REST-PSLL: Re-engineering Surgical Recovery and Transitions Using Technology Patient Safety Learning Laboratory

PROJECT SUMMARY/ABSTRACT: Emergency general surgery (EGS) - accounting for 11% of US hospital admissions; over 50% of operative mortality; the highest risk, acuity, rate of complications, and cost in general surgery - particularly the subset of emergency laparotomy (EL) patients which suffer the worst EGS outcomes - is increasingly recognized as a public health crisis. While enhanced recovery programs (ERPs) have dramatically advanced pre-, intra-, and inpatient postoperative evidenced-based best practices (EBPs), ERPs have largely ignored subsequent postoperative home-based recovery. Despite certain postoperative complications occurring commonly after discharge (notably over 40% of surgical site infections [SSI]), recovery for surgical patients once discharged to home remains understudied and ripe for improvement and innovation, especially as surgical care models increasingly shift greater proportions of postoperative recovery into the home-based setting. Digital solutions for remote monitoring, patient engagement/education, and surgical prediction show promise but are used minimally for surgical recovery. We hypothesize that well-designed technology solutions for EL home- and transition-based workflows engaging diverse stakeholders will empower EL patients, their caregivers, and care teams to achieve optimal outcomes and safe recovery. The goal of REST-PSLL (Re-engineering Surgical Recovery and Transitions Using Technology Patient Safety Learning Laboratory) is to apply systems engineering approaches to co-produce innovative and scalable patient- and care team-centric solutions for EL home-based recovery. REST-PSLL has the following specific aims. Aim 1: Identify barriers and facilitators to ideal at-home recovery for patients following EL. We will engage stakeholders using the Systems Engineering for Patient Safety (SEIPS) model to identify and evaluate factors to understand barriers and facilitators of optimal care and postoperative complications with a focus on SSI. Aim 2: Iteratively design and develop new processes, tools, and technologies that help remove or reduce barriers to ideal at-home recovery. We will use swimlane diagrams to then analyze for areas of improvement to generate initial design requirements and prototypes for tools/technologies followed by iterative user-centered design to specify design requirements, develop solutions, and conduct end-user testing at our clinical sites. Aim 3: Implement and evaluate solutions in practice. Perform pilot testing and implementation, assess primary (addressing or avoiding trigger/potential issue, solution us) and secondary outcomes guided by RE-AIM framework; evaluate implementation phases guided by EPIS implementation framework to generate implementation learnings and solution revision plan(s). REST-PSLL is poised to be highly successful and impactful, highlighted by: a) anticipated learnings that can be extrapolated to other surgical populations; b) use of transdisciplinary complementary systems expertise and approaches; c) deep clinical expertise; d) patient- and caregiver- co-production; and e) expanding or optimizing existing solutions/platforms.