Utilizing Innovative Technology To Improve Compliance With Patient Elevation Guidelines – The Impact Of Angulus On Adherence To The Evidence-Based VAP-Prevention Bundle

 描述（由申请人提供）：在美国，每年有超过250，000名重症监护病房的通气患者感染呼吸机相关性肺炎（VAP），这是一种医院获得性感染，引起了重症监护领域众多利益相关者的关注。VAP的死亡率为30% 1，2，平均导致ICU住院时间延长4.3天1，2，3，4。医院每名患者的增量成本增加了40，000美元3，全国平均每年减少呼吸机相关性肺炎（VAP）的发病率和100亿美元用于VAP 3，16。呼吸机相关事件（VAE）对于临床医生、医院利益相关者、认证机构以及最终患者来说至关重要。然而，尽管有证据表明，将通气患者维持在30-45度之间的高度与VAP结局的显著改善相关3，6，10，12，但目前缺乏有效的方法来准确有效地测量患者的真实的高度。现有的测量病人身高的工具是陈旧的，不灵活和不可靠的。如果没有关于患者海拔的准确、可靠和可用的数据，至少可以说，评估和改善对床头指南的依从性是具有挑战性的。一种能够准确测量患者海拔高度并向护士发出高度期望的信息信号的机制，可以显著提高对最佳实践患者海拔指南的依从性，这反过来又会降低VAP的发生率，缩短ICU住院时间，并转化为医院的巨大成本节约和临床效果改善。开发Angulus是为了填补重症监护技术的这一空白。这是一种新型传感器，能够在真实的时间内准确测量患者的海拔高度--无论患者的特殊方位如何--并通过蓝牙将按需的每分钟数据和汇总趋势传输到相应的显示设备。Angulus由两个组件组成-固定在患者胸骨上的无线传感器和显示患者仰角的相应软件界面。Angulus的使用将使重症监护治疗团队能够更有效地监测患者的海拔，并提高对HOB指南的依从性。在第一阶段的提案中，我们将与阿尔伯特·爱因斯坦/蒙蒂菲奥里医疗中心合作：1）开展初始最终用户焦点小组，2）验证Angulus作为患者抬高测量工具的准确性，3）实施随机交叉试验，以测量Angulus对改善患者抬高指南依从性的影响，以及4）收集最终用户满意度和可用性分数，并将关键功能与敏捷和迭代的产品开发方法集成。通过为重症监护团队提供关于患者真实的仰角的可理解、可访问和准确的按需数据，Angulus将提高患者仰角指南的依从性。这项工作将对解决与患者发病率增加和天文数字成本相关的负担问题产生巨大影响。这一提议与NHLBI的总体使命高度一致。

 DESCRIPTION (provided by applicant): Each year in the U.S. over 250,000 ventilated patients in the intensive care unit contract Ventilator-associated pneumonia (VAP), a hospital-acquired infection which has captured the attention of numerous stakeholders in the critical care domain. VAP has a 30% mortality rate1,2 and results in an extended ICU stay of 4.3 days1,2,3,4, on average. Hospitals incur an additional $40,000 in incremental costs3 per patient, and a national average of Reducing the incidence of Ventilator-associated pneumonia (VAP) and $10 Billion is spent on VAP annually3,16. related ventilator-associated events (VAE) is of prime importance to clinicians, hospital stakeholders, accrediting agencies and ultimately patients. However, despite evidence that maintaining ventilated patients at an elevation between 30-45 degrees is correlated with significantly improved VAP outcomes3,6,10,12, there is currently a dearth of effective methods for accurately and efficiently measuring a patient's elevation in real time. Existing tools for measuring patient elevation are archaic, inflexible and unreliable. Without accurate, reliable and available data on a patient's elevation, evaluating and improving compliance with head of bed guidelines is challenging to say the least. A mechanism that accurately measures a patient's elevation and signals that information to nurses is highly desired, and can dramatically improve compliance with best-practice patient-elevation guidelines, which in turn would reduce the incidence of VAP, shorten ICU stays and translate into tremendous cost savings and improved clinical outcomes for hospitals. Angulus was developed to fill this gap in critical care technology. It is a novel sensor, which accurately measures patient elevation in real time - irrespective of a patient's idiosyncratic orientation - and transmits on-demand minute-to-minute data and aggregate trends to a corresponding display device via Bluetooth. Angulus is composed of two components - a wireless sensor which is affixed to the patient's sternum, and a corresponding software interface, which displays the patient elevation angle. Utilization of Angulus will empower critical care treatment teams to more efficiently monitor patients' elevation, and improve compliance to HOB guidelines. In this Phase I proposal we will collaborate with Albert Einstein/ Montefiore Medical center to: 1) conduct initil end-user focus groups, 2) validate the accuracy of Angulus as a patient elevation measurement tool, 3) implement a randomized cross over trial to measure the impact of Angulus on improving compliance with patient elevation guidelines, and 4) collect end-user satisfaction and usability scores and integrate critical functionality with an agile and iterative product development approach. By empowering critical care teams with intelligible, accessible and accurate on demand data about a patient's elevation angle in real time, Angulus will improve compliance with patient elevation guidelines. This work will have a tremendous impact on resolving a burdensome problem associated with increased patient morbidity and astronomical costs. This proposal is very highly aligned with the overall mission of NHLBI.