EnhanCed HandOffs (ECHO)

增强型切换 (ECHO)

• 批准号: 10636447
• 负责人: Joanna Abraham
• 金额: $ 39.62万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636447
• 关键词: EnhanCed; HandOffs; ECHO

ABSTRACT: ECHO PROJECT Patients undergoing complex surgeries are most vulnerable during the immediate postoperative period; thus, handoffs from the OR (operating room) to ICU (intensive care unit) require seamless communication and coordination between surgical, anesthesia, and critical care teams. Postoperative handoffs are a threat to patient safety, causing ~35% of medical errors in the US. To mitigate these errors, the National Patient Safety Goal (2E) necessitated the “standardization” of handoff process and content, which resulted in adoption of information transfer checklists, handoff process-based protocols, or both. Although such strategies have improved handoff quality, our meta-analysis found that such improvements were temporary and had limited sustainability, due to the structured formats imposing “rigid” standardization with limited flexibility and support for interactive and personalized communication. Our central hypothesis is that a flexible standardization approach will lead to not only improvements in information sharing, but also improvements in shared understanding of patient risks, handoff interactivity, and handoff duration. Towards this end, we propose to develop the INTERACT (Intelligent interactive care continuity) handoff bundle, a flexible, standardized, EHR- integrated, and resilient sociotechnical intervention comprised of a: (1) telemedicine-augmented handoff process (i.e., the social component) supported by a (2) machine learning (ML)-augmented handoff report (i.e., the technical component). INTERACT underscores the importance of using a perioperative telemedicine suite as a safety net to support resilience to errors in OR-ICU handoff process and content. The ML-augmented handoff report supports personalized communication of core (i.e., standardized) and tailored (flexible) content based on predicted patient risks for postoperative complications. Aim 1 will focus on updating our current ML models for predicting risks associated with postoperative complications, based on state-of-the-art imputation and feature engineering techniques. We will enhance our model-agnostic explanation framework to support postoperative handoffs and decision-making, which will also be validated with a summative user evaluation study. Aim 2 will follow a user-centered design approach to iteratively develop and test the INTERACT bundle including handoff report design ideation, and usability testing, and lastly, the INTERACT bundle in-situ simulations. Aim 3 will adopt a Hybrid Type 1 trial design and the Care Transitions Framework to evaluate the effectiveness and implementation-potential of the INTERACT bundle. Our primary outcome is information sharing score (i.e., a measure of information completeness), while secondary outcomes include information inaccuracies, realized errors and adverse events, and ICU length of stay. With an integrated multidisciplinary approach to improving perioperative care transitions, the proposed INTERACT bundle will address the stated AHRQ FOA goals of “defragmenting information, improving communication, and assuring care team access to reliable and complete health information; and empowering care teams to improve health outcomes.”

摘要：回声项目 接受复杂手术的患者在术后初期最容易受到伤害； 从 OR（手术室）到 ICU（重症监护病房）的交接需要无缝通信和 手术、麻醉和重症监护团队之间的协调对术后交接构成威胁。 患者安全，导致美国约 35% 的医疗错误。 目标 (2E) 需要交接流程和内容的“标准化”，这导致采用 信息传输清单、基于切换过程的协议或两者兼而有之。 提高了切换质量，我们的荟萃分析发现这种改进是暂时的并且效果有限 可持续性，由于结构化格式强加了“严格”​​标准化，灵活性和支持有限 我们的中心假设是灵活的标准化。 这种方法不仅会改善信息共享，还会改善共享 了解患者风险、切换交互性和切换持续时间，我们建议： 开发 INTERACT（智能交互式护理连续性）交接包，这是一个灵活、标准化的 EHR- 综合且有弹性的社会技术干预包括：(1) 远程医疗增强交接 由 (2) 机器学习 (ML) 增强的交接报告（即， INTERACT 强调使用围手术期远程医疗套件的重要性 作为一个安全网，支持 OR-ICU 切换过程和内容中的错误恢复能力。 交接报告支持核心（即标准化）和定制（灵活）内容的个性化通信 基于预测的患者术后并发症风险，目标 1 将重点更新我们当前的 ML。 基于最先进的插补来预测术后并发症相关风险的模型 我们将增强与模型无关的解释框架以支持。 术后交接和决策，也将通过总结性用户评估进行验证 研究目标 2 将遵循以用户为中心的设计方法来迭代开发和测试 INTERACT 捆绑包。 包括交接报告设计构思和可用性测试，最后是现场交互捆绑包 目标 3 将采用混合类型 1 试验设计和护理过渡框架来评估 INTERACT 捆绑包的有效性和实施潜力我们的主要成果是信息。 共享分数（即信息完整性的衡量标准），而次要结果包括信息 不准确、已实现的错误和不良事件以及 ICU 住院时间。 为了改善围手术期护理过渡，拟议的 INTERACT 捆绑包将解决上述问题 AHRQ FOA 的目标是“整理信息碎片、改善沟通并确保护理团队能够访问 可靠和完整的健康信息；并赋予护理团队改善健康结果的能力。”