证据的最佳实践（EBP），ERP在很大程度上被忽略了 术后家庭恢复。尽管某些术后并发症通常发生在 出院（尤其是超过40％的手术部位感染[SSI]），曾经出院的手术患者恢复 房屋仍在研究并成熟以改进和创新，尤其是作为手术护理模型 越来越多地将术后恢复比例更大的比例转移到基于家庭的环境中。数字解决方案 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 最少的手术恢复。我们假设为EL Home和Home-Home和 基于过渡的工作流程吸引各种利益相关者将赋予EL患者，护理人员和护理能力 实现最佳成果和安全康复的团队。 REST-PSLL的目标（重新设计外科手术 使用技术患者安全学习实验室恢复和过渡）是应用系统 为EL共同生产创新和可扩展的患者和护理团队解决方案的工程方法 基于家庭的恢复。 REST-PSLL具有以下特定目标。目标1：确定障碍和促进者 EL之后患者的理想住家恢复。我们将使用系统工程吸引利益相关者 为了患者安全（SEIP）模型，以识别和评估因素，以了解 最佳护理和术后并发症，重点是SSI。目标2：迭代设计并开发新的 有助于消除或减少理想在家恢复的过程，工具和技术。我们将使用 然后，泳道图可以分析改进领域，以产生初始设计要求和 工具/技术的原型，然后是以用户为中心的迭代设计，以指定设计要求， 开发解决方案，并在我们的临床部位进行最终用户测试。目标3：实施和评估解决方案 实践。进行试点测试和实施，评估初级（解决或避免触发/潜力 问题，解决方案）和由Re-Aim框架指导的次要结果；评估实施阶段 以EPIS实施框架为指导，以生成实施学习和解决方案修订计划。 REST-PSLL准备将非常成功和有影响力，强调：a）可以预期的学习 推断到其他手术人群； b）使用跨学科的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 优化现有的解决方案/平台。