Handoffs and Transitions in Critical Care - Understanding Scalability

重症监护中的交接和过渡 - 了解可扩展性

基本信息

批准号：
10246458
负责人：
Meghan Brooks Lane-Fall
金额：
$ 70.18万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10246458
关键词：
Acute Address Adherence Admission activity Adoption Adult Adverse event American Heart Association Area Cardiopulmonary Case Study Chronic Disease Communication Complement Complex Continuity of Patient Care Critical Care Critical Illness Custom Disease Effectiveness Engineering Ensure Environment Evaluation Event Evidence based intervention Failure Goals Health system Healthcare Hospitals Human Hybrids Inpatients Intensive Care Units Intervention Knowledge Leadership Life Measures Medical center Methods Modeling Modernization National Heart, Lung, and Blood Institute Operating Rooms Operative Surgical Procedures Organ failure Outcome Patient Care Patient-Focused Outcomes Patients Pediatric Intensive Care Units Performance Postoperative Period Process Protein Structure Initiative Protocols documentation Provider Public Health Publishing Randomized Resources Site Social Marketing Standardization State Interests Translating Translational Research United States United States Agency for Healthcare Research and Quality Visit Work Workload acute care base cost design digital effective intervention effectiveness implementation study effectiveness outcome effectiveness testing evidence base guided inquiry implementation cost implementation determinants implementation efforts implementation framework implementation outcomes implementation science implementation strategy implementation study implementation trial improved pragmatic trial preservation prevent primary outcome satisfaction theories trial design uptake usability

项目摘要

PROJECT SUMMARY: “Handoffs and Transitions in Critical Care – Understanding Scalability (HATRICC-US)” Modern care of the patient with acute cardiopulmonary failure requiring critical care support is marked by the inadequate adoption and use of interventions with proven effectiveness. There is an urgent need to characterize implementation strategies suitable for use in the fast-paced, high stakes environment of critical care; doing so would generate a substantial public health impact by narrowing the evidence-to-practice performance gap for these high-acuity patients. One such gap is caused by inconsistent adoption of standardized post-surgical handoffs in U.S. hospitals, an intervention deemed high priority by the American Heart Association. In this project, we use an evidence-based standardized protocol for patient care handoffs from the operating room (OR) to the intensive care unit (ICU) as a model to study the uptake and use of complex sociotechnical interventions in acute care. In previous work, our group demonstrated adoption, fidelity, and improvement in process outcomes in a pilot 2-site study of OR-to-ICU handoff standardization. Our published work in this area builds on a base of more than 65 published studies demonstrating the effectiveness of handoffs protocols on a range of outcomes relevant to the care of patients with cardiopulmonary failure, including process, provider, and patient outcomes. The proposed study is an extension of our work that will address critical knowledge gaps about implementation in acute care by studying the implementation of a standardized handoff protocol in 12 adult and pediatric ICUs in eight hospitals in five health systems. This pragmatic study is a Hybrid Type 2 effectiveness-implementation study with a dual focus on demonstrating improvements in short-term patient outcomes (composite measure of new-onset organ failure [co-primary]; adverse postoperative events) and implementation outcomes (fidelity [co- primary]; feasibility; acceptability; appropriateness; implementation cost; and sustainment over two years). The study integrates implementation frameworks, theories, and models with engineering approaches to workflow evaluation, intervention adaptation, and evaluation. Our specific aims are to: (1) elucidate handoff protocol implementation determinants using mixed-methods on-site contextual inquiry, (2) use an engineering approach known as participatory design to adapt the handoff protocol to each ICU and use theory-based implementation mapping to select tailored, multifaceted, multilevel implementation strategies, (3) implement handoff protocols in stepped wedge fashion with randomized roll-out under the leadership of site based teams, and (4) use human- centered design to create an implementation toolkit to facilitate the dissemination and use of study findings to a broad audience. The proximate goal of this work is to determine effective approaches to implementation for complex sociotechnical interventions in acute care settings. The longer-term goal is to use this approach to promote the uptake and sustained use of proven-effective interventions in the care of patients with acute cardiopulmonary failure. This work directly addresses the stated interest of NHLBI's Center for Translation Research and Implementation Science in mixed methods studies and those using pragmatic trial designs.

项目概要： “重症监护中的交接和过渡 - 了解可扩展性 (HATRICC-US)” 需要重症监护支持的急性心肺衰竭患者的现代护理特点是已证明有效的干预措施的采用和使用不够充分迫切需要确定其特征。适合在快节奏、高风险的重症监护环境中使用的实施策略；将通过缩小证据与实践的绩效差距来产生重大的公共卫生影响这些高危患者的差距之一是由于标准化术后的采用不一致造成的。美国医院的交接是美国心脏协会在该项目中高度重视的一项干预措施。我们使用基于证据的标准化协议将患者护理从手术室 (OR) 转移到手术室重症监护病房（ICU）作为研究急性重症患者复杂社会技术干预措施的吸收和使用的模型在之前的工作中，我们的团队展示了流程结果的采用、保真度和改进。我们在该领域发表的工作建立在更多的基础上。超过 65 项已发表的研究证明了交接协议对一系列相关结果的有效性心肺衰竭患者的护理，包括流程、提供者和患者结果。拟议的研究是我们工作的延伸，它将解决有关实施的关键知识差距通过研究标准化交接协议在 12 个成人和儿童 ICU 中的实施情况来进行急性护理这项务实研究是一项混合 2 型有效性实施研究。研究的双重重点是证明短期患者结果的改善（综合衡量新发器官衰竭[共同主要]；不良术后事件）和实施结果（保真度[共同- 可行性；可接受性；以及两年内的维持成本）。研究将实施框架、理论和模型与工作流程的工程方法相结合我们的具体目标是：（1）阐明切换协议。使用混合方法现场情境调查的实施决定因素，（2）使用工程方法称为参与式设计，使切换协议适应每个 ICU 并使用基于理论的实施映射以选择定制的、多方面的、多层次的实施策略，(3) 实施切换协议阶梯式楔形时尚，在现场团队的领导下随机推出，以及（4）使用人力以创建实施工具包为中心的设计，以促进研究结果的传播和使用这项工作的近期目标是确定有效的实施方法。长期目标是使用这种方法来进行急性护理环境中的复杂社会技术干预。促进在急症患者护理中采用和持续使用经证明有效的干预措施这项工作直接满足了 NHLBI 翻译中心的既定兴趣。混合方法研究和使用实用试验设计的研究和实施科学。