ABSTRACT
Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33％ in June 2017 to 94.44％ in December 2017,and up to 100％ in October 2017,and the average completion rate from January to July 2018 was 94.00％.The completion rate of ICU clinical pathway was increased from 81.82％ in January 2008 to 92.86％ in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P ＜ 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P ＜ 0.01).The average length of hospital stay was shortened by about 3.84 days (P ＜ 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P ＜ 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P ＜ 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P ＜ 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16％ (7/603) to 42.26％ (105/227),and the improvement rate was decreased from 94.36％ (569/603) to 52.86％ (120/227,both P ＜ 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77％ (33/1 193) vs.2.22％ (2/90),79.21％ (945/1 193) vs.97.78％ (88/90),both P ＞ 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.
ABSTRACT
BACKGROUND: Transfusion guidelines are not only essential for the optimal use of blood products, but also help reduce transfusion-related adverse reactions and improve patients' outcomes. In this hospital, a transfusion-indication data-entry program based on the national transfusion guidelines was developed and applied to the electronic medical record system in 2016. All transfusion orders, except for emergencies, have been performed using this program since then. This study analyzed the reasons for the transfusion to monitor the blood product usage and provide feedback to clinicians.
Subject(s)
Anemia , Electronic Health Records , Emergencies , Erythrocytes , Hemorrhage , Korea , Plasma , Plasma ExchangeABSTRACT
Described in the paper are the outcomes and progress of the MEG standards in six years, along with the imperativeness and revision pathways of the standards for the purpose of further promoting the level of HIT development in China.
ABSTRACT
Personal Health Record is a way of giving the power to the individual to manage its own health related problems. Nurses would acquire the skills to assist the individuals in taking advantages of prevention and to help them manage their health related problems to reach high level of health and quality of living...
O Prontuário Pessoal é uma forma de poder dar mais poder aos indivíduos, para que possam gerencia sua própria saúde e os problemas relacionados. Os enfermeiros podem adquirir habilidades para prestar assistência, utilizando tais ferramentas para obter vantagens na prevenção de doenças e para auxiliar os pacientes em busca de bem estar e qualidade de vida...
El Registro Personal de Salud es una forma de poder capacitar a las personas para que puedan gestionar su propia salud y los problemas relacionados. Las enfermeras pueden adquirir habilidades para ayudar, utilizando estas herramientas para obtener ventajas en la prevención de la enfermedad y ayudar a los pacientes en busca de bienestar y calidad de vida...
Subject(s)
Humans , Nursing Care , Medical Informatics , Disease Prevention , Quality of Life , Electronic Health Records , Information TechnologyABSTRACT
OBJECTIVES: The purpose of this study was to examine the applicability of the International Organization for Standardization (ISO) reference terminology model for nursing to describe the terminological value domain content regarding the entities and attributes of the detailed clinical models (DCMs) used for nursing assessments. METHODS: The first author mapped 52 DCM entities and 45 DCM attributes used for perinatal care nursing assessments to semantic domains and their qualifiers to the ISO model. The mapping results of the entity and attribute concepts were classified into four categories: mapped to a semantic domain qualifier, mapped to a semantic domain, mapped to a broader semantic domain concept, and not mapped. The DCM mapping results were classified into three categories: fully mapped, partially mapped, and not mapped. The second author verified the mapping. RESULTS: All of the entities and 53.3% of the attribute concepts of the DCMs were mapped to semantic domains or semantic domain qualifiers of the ISO model, 37.8% of the attributes were mapped to the broader semantic domain concept, and 8.9% of the attributes were not mapped. At the model level, 48.1% of the DCMs were fully mapped to semantic domains or semantic domain qualifiers of the ISO model, and 51.9% of the DCMs were partially mapped. CONCLUSIONS: The findings of this study demonstrate that the ISO reference terminology model for nursing is applicable in representing the DCM structure for perinatal care nursing assessment. However, more qualifiers of the Judgment semantic domain are required in order to clearly and fully represent all of the entities and attributes of the DCMs used for nursing assessment.
Subject(s)
Concept Formation , Judgment , Medical Records Systems, Computerized , Nursing Assessment , Perinatal Care , SemanticsABSTRACT
OBJECTIVE: Seoul National University Bundang Hospital is the first full digital hospital with electronic medical record(EMR) system in Korea. We evaluated the user's satisfaction on the EMR system at 15 months from its beginning. METHODS: A total of 105 doctors and 503 nurses participated in this study. The questionnaire was composed of four domains: user satisfaction between paper records and EMR, User perceived improvement of work efficiency with EMR, user interface satisfaction and advantage/ disadvantage of EMR. A Likert-type 5-point scale was used for the degree of satisfaction, with 5 indicating 'very satisfied'. RESULTS: Doctors were more satisfied with EMR system than paper records, especially on editing (3.33 vs. 2.73, p0.05). Nurses were more satisfied with EMR system than paper records, e.g., editing (3.51 vs. 2.74, p<0.05), retrieval (4.07 vs. 2.51, p<0.05) and input (3.82 vs. 2.90, p<0.05). Also, doctors and nurses showed satisfaction for most of user interfaces. CONCLUSION: Users seem to be satisfied with the EMR system. EMR system should have a flexible system to improve the input system, the structured forms, and the standardized terminology according to the need of users.
Subject(s)
Electronic Health Records , Electronics, Medical , Korea , Surveys and Questionnaires , SeoulABSTRACT
We compared the effects on clinical clerkships of an electronic medical record (EMR) system and a standard medical record system. Using an EMR system, students described medical records with a problem-oriented medical record system/subject objective assessment, and plan that was much better than the standard medical record system. In the EMR system, students cannot see physicians' medical records, including laboratory data and X-ray films. Instead, students themselves must obtain the patient history and request examinations as physicians do. This system helps supervisors give suitable comments and provide data that students have requested. Directors can also evaluate supervisors by reviewing their comments. Therefore, an EMR system has the advantage of problem-oriented medical record system-based learning for students and is also useful for clinical clerkships.