北京生物醫(yī)學(xué)工程

基于過程挖掘的急性缺血性腦卒中患者院內(nèi)靜脈溶栓時效分析

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

作者：任軍焦巖王榮徐建春楊俊徐海峰

單位：新疆軍區(qū)總醫(yī)院神經(jīng)內(nèi)科(烏魯木齊 830000) 新疆軍區(qū)總醫(yī)院信息科(烏魯木齊 830000) 通信作者:楊俊,主任醫(yī)師? E-mail:junyang0919@ 163. com

關(guān)鍵詞：過程挖掘; 急性缺血性腦卒中; 院內(nèi)急救; 靜脈溶栓; 依賴圖

分類號：R318; R195. 4; R743.3

出版年·卷·期（頁碼）：2020·39·4（364-371）

摘要：

目的直觀刻畫靜脈溶栓患者的急救過程,發(fā)現(xiàn)現(xiàn)有流程中存在的問題及原因并提出改進方案。方法首先從醫(yī)院信息系統(tǒng)中提取日志信息,經(jīng)過標(biāo)準(zhǔn)化、映射等步驟獲取患者的軌跡數(shù)據(jù);接著利用過程挖掘工具 ProM 構(gòu)建靜脈溶栓治療的過程模型并由臨床專家對模型的正確性?簡潔性進行評估,再由醫(yī)療信息專家根據(jù)反饋結(jié)果制定新的過程挖掘策略,通過這一迭代挖掘過程,最終得到能夠反映醫(yī)療機構(gòu)靜脈溶栓治療實際的過程模型;之后計算模型中關(guān)鍵事件的發(fā)生時間中位數(shù),分析醫(yī)療機構(gòu)靜脈溶栓治療的時效性,確定是否存在院內(nèi)延誤及原因;最后由臨床專家及管理者基于時效性分析的結(jié)果制定流程改進方案。結(jié)果對合作醫(yī)院 125 例接受靜脈溶栓治療的急性缺血性卒中患者的急救過程進行了分析;構(gòu)建了反映該院靜脈溶栓治療時效的依賴圖模型,該模型直觀展示了該院靜脈溶栓治療不同階段(急診室與住院)醫(yī)療人員主要完成的臨床活動及完成時間;分析了該院院內(nèi)延誤的原因:靜脈溶栓場所不在急診室,溶栓患者需要進行轉(zhuǎn)運以及神經(jīng)內(nèi)科醫(yī)生參與救治的時間較晚。結(jié)論針對存在的問題建議該院溶栓治療可以在急診室進行,當(dāng)懷疑患者為卒中時,急診醫(yī)生應(yīng)呼叫神經(jīng)內(nèi)科醫(yī)生參加急救流程。

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.

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