智能化辅助决策在儿科急诊五级分诊中的应用研究

Research on application of intelligent assistant decision-making in the five-level triage of pediatric emergency department

目的探讨智能化辅助决策在儿科急诊五级分诊中的应用效果.方法将使用智能化辅助决策系统前后1个月于我院儿科急诊就诊的患儿分为两组.传统组17900例,按五级预检分诊标准,由护士人工进行分诊;智能组18590例,借助智能化辅助决策系统进行分诊.智能化辅助决策包括对生命体征数据是否异常的自动识别和对分诊级别自动提供依据帮助护士确认两大功能.按照既定的内容收集患儿信息,系统根据相应的分诊依据,可自动识别与呈现,确定分诊级别.对两组患儿在疾病分布情况、分诊级别情况、分诊结果一致性等方面进行对比分析,评价智能化辅助决策系统在急诊儿科分诊的临床应用效果.结果两组患儿的一般情况、疾病分布差异无统计学意义,排在前3位的疾病均为呼吸系统疾病、传染性疾病、消化系统疾病.智能组Ⅲ级、Ⅳ级、Ⅴ级患儿分诊至就诊时间比传统组短,差异有统计学意义(P<0.05).护士分诊与医生评估患儿病情严重程度的一致性,智能组(Kappa=0.968,P<0.001)与传统组(Kappa=0.883,P<0.05)均较好,但智能组一致性系数更高.智能组Ⅲ级、Ⅳ级、Ⅴ级患儿家属满意度高于传统组(t=5.523,P<0.05).结论应用智能化辅助决策系统,提高了预检分诊的效率及准确率,确保分诊的有效性,保障患儿安全,提高家属的满意度.

Objective To explore the application effect of intelligent assistant decision-making in the five-level triage of pediatric emergency department.Methods The patients treated in the pediatric emergency department of Xiamen Children′s Hospital using the intelligent assistant decision-making system were divided into two groups before and after one month.In March 2018,17900 cases were in the traditional group,and in April 2018,18590 cases were in the intelligent group.The traditional group conducted manual triage according to the five-level pre-screening and triage standard.The intelligent group conducted triage based on the self-developed intelligent assistant decision-making system.Intelligent assistant decision-making included automatic identification of whether vital signs data was abnormal and automatic provision of basis for triage level to help nurses confirm two major functions.The patients′information were collected according to the established content,and the system would automatically identify and present according to the corresponding triage basis to determine the triage level.The two groups of children were compared and analyzed in terms of disease distribution,triage level,triage accuracy.The clinical application effect of the emergency pediatric pre-check triage system was evaluated.Results There was no significant difference in disease distribution between the two groups.The top three were respiratory diseases,infectious diseases and digestive diseases.In the comparison of waiting time between the two groups,the waiting time of gradeⅢ,ⅣandⅤpatients in the intelligent group was shorter than that in the traditional group,the difference was statistically significant(P<0.05).The consistency of triage grade in the intelligent group was higher than that in the traditional group.The family satisfaction of children in the intelligent group ofⅢ,Ⅳ,andⅤgrade was higher than that in the traditional group.Conclusion The application of intelligent assistant decision-making could improve the efficiency and accuracy of the pre-examination of the nurses,ensure the effectiveness of the triage and the safety of the children,and improve the satisfaction of family members.