基于过程挖掘的急性缺血性脑卒中患者院内静脉溶栓时效分析

Time effect analysis of in-hospital intravenous thrombolysis process of patients with acute ischemic stroke using process mining

目的直观刻画静脉溶栓患者的急救过程,发现现有流程中存在的问题及原因并提出改进方案。方法首先从医院信息系统中提取日志信息,经过标准化、映射等步骤获取患者的轨迹数据;接着利用过程挖掘工具ProM构建静脉溶栓治疗的过程模型并由临床专家对模型的正确性、简洁性进行评估,再由医疗信息专家根据反馈结果制定新的过程挖掘策略,通过这一迭代挖掘过程,最终得到能够反映医疗机构静脉溶栓治疗实际的过程模型;之后计算模型中关键事件的发生时间中位数,分析医疗机构静脉溶栓治疗的时效性,确定是否存在院内延误及原因;最后由临床专家及管理者基于时效性分析的结果制定流程改进方案。结果对合作医院125例接受静脉溶栓治疗的急性缺血性卒中患者的急救过程进行了分析;构建了反映该院静脉溶栓治疗时效的依赖图模型,该模型直观展示了该院静脉溶栓治疗不同阶段(急诊室与住院)医疗人员主要完成的临床活动及完成时间;分析了该院院内延误的原因:静脉溶栓场所不在急诊室,溶栓患者需要进行转运以及神经内科医生参与救治的时间较晚。结论针对存在的问题建议该院溶栓治疗可以在急诊室进行,当怀疑患者为卒中时,急诊医生应呼叫神经内科医生参加急救流程。

Objective To characterize the in-hospital emergency process of patients with intravenous thrombolysis,and to identify and improve the problems in the process.Methods Firstly,the log information is extracted from the hospital information system,and the track data of each patient is obtained through standardization,mapping and other steps.Secondly,the process model of intravenous thrombolysis treatment is constructed by using the process mining tool-ProM.Thirdly,the correctness and simplicity of the model are evaluated by the clinical experts,and the new process mining strategy is determined by the medical information experts according to the feedback results,so as to get the model that reflects the actual process model of intravenous thrombolysis treatment in the medical institution with the iterative mining process.Fourthly,the median time of key events in the model is calculated,and the timeliness of intravenous thrombolysis treatment in the medical institution is analyzed on this basis to determine whether there is hospital delay and the reasons.Finally,clinical experts and managers develop process improvement plan based on the results of timeliness analysis.Results The dependency graph model reflecting the time effect of intravenous thrombolysis treatment is constructed in the hospital,which intuitively shows the main clinical activities and completion time of medical staff in different stages(emergency room and inpatient)of intravenous thrombolysis treatment,and the causes of delay in the hospital are that the site of intravenous thrombolysis therapy is not in the emergency room and the thrombolytic patients need to be transported.Meanwhile,the time of nerve physicians contact the patients is late.Conclusions In view of the existing problems,it is suggested that thrombolysis therapy should be carried out in the emergency room.When it is suspected that the patient is suffering stroke,the emergency doctor should call the nerve physician to participate in the emergency process.