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

重症患者的管理（例如，创伤、心肌梗塞和中风） 运输需要快速的护理协调以及院前和医院团队之间的共同决策。 尽管它的关键作用，护理协调和沟通之间的院前和医院的团队仍然 效率低下且具有挑战性。目前的机制（例如，无线电和电话）对于信息共享不是最佳的 和护理协调在院前遭遇，部分原因是他们的无效和有限的能力， 紧急护理专业人员与手持计算设备交互。因此，新技术 和模式的互动需要支持院前护理协调，同时允许紧急 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， 在院前和医院护理提供者之间建立一个不显眼的技术渠道，因为他们承诺 例如免提操作和上下文感知用户交互。为此， 本项目的目标是设计、开发和评估智能玻璃的应用和不显眼的交互 改善院前护理协调的机制，同时考虑到社会技术 为复杂、快节奏的院前护理环境开发技术的挑战。这 这项研究意义重大，因为它是开发新的“免提”技术的必要的早期步骤 可以无缝集成到手和眼繁忙的医疗环境中， 急诊护理专业人员在协调跨地理区域的患者护理方面的工作流程， 组织边界，并加强院前和其他重症监护环境中的护理协调。我们 我提出了两个引人注目的具体目标：1）设计和开发支持实时 院前护理协调; 2）评估技术解决方案对院前护理的影响 协同我们将采用多阶段、以用户为中心的设计方法来实现第一个目标， 参与式设计研讨会、快速原型制作和形成性评估。我们将实现第二个目标， 通过模拟评估院前就诊期间的护理协调和团队合作效率。的 拟议的研究是创新的，因为它代表了一个实质性的偏离现状， 院前接触期间护理协调的技术开发，重点是开发新的 支持免提、实时护理的具有不显眼交互技术的可穿戴系统 紧急护理和其他重症护理过程中的协调。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表现出了希望，但令人惊讶的是， 很少有研究人员使用PD来设计以临床医生为中心的系统，特别是在 紧急护理。我们的长期目标是建立一个集成的计算机化系统，可以支持共享 院前和医院团队之间的决策和护理协调，以改善患者的治疗效果 同时减少他们的认知和身体工作量。这一具有重大影响的提案将是朝着 实现我们的长期目标，并支持更好地以患者为中心的护理服务和协调。这 该提案与AHRQ和本具体征集在开发新型卫生信息技术方面的优先事项一致 促进数据共享的系统，以支持多个机构的治疗决策和护理协调 护理提供者，并最终提高医疗保健质量和结果。

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.