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25万名重症监护病房的呼吸机患者感染呼吸机相关肺炎(VAP)，这是一种医院获得性感染，已引起重症监护领域众多利益相关者的注意。VAP的死亡率为30%，1，2，平均延长ICU住院时间1，2，3，4天。医院为每位患者增加了40,000美元的额外成本3，全国平均每年在呼吸机相关肺炎(VAP)上花费100亿美元3，16.与呼吸机相关的事件(VAE)对临床医生、医院利益攸关方、认证机构以及最终患者至关重要。然而，尽管有证据表明，将患者的呼吸机维持在30-45度的海拔高度与显著改善的VAP结果3、6、10、12相关，但目前缺乏准确和有效地实时测量患者海拔高度的有效方法。现有的测量患者仰角的工具陈旧、僵化、不可靠。如果没有关于患者海拔高度的准确、可靠和可用的数据，至少可以说，评估和改善对床头指南的遵从性是具有挑战性的。这种机制可以准确测量患者的仰卧度，并向护士发出非常需要的信息，可以极大地提高对最佳实践患者仰卧位指南的遵从性，从而降低VAP的发生率，缩短ICU停留时间，并为医院节省大量成本和改善临床结果。Angulus就是为了填补重症监护技术的这一空白而开发的。这是一种新型传感器，可以实时准确地测量患者的抬高-无论患者的特殊取向-并通过蓝牙将按需每分钟的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--一个固定在患者胸骨上的无线传感器，以及一个相应的软件界面，它显示患者的仰角。使用Angulus将使重症监护治疗团队能够更有效地监控患者的海拔高度，并提高对HOB指南的遵从性。在这个第一阶段的提案中，我们将与阿尔伯特·爱因斯坦/蒙特菲奥里医学中心合作：1)开展初始最终用户焦点小组，2)验证Angulus作为患者隆起测量工具的准确性，3)实施随机交叉试验，以衡量Angulus在改善患者隆起指南遵从性方面的影响，4)收集终端用户满意度和可用性得分，并将关键功能与敏捷和迭代的产品开发方法相集成。通过为重症监护团队提供关于患者仰角的实时可理解、可访问和准确的按需数据，Angulus将提高对患者仰角指南的遵从性。这项工作将对解决与增加患者发病率和天文数字成本相关的负担问题产生巨大影响。这项提议与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.