系統識別號 | U0002-0302201818353400 |
---|---|
DOI | 10.6846/TKU.2018.00063 |
論文名稱(中文) | 建構加護病房臨床資訊系統提升病房自動化效能-以心臟血管外科為例 |
論文名稱(英文) | Constructing a Clinical Information System of an Intensive Care Unit to Improve Ward Automation Effectiveness:An Example of Cardiovascular Surgery |
第三語言論文名稱 | |
校院名稱 | 淡江大學 |
系所名稱(中文) | 資訊工程學系博士班 |
系所名稱(英文) | Department of Computer Science and Information Engineering |
外國學位學校名稱 | |
外國學位學院名稱 | |
外國學位研究所名稱 | |
學年度 | 106 |
學期 | 1 |
出版年 | 107 |
研究生(中文) | 鄭元成 |
研究生(英文) | Yuan-Cheng Cheng |
學號 | 899410087 |
學位類別 | 博士 |
語言別 | 英文 |
第二語言別 | |
口試日期 | 2016-12-24 |
論文頁數 | 85頁 |
口試委員 |
指導教授
-
葛煥昭
委員 - 施俊哲 委員 - 鄧有光 委員 - 蔣璿東 委員 - 張志勇 委員 - 石貴平 |
關鍵字(中) |
臨床資訊系統 加護病房 臨床績效 |
關鍵字(英) |
Clinical Information System Intensive care unit Clinical Performance |
第三語言關鍵字 | |
學科別分類 | |
中文摘要 |
加護病房之病患通常為重症、需特殊照護者,因此病床邊都會需要接上各式各樣的監測儀器,用來維持病患的生命及監測病患的生命徵象,而病患的生命參數必須由護理師定時記錄;觀察發現,護理人員在床邊以紙本方式記錄病患生命參數後,必須再返回護理站或至行動護理車旁,將抄寫的資料逐一輸入病患照護系統,導致醫護人員重複輸入文書工作,尤其對於站在第一線工作照顧急重症加護病房的醫護人員,造成不必要的工作負擔。 隨著資訊技術的進步及環保提倡,病歷資料漸趨電子化,本研究於心臟血管外科加護病房建構一套臨床資訊系統,以HL7與院內系統及監測病人資訊的床邊儀器進行資料交換,並建立電子化的表單減少人工書寫作業,原本需手寫的裝置監測數值與參數改善成直接從儀器上傳到臨床資訊系統零錯誤率,成功幫臨床護理人員每日節省約76.8分鐘,讓臨床人員有更多時間專注於照護病患,並提昇醫師診斷的效率,更能保障病人的安全。 |
英文摘要 |
Patients in intensive care units are usually critically ill in need of special care, and there are many device and vital signs monitors to help clinical personal care them at bedside. The ICU nurse has to record these device parameters and vital signs by order. With the progress of information technology, medical records data gradually electronic, nurses in the bedside by way of paper to record the patient's life parameters must be back to the nursing station or nursing car, the copy of the data entered into the patient care system, resulting in more clinical staff clerical workload especially in Intensive Care Unit (ICU). In this study, a clinical information system was constructed in the ICU of Cardiovascular Surgery. The Clinical Information System exchange data with the Hospital Information System and patient bedside equipment through Health Level Seven (HL7). In addition, we create electronic forms to reduce manual writing and successfully help clinical therapists save 76.8 minutes to key in these dates into NIS per day. The original device was wrote to monitor the value and parameters into a direct upload from the instrument to the clinical information system zero error rate. |
第三語言摘要 | |
論文目次 |
Chapter 1 Introduction 1 1.1 Background and Motivation 1 1.2 Purpose of the Research 2 1.3 Research Structure 4 Chapter 2 Related Research 6 2.1 Clinical Information System 6 2.2 Health Level Seven (HL7) 7 2.3 Severity Assessment Score for Patient in ICU 8 2.4 Healthcare 4.0 35 Chapter 3 System Architecture and Design 43 3.1Clinical Information System Architecture 45 3.2 Clinical Information System and Medical Information System Data Exchange Planning 47 3.3 Form design tools 48 3.4 Integration planning of medical equipment’s connection 49 Chapter 4 Implementation results and analysis 52 4.1 Patient List Management 52 4.2 Clinical record form of ICU 53 4.3 Clinical advice and alarm 56 4.4 Nutritional Assessment Record 57 4.5 Digital Picture 57 4.6 Statistical report 58 4.7 Disease severity assessment system 59 4.8 Statically table / Report printing 61 4.9 Clinical performance improvement 62 Chapter 5 Conclusion and Future Research 68 5.1 Conclusion 68 5.2 Future Research 70 Reference 72 Attachment 75 List of Tables Table 1 Factors for SAPS II 9 Table 2 Killip’s Classification 11 Table 3 GCS Scale 12 Table 4 NYHA FC List 13 Table 5 AHA Grades of Congestive Heart Failure 13 Table 6 UA TIMI score 15 Table 7 RASS Assessment Form 16 Table 8 MODS Assessment Form 18 Table 9 MODS Death Predict Rate 19 Table 10 SOFA 20 Table 11 ISS Assessment (Health and Welfare Department) 24 Table 12 NIH stroke scale 32 Table 13 TRISS Parameters 35 Table 14 RTS Parameters 35 List of Figures Figure 1 Research Structure 4 Figure 2 HL7 standardized format 8 Figure 3 OR .NET [30] 37 Figure 4 Structure for Integration of Assistant Healthcare Information System and Internet for Things 38 Figure 5 Changes of Senior Population 39 Figure 6 Structure for System of Tele-care and Alert with Wireless Mini-Sensor 40 Figure 7 ICE Functional Architecture {International, 2009 #53} 41 Figure 8 the Clinical Information System Architecture 45 Figure 9 Data exchange diagram 48 Figure 10 Monitoring instrument information delivery order 50 Figure 11 Monitoring instrument connection architecture in ICU 51 Figure 12 Movable monitoring instrument connection architecture 51 Figure 13 the patient list manage function 53 Figure 14 record sheet in the user interface 54 Figure 15 The window of event notification 56 Figure 16 Nutrition assessment example screen 57 Figure 17 The image is embedded in the form 58 Figure 18Various types of statistics 59 Figure 19 various reports (dashboard form) 59 Figure 20 Scoring System - One-time integration presents patient assessment scores 61 Figure 21 select the recording interval to print 61 Figure 22 Preview the report page 62 Figure 23 IV PUMP 64 Figure 24 Bedside hemodialysis machine 64 Figure 25 the system uses the device connector 65 Figure 26 Respiratory therapy machine with gas cylinder 65 Figure 27 Respiratory therapy machine 66 Figure 28 Portable ECG machine 66 Figure 29 Clinical Patient Use Device Connection Status 67 Figure 30 Numerical Value and Chart Presented in Same Timeline 69 List of Attachment Attachment 1 Original Vital Signs………………………………………..75 Attachment 2 Original Nursing Assessment……………………………...77 Attachment 3 Original Nursing Progressing Note………………………..80 Attachment 4 Original hypodermic injection record……………………..81 Attachment 5 Original muscle power record……………………………..82 Attachment 6 Original Glasgow Coma Scale…………………………….83 Attachment 7 Original Risk Assessment: Braden………………………...84 Attachment 8 Original Input and Output Record…………………………85 |
參考文獻 |
[1] A. Garland, "Improving the icu*: Part 2," Chest, vol. 127, no. 6, pp. 2165-2179, 2005. [2] A. W. Kushniruk, C. Patel, V. L. Patel, and J. J. Cimino, "‘Televaluation’ of clinical information systems: an integrative approach to assessing Web-based systems," International Journal of Medical Informatics, vol. 61, no. 1, pp. 45-70, 2001/04/01/ 2001. [3] A. Aman, "Clinical information systems in private hospitals," in 2013 15th International Conference on Advanced Communications Technology (ICACT), 2013, pp. 1032-1035. [4] M. L. Popernack, "A Critical Change in a Day in the Life of Intensive Care Nurses: Rising to the e‐Challenge of an Integrated Clinical Information System," Critical Care Nursing Quarterly, vol. 29, no. 4, pp. 362-375, 2006. [5] Introduction to HL7 Standards, 2015. [6] H. L. Seven. (2007, Jun. 26th). Introduction to HL7 Standards. Available: http://www.hl7.org/implement/standards/index.cfm?ref=common [7] J. R. Le Gall et al., "A simplified acute physiology score for ICU patients," (in eng), Crit Care Med, vol. 12, no. 11, pp. 975-7, Nov 1984. [8] J. Le Gall, S. Lemeshow, and F. Saulnier, "A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.," JAMA, vol. 270, no. 24, pp. 2957-63, 1993. [9] X. Castella, A. Artigas, J. Bion, and A. Kari, "A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study: The European/North American Severity Study Group," Critical Care Medicine, vol. 23, pp. 1327-1335, 1995. [10] W. A. KNAUS, J. E. ZIMMERMAN, D. P. WAGNER, E. A. DRAPER, and D. E. LAWRENCE, "APACHE—acute physiology and chronic health evaluation: a physiologically based classification system," Critical Care Medicine, vol. 9, no. 8, pp. 591-597, 1981. [11] W. A. Knaus, E. A. Draper, D. P. Wagner, and J. E. Zimmerman, "APACHE II: a severity of disease classification system," (in eng), Crit Care Med, vol. 13, no. 10, pp. 818-29, Oct 1985. [12] S.-P. Luh, N.-K. Chou, and S.-S. Wang, "Traditional and Developing Concepts (the POSSUM Score) of Disease Severity Index of Patients in Surgical Intensive Care Units " Formosan Journal of Medicine, vol. 15, no. 1, pp. 86-94, 2011. [13] W. A. Knaus et al., "The APACHE III Prognostic System," CHEST, vol. 100, no. 6, pp. 1619-1636, 1991. [14] H.-Y. Chen, M.-L. Lin, M.-J. Huang, Y.-T. Liu, and C.-C. Yang, "Establishing the Foundation of Attended Manpower for Emergency First Aid Rooms," VGH Nursing, vol. 23, no. 4, pp. 256-363, 2006. [15] T. Killip, 3rd and J. T. Kimball, "Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients," (in eng), Am J Cardiol, vol. 20, no. 4, pp. 457-64, Oct 1967. [16] G. Teasdale and B. Jennett, "Assessment of coma and impaired consciousness. A practical scale," (in eng), Lancet, vol. 2, no. 7872, pp. 81-4, Jul 13 1974. [17] T. A. H. Association. (2017, NOV. 26th). Classes of Heart Failure. Available: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.WiOxzUqWaM8 [18] M. L. Boston, " The Criteria Committee of the New York Heart Association," in Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels9th ed ed. Boston: Little, Brown & Co., 1994, pp. 253–256. [19] E. M. Antman et al., "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making," (in eng), Jama, vol. 284, no. 7, pp. 835-42, Aug 16 2000. [20] C. N. Sessler et al., "The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients," American journal of respiratory and critical care medicine, vol. 166, no. 10, pp. 1338-1344, 2002. [21] J. C. Marshall, D. J. Cook, N. V. Christou, G. R. Bernard, C. L. Sprung, and W. J. Sibbald, "Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome," Critical care medicine, vol. 23, no. 10, pp. 1638-1652, 1995. [22] J. L. Vincent et al., "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine," (in eng), Intensive Care Med, vol. 22, no. 7, pp. 707-10, Jul 1996. [23] H.-C. Pan, Y.-C. Chen, and J.-T. Fang, "Scoring Systems in Intensive Care Unit," Kidney and Dialysis Vol.27, No.4, pp. 159-166 (December, 2015), vol. 27, no. 4, pp. 159-166, 2015. [24] S. P. Baker, B. o'Neill, W. Haddon Jr, and W. B. Long, "The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care," Journal of Trauma and Acute Care Surgery, vol. 14, no. 3, pp. 187-196, 1974. [25] T. N. I. o. N. Disorders and S. r.-P. S. S. Group, "Tissue Plasminogen Activator for Acute Ischemic Stroke," New England Journal of Medicine, vol. 333, no. 24, pp. 1581-1588, 1995. [26] C. R. Boyd, M. A. Tolson, and W. S. Copes, "Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score," (in eng), J Trauma, vol. 27, no. 4, pp. 370-8, Apr 1987. [27] H. Iseki et al., "SCOT (Smart Cyber Operating Theater) project: Advanced medical information analyzer for guidance of the surgical procedures," presented at the Proceedings of the International Display Workshops, 2012. [28] K. Masamune, H. Suenaga, E. Kobayashi, H. Iseki, and Y. Muragaki, "OPEN PLATFORM OF MEDICAL ROBOTS/ DEVICES WITH SMART CYBER OPERATING THEATER (SCOT): DESIGN CONCEPT AND PROTOTYPE ROBOT DEVELOPMENTS," presented at the 2016 The 16th International Conference on Biomedical Engineering, The National University of Singapore University Town, Singapore, 2016. [29] mediTEC. (2013, July 9). OR.NET - Secure Dynamic Networking in the Operating Room and Clinic. Available: http://www.meditec.hia.rwth-aachen.de/en/research/current-projects/ornet/ [30] O. .NET. (2017, July 12). OR.NET Video. Available: http://ornet.org/en/video/ [31] Y. J. Fan, Y. H. Yin, L. D. Xu, Y. Zeng, and F. Wu, "IoT-Based Smart Rehabilitation System," IEEE Transactions on Industrial Informatics, vol. 10, no. 2, pp. 1568-1577, 2014. [32] R. O. C. Ministry of the Interior. (2016). Population by Age of 2016. Available: http://sowf.moi.gov.tw/stat/year/list.htm [33] H. C. KEH, N. C. HUANG, Y. C. CHENG, P. Y. YU, and H. K. HO, "The System of Tele-care and Alert with Wireless Mini-Sensor " Republic of China Patent I456532, 2014. |
論文全文使用權限 |
如有問題,歡迎洽詢!
圖書館數位資訊組 (02)2621-5656 轉 2487 或 來信