IMProving Outcomes Related to Patients Through Advanced Nursing Technology (IMPORTANT)

尽管美国的医疗保健成本在世界上名列前茅，但关键的健康结果排名 低于其他资源丰富的国家。为了提高医疗质量，同时减少 国会确定了某些严重和昂贵但可预防的医院获得性疾病，如 患者福尔斯跌倒、压疮损伤（PUI）和医院获得性感染（HAI）， 由医疗保险和医疗补助服务中心报销。这些可预防的不良事件已被 与病人的护理时间有关。护士在预防不良后果方面发挥着关键作用， 识别处于风险中的患者，评估这些风险的程度，并根据患者不断变化的状态采取行动， 这一过程被称为“护士监督”因此，护士是整体患者监测的关键贡献者， 安全为代价的联合委员会建议护士在病人床边报告，称为“床边 轮班报告”（BSR），以减少错误并提高护理的连续性;还建议每小时查房（HR 减少福尔斯;这两种措施都有助于护士对患者的监测，但它们与患者的关系 结果仍然没有得到充分研究。纽约-长老会，一个大型的学术卫生系统，正在试行一个 创新的技术称为“iN”，以改善BSR和HR通过使用变色灯和集成 移动的应用程序，以提醒护士时，这些活动还没有完成。这项技术使用了一种组合 通过模糊计算机视觉对患者房间中安装的硬件进行实时监控， 通过集成这些技术的移动的手机应用程序提供的患者房间和配套软件。这 一种新的干预措施，以增加BSR和人力资源的护士，产生详细的过程数据，提供了一个 这是一个前所未有的机会，可以完全了解发生在床边的所有活动， 但尚未研究护士监督的特征或评估与相关患者的关联 结果。通过先进的护理技术改善与患者相关的结果（重要） 研究将描述护理监督及其对患者福尔斯、HAI和PUI的影响，以产生新的 了解影响这些护士敏感患者结局的因素。使用内置的数据集 这项研究将整合来自iN设备、电子健康记录、人员配备和人口普查数据以及医院的数据， 报告了关于福尔斯、HAI和PUI的质量指标，本前瞻性队列研究设计将使用描述性 统计学和Cox比例风险模型来描述护士监督和BSR的贡献 以及HR到护士监测，以生成这些护士敏感结局的预测指标（福尔斯，PUI HAI），可用于确定干预目标。重要的研究涉及AHRQ的具体问题， 优先进行“研究，以改善医疗保健病人的安全”，和“收集数据和技术， 提高医疗质量和患者的治疗效果，并提供患者的360度视图”，并将 解决AHRQ的优先人群，即患有多种慢性病的人、少数民族和妇女。

Although healthcare costs in the United States rank among the highest in the world, critical health outcomes rank lower than other high resource countries. In an effort to improve healthcare quality and concomitantly reduce costs, Congress identified certain serious and expensive but preventable hospital acquired conditions such as patient falls, pressure ulcer injuries (PUI) and hospital acquired infections (HAI), that would no longer be reimbursed by Centers for Medicare and Medicaid Services. These preventable adverse events have been linked with nursing time with patients. Nurses play a critical role in preventing adverse outcomes by quickly identifying patients at risk, evaluating the extent of these risks, and acting upon the changing status of the patient, a process termed “nurse surveillance.” Hence, nurses are key contributors to overall patient surveillance and safety. The Joint Commission recommends that the nurses give report at the patient bedside, termed “bedside shift report” (BSR), to reduce errors and improve continuity of care; hourly rounds (HR) are also recommended to reduce falls; both of these measures contribute to nurse surveillance of patients, but their relationship to patient outcomes remains understudied. NewYork-Presbyterian, a large academic health system, is piloting an innovative technology called “iN,” to improve BSR and HR through the use of color-changing lights and integrated mobile app to remind nurses when these activities have not been completed. This technology uses a combination of mounted hardware in the patient room with obfuscated computer vision to provide constant surveillance of the patient room and companion software supplied via a mobile phone app that integrates these technologies. This novel intervention to increase BSR and HR by nurses, which generates detailed process data, offers an unprecedented opportunity to gain a complete understanding of all activities that take place at the bedside and yet has not yet been studied to characterize nurse surveillance or to assess associations with related patient outcomes. The IMProving Outcomes Related to patients Through Advanced Nursing Technology (IMPORTANT) study will characterize nurse surveillance and its influence on patient falls, HAI, and PUI to generate new knowledge about factors that influence these nurse-sensitive patient outcomes. Using the dataset built in this study that will integrate data from the iN device, electronic health record, staffing and census data, and hospital reported quality measures on falls, HAI and PUIs, this prospective cohort study design will use descriptive statistics and a Cox-proportional hazard model to characterize nurse surveillance and the contribution of BSR and HR to nurse surveillance to generate predictive indicators of these nurse-sensitive outcomes (falls, PUIs HAIs), which can be used to identify intervention targets. The IMPORTANT study addresses AHRQ’s specific priorities to conduct “Research to improve health care patient safety,” and “Harness data and technology to improve healthcare quality and patient outcomes and to provide a 360-degree view of the patient” and will address AHRQ priority populations of the those with multiple chronic conditions, minorities, and women.