A novel approach for supporting care coordination across distributed emergency care teams

急救车期间危重病人(如创伤、心肌梗塞和中风)的处理 运输需要院前和医院团队之间的快速护理协调和共同决策。 尽管发挥了关键作用，但院前和医院团队之间的护理协调和沟通仍然存在 效率低下，富有挑战性。目前的机制(例如，无线电和电话)对于信息共享来说并不是最优的 以及院前会诊中的护理协调，部分原因是它们的效率低下和能力有限 急救护理专业人员与手持计算设备进行交互。因此，新技术 需要互动模式来支持院前护理协调，同时允许紧急情况 护理专业人员要把手放在病人身上。智能眼镜具有很大的潜力作为一种 院前和医院护理提供者之间不引人注目的技术渠道，因为他们承诺 免提操作和情景感知用户交互等优势。为此，最重要的是 该项目的目标是设计、开发和评估智能玻璃应用程序以及不引人注意的交互 改善院前护理协调的机制，同时考虑到社会技术 在复杂、快节奏的院前护理背景下开发技术所涉及的挑战。这 研究意义重大，因为它是开发新的“免提”技术的重要早期步骤 这可以无缝地集成到手忙脚乱的医疗环境中，进而简化 急救护理专业人员跨地域和跨地区协调患者护理的工作流程 组织边界，以及加强院前和其他危重护理环境中的护理协调。我们 提出两个令人信服的具体目标：1)设计和开发支持实时 院前护理协调；以及2)评估技术解决方案对院前护理的影响 协调。我们将使用多阶段、以用户为中心的设计方法来追求第一个目标，结合 参与式设计研讨会、快速原型制作和形成性评估。我们将通过以下方式实现第二个目标 通过模拟评估院前会诊期间的护理协调和团队合作效率。这个 拟议的研究具有创新性，因为它代表了对 院前会诊期间护理协调的技术开发，重点是开发新的 具有非侵入性交互技术以支持免提、实时护理的可穿戴系统 在紧急护理和其他危重护理流程中的协调。此外，我们的研究方法是新颖的- 尽管参与式设计(PD)在面向患者的技术设计中显示出了希望，但令人惊讶的是 很少有研究人员使用PD来指导以临床医生为中心的系统的设计，特别是在 紧急护理。我们的长期目标是建立一个能够支持共享的集成计算机化系统 院前团队和医院团队之间的决策和护理协调，以改善患者结局 同时减少他们的认知和体力工作负荷。这项影响巨大的提案将是实现以下目标的重要一步 实现我们的长期目标，支持更好地以患者为中心的护理交付和协调。这 该提案与AHRQ和这一具体征集在开发新的卫生信息技术方面的优先事项保持一致 促进数据共享的系统，以支持跨多个 卫生保健服务提供者，并最终提高卫生保健质量和结果。

Management of critically ill patients (e.g., trauma, myocardial infarction, and stroke) during ambulance transport requires fast care coordination and shared decision making between prehospital and hospital teams. Despite its critical role, care coordination and communication between prehospital and hospital teams remain ineffective and challenging. Current mechanisms (e.g., radio and phone) are not optimal for information sharing and care coordination in prehospital encounters due in part to their ineffectiveness and limited capabilities of emergency care professionals in interacting with handheld computing devices. Therefore, novel technologies and modes of interactions are needed for supporting prehospital care coordination while allowing emergency care professionals to keep their hands on the patient. Smart glasses have high potential for serving as an unobtrusive technological conduit between prehospital and hospital care providers because they promise advantages such as hands-free operation and context-aware user interaction. To that end, the overarching goal of this project is to design, develop, and evaluate smart glass applications and unobtrusive interaction mechanisms to improve prehospital care coordination while taking into consideration the socio-technical challenges involved in developing technology for the complex, fast-paced prehospital care context. This research is significant because it is an essential early step toward developing novel “hands-free” technology that can be seamlessly integrated into hands- and eyes-busy medical environments, and in turn, streamlining the workflow of emergency care professionals in coordinating patient care across geographical and organizational boundaries, and enhancing care coordination in prehospital and other critical care settings. We propose two compelling specific aims: 1) To design and develop technologies that support real-time prehospital care coordination; and 2) To evaluate the impact of technology solutions on prehospital care coordination. We will pursue the first aim using a multi-phased, user-centered design approach, combining participatory design workshops, rapid prototyping, and formative evaluation. We will pursue the second aim by assessing care coordination and teamwork efficiency during prehospital encounters through simulations. The proposed research is innovative because it represents a substantive departure from the status quo in the technology development for care coordination during prehospital encounters, focusing on developing novel wearable system with unobtrusiveness interaction techniques to support hands-free, real-time care coordination in emergency care and other critical care processes. In addition, our study approach is novel— despite participatory design (PD) has shown promise in the design of patient-facing technology, surprisingly few researchers have used PD to inform the design of clinician-focused systems, especially in the context of emergency care. Our long-term goal is to build an integrated computerized system that can support shared decision-making and care coordination between prehospital and hospital teams to improve patient outcomes while reducing their cognitive and physical workload. This high impact proposal will be an essential step toward achieving our long-term goal and supporting better patient-centered care delivery and coordination. This proposal aligns with the priorities of both AHRQ and this specific solicitation in developing novel health IT systems that facilitate data sharing to support treatment decision-making and care coordination across multiple care providers, and ultimately, improving health care quality and outcomes.