北京生物醫(yī)學工程

一種適用于腦卒中急救場景的移動智能核查清單系統(tǒng)及其應用

A mobile intelligent checklist system for stroke emergency and its application

作者：龐劍飛徐海峰南山徐術(shù)博李梅趙東升

單位：中國人民解放軍軍事科學院軍事醫(yī)學研究院信息中心（北京 100850）浙江大學生物醫(yī)學工程系（杭州 310027）健和九州（北京）科技有限公司（北京 100101）

關(guān)鍵詞：患者安全；智能核查清單；卒中急救；移動化；靜脈溶栓

分類號：R318

出版年·卷·期（頁碼）：2020·39·2（169-178）

摘要：

目的相比住院、ICU等醫(yī)療場景，腦卒中急救場景中面臨的患者安全問題更加突出。智能核查清單是一種信息輔助工具，能夠在疾病診療的關(guān)鍵環(huán)節(jié)動態(tài)生成患者個體化的核查內(nèi)容。現(xiàn)有的智能核查清單系統(tǒng)大都需要醫(yī)護人員在固定的工作站進行核查，這種核查方式難以適應腦卒中急救場景具有的時間緊迫、人員位置頻繁移動、工作壓力大和負荷重等特點。因此，有必要針對腦卒中急救場景中面臨的患者安全問題及其特殊性設計一種智能核查清單系統(tǒng)。方法通過調(diào)研、討論確定在腦卒中急救場景下智能核查清單系統(tǒng)的需求；基于Drools開源規(guī)則引擎，設計了一種將臨床規(guī)則與應用程序分離的系統(tǒng)架構(gòu)；采用基于模板的方法動態(tài)生成清單內(nèi)容，實現(xiàn)系統(tǒng)的靈活配置、快速部署。結(jié)果針對腦卒中急救場景，實現(xiàn)了一種醫(yī)療人員能夠在移動終端進行安全核查的智能核查清單系統(tǒng)；與臨床專家合作，設計了靜脈溶栓核查清單并進行初步測試，驗證了系統(tǒng)的可用性。結(jié)論移動智能核查清單系統(tǒng)可動態(tài)生成患者個體化的核查內(nèi)容，為解決腦卒中急救場景中的患者安全問題提供了新的手段。

Objective The patient safety issues in the stroke emergency are more serious than hospitalization, ICU and other medical scenario. Intelligent checklist is an information assistant tool, which can dynamically generate individual checking content in the key link of disease diagnosis and treatment. Most of the existing intelligent checklist systems require medical staff to check at a fixed workstation, which is unable to adapt to the environment of stroke emergency due to time-critical, dynamical, high pressure and heavy workload. Therefore, it is necessary to develop an intelligent checklist system that can solve the patient safety issues and considering their and their particularity in stroke emergency process. Methods Through research and discussion, the requirements of the intelligent checklist system were determined firstly. Based on Drools (an open source rule engine), a system architecture is designed to separate clinical rules from checklist system. The content of the checklist is generated dynamically using a template-based approach that enables flexible configuration and rapid deployment. Results An intelligent checklist system for stroke emergency, which can be used on mobile terminal is developed. In cooperation with clinical experts, a checklist before intravenous thrombolysis is designed and a preliminary test was carried out, which verifies the availability of the system. Conclusions The mobile intelligent checklist system can dynamically generate the individual checking content of patient, which provides a new means to solve the patient safety issues in stroke emergency.

參考文獻：

[1] GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013[J].The Lancet, 2015,385(9963): 117-171.

[2] Rajajee V, Saver J. Prehospital care of the acute stroke patient[J]. Techniques in Vascular & Interventional Radiology, 2005, 8(2): 74-80.

[3] Furie KL, Jayaraman MV. 2018 guidelines for the early management of patients with acute ischemic stroke[J]. Stroke, 2018, 49(3): 509-510.

[4] Kocher KE, Asplin BR. Emergency department crowding 2.0: coping with a dysfunctional system[J]. Annals of Emergency Medicine, 2012, 60(6):687-91.

[5] 徐勝勇, 徐騰達, 張暉, 等. 急診科擁擠對急診臨床實踐的影響[J]. 中國急救醫(yī)學, 2014, 34(12):1085-1089,1090.

Xu SY, Xu TD, Zhang H, et al. Impact of emergency department crowding on emergency clinical practice[J]. Chinese Journal of Critical Care Medicine, 2014, 34(12):1085-1089,1090.

[6] Farmer BM. Patient safety in the emergency department[J]. Emergency Medicine, 2016, 48: 396-404.

[7] Winters BD, Gurses AP, Lehmann H, et al. Clinical review: checklists - translating evidence into practice[J]. Critical Care, 2009, 13(6): 210-218.

[8] Fourcade A, Blache JL, Grenier C, et al. Barriers to staff adoption of a surgical safety checklist[J]. BMJ Quality & Safety, 2012, 21(3):191-197.

[9] Avrunin GS, Clarke LA, Osterweil LJ, et al. Smart checklists for human-intensive medical systems[C]// IEEE/IFIP International Conference on Dependable Systems & Networks Workshops (DSN 2012). Boston, MA: IEEE Press, 2012: 1-6.

[10] Bie AJRD, Nan S, Vermeulen LRE, et al. Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit[J]. British Journal of Anaesthesia, 2017, 119(2): 231-238.

[11] Nan S, Van Gorp P, Lu X, et al. A meta-model for computer executable dynamic clinical safety checklists[J]. BMC Medical Informatics and Decision Making, 2017, 17(1):170-176.

[12] Sarcevic A , Rosen BJ, Kulp LJ, et al. Design challenges in converting a paper checklist to digital format for dynamic medical settings[C]// International Conference on Pervasive Computing Technologies for Healthcare. Cancun, Mexico: 2016, 2016: 33-40.

[13] Katzan I, Speck M, Uchino K, et al. The stroke 8: a daily checklist for inpatient stroke management[J]. Critical Pathways in Cardiology, 2015, 14(1):1-6.

[14] 王伊龍, 廖曉凌, 董可輝, 等. 溶栓相關(guān)臨床工具[J]. 中國卒中雜志, 2006, 1(6):423-432.

[15] Proctor M. Drools: a rule engine for complex event processing [C] // International Conference on Applications of Graph Transformations with Industrial Relevance (AGTIVE 2011). Berlin, Heidelberg, 2012 :2.

[16] 中華醫(yī)學會神經(jīng)病學分會, 中華醫(yī)學會神經(jīng)病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南2018[J]. 中華神經(jīng)科雜志, 2018, 51(9):666-682.

Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9):666-682.

[17] Jaueh EC, Saver JL, Adams HP, et a1. Guidelines for the early management of patients with acute ischemie stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(3): 870-947.

[18] 國家衛(wèi)生健康委. 2019年深入落實進一步改善醫(yī)療服務行動計劃重點工作方案的通知[EB/OL]. [2019-03-18] http://www.nhc.gov.cn/yzygj/s3593g/201903/b9dc4d2c8d2044e585fb4f93ee4bcd60.shtml.

[19] Silva BM, Rodrigues JJ, de la Torre Díez I, et al. Mobile-health: a review of current state in 2015[J]. Journal of Biomedical Informatics, 2015, 56: 265-272.

[20] Lin HJ, Hsu MH, Huang CC, et al. Developing a mobile electronic D2B checklist for treatment of ST elevation myocardial infarction patients who need a primary coronary intervention[J]. Telemedicine and e-Health, 2015, 21(4):274-280.

[21] Sun MC, Chan JA. A clinical decision support tool to screen health records for contraindications to stroke thrombolysis–a pilot study[J]. BMC Medical Informatics and Decision Making, 2015, 15: 105.

Thongprayoon C, Harrison AM, O'Horo JC, et al. The effect of an electronic checklist on critical care provider workload, errors, and performance[J]. Journal of Intensive Care Medicine, 2016, 31(3): 205-212.

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