一种面向医疗安全的智能清单系统

An Intelligent Support System for Patient Safety Checklists

安全清单是一种规范化诊疗行为的有效工具,在临床上日益受到重视。安全清单要求医务工作者在诊疗流程中的关键环节对任务的准备情况或完成情况按临床规范进行核对,从而保证医疗安全。但传统的安全清单难与临床工作流程集成,对病人缺乏针对性,并且缺乏信息系统支持,因而临床应用效果不佳。通过研究清单的计算机化表达方法,将安全清单分解为诊疗流程、清单表格、医学算法和辅助信息等4个层次的知识;设计一套执行机制,利用工作流引擎和规则引擎对这些知识进行执行,并在此基础上开发一套智能清单系统来实现此机制。通过一个心内科经皮冠状动脉介入治疗清单案例,对系统进行评估。该系统将清单细化成11个对应于流程中关键场景的清单,在恰当时机将清单推送给预定义的医护人员,从而使清单融入他们的诊疗工作。每个场景的清单都是由预定义的医学算法结合病人实际情况动态生成,从而确保清单的针对性。结果表明,这种方法可以有效支持智能清单的表达和执行,提供能够与诊疗流程集成的病人个体化清单,方便医护人员的使用。

Safety checklists have gain increasingly attention in recent years as an effective way of standardizing heahhcare. They serve as a quality improving tool by enabling providers checking the variance between the actual situation and the best practice prior to the critical activities. However, the traditional checklists in paper form are lack of integration with clinical workflow, specification to individual patients and information system support, which increases the workload of providers and leads to ineffective implementation. This study decomposed safety checklist knowledge into 4 layers, i.e. clinical workflow, checklist form, medical algorithm and supplementary information, aiming to make checklists adjustable and executable by computerized systems. A support system had been developed according to the checklist representation and execution mechanism. The system was able to reduce the providers＇ workload by integrating checklist into the daily care process of providers for individual patients and providing related patient data and knowledge. A percutaneous coronary intervention peri-operative checklist set had been used to validate the proposed system. By using the system, the process was decomposed into 11 scenarios integrated with the actual clinical workflow. In each scenario, a group of clinical algorithms was applied to produce checkable items. The results indicated that the proposed approach effectively supported the representation and execution of checklists and providers could have benefit from the system by using the process-oriented and patient-specific checklists.