A Layered, Multi-Agent System To Facilitate Healthcare Team Processes

描述（由申请人提供）：农村医院对紧急剖腹产（ECD）的反应不仅由于分娩期间胎儿和/或产妇窘迫的监测和早期检测效率低下，而且由于农村环境的条件而变得复杂。许多农村医院缺乏资源，无法配备24小时手术人员和专门用于剖腹产的手术室。尽管有上级廉价的技术，但ECD团队经常使用不适当的寻呼机和电话方法进行手术。必须或选择生活在农村地区的人与大城市的人一样，应得到及时和有效的产科急诊。医疗保健研究和质量机构将未能抢救，即一旦发现早期医疗并发症后采取行动缺乏有效性和及时性定义为护理质量的衡量标准之一。反应的延迟以及错误和遗漏可能导致未能抢救胎儿和母亲，导致死亡率和新生儿发病率增加。基于现有原型的初步工作，鲍尔实验室建议测试可行性，并进行进一步的研究和开发智能电子召唤和企业管理系统，旨在根据最佳实践指南协调ECD团队的有效和及时组装以及患者和手术室的准备。我们的系统不仅能够召集手术团队，还能够促进团队成员之间的沟通，协调团队决策，标准化准备活动，并使工作人员了解团队，患者和手术室的状态。此外，我们的系统提供了电子病历（EMR）和商业可用的资产管理和患者跟踪解决方案之间的接口，旨在提供所需的决策和协调支持。在第一阶段，我们建议：A）充分评估现有原型的有效性和可操作性， 临床ECD和收集用户对进一步系统开发的意见。B）建立一个强大和可靠的第二代原型，满足以前评估中确定的技术和可操作性要求。C）使用鲍尔实验室专有的多智能体系统技术，开发将EMR中的患者医疗信息整合到召唤系统中的方法。D）开发我们的系统与现成的资产管理和患者跟踪解决方案之间的接口。E）在整个团队和医院ECD模拟试验期间，评估我们的系统在减少错误、增加沟通以及满足30分钟“决定到切开”间隔目标方面的有效性和可操作性。该项目的最终目标是证明使用基于Bauer实验室专有的多代理系统技术的智能和集成医疗服务管理系统的技术可行性，以通过智能地集成临床，后勤和操作信息来防止救援失败，并以非侵入性地与临床工作流程集成的方式将其呈现给护理团队。 公共卫生相关性：捕获有关临床过程的详细知识并实时使用它来指导程序，提供决策支持，捕获和显示患者数据，并提醒医疗团队关键信息的能力将是医疗系统能力的重大改进，从而减少紧急手术干预期间的延迟，遗漏和其他错误。这些改进将缩短紧急剖宫产从决定到切开的时间，并降低导致患者（母亲和胎儿）发病率和死亡率的事故的可能性。

DESCRIPTION (provided by applicant): Response to an Emergency Cesarean Delivery (ECD) at rural hospitals is complicated not only by inefficiencies in monitoring and early detection of fetal and/or maternal distress during labor, but by the conditions of the rural settin. Many rural hospitals lack the resources to have round-the-clock surgical staff and operating rooms reserved for cesarean delivery. Despite the availability of superior inexpensive technologies, an ECD team is often summoned to surgery using inadequate pager and telephone methods. People who must, or choose to, live in rural areas are no less deserving of timely and effective emergency obstetrical care than those in large cities. The Agency for Healthcare Research and Quality defines failure to Rescue, the lack of effectiveness and timeliness of actions taken once early medical complications are recognized, as one of the measures of quality of care. Delays in response as well as errors and omissions can lead to failures to rescue the fetus and mother, leading to increased mortality and neonatal morbidity. Based on preliminary work with an existing prototype, Bauer Labs proposes to test the feasibility and to conduct further research and the development of an intelligent e-summoning and enterprise management system aimed at coordinating the effective and timely assembly of the ECD team and the preparation of patients and operating room according to best practice guidelines. Our system has the capability to not only summon the surgical team, but also to facilitate communication among team members, coordinate team decisions, standardize preparation activities, and keep personnel informed of the status of the team, the patient, and the operating room. Furthermore, our system provides an interface between the electronic medical record (EMR), and commercially available asset management and patient tracking solutions aimed at providing needed decision and coordination support. In phase 1, we propose to: A) Fully evaluate the effectiveness and operability of the existing prototype under a simulated clinical ECD and gather input from users on further system development. B) Build a robust and reliable second generation prototype meeting the technical and operability requirements identified in the previous evaluation. C) Develop the methods to integrate patient medical information from the EMR into the summoning system using Bauer Lab's proprietary multi-agent system technology. D) Develop the interface between our system with off-the-shelf asset management and patient tracking solutions. E) Evaluate the effectiveness and operability of our system in reducing errors, increasing communication, and meeting the 30-minute "decision-to-incision" interval target during total team and hospital ECD simulation trials. The ultimate goal o this project is to demonstrate the technical feasibility of using intelligent and integrated healthcare delivery management systems based on Bauer Lab's proprietary multi-agent system technology to prevent failures to rescue by intelligently integrating clinical, logistical, and operational information, and presenting it to the care team in a manner that integrates non-intrusively with the clinical workflow. PUBLIC HEALTH RELEVANCE: The ability to capture detailed knowledge about clinical processes and use it in real-time to guide procedures, provide decision support, capture and display patient data, and alert the medical team to critical information will be a major improvement in the capabilities of the medical system, leading to the reduction of delays, omissions, and other errors during emergency surgical interventions. These improvements will reduce the time from decision-to-incision in Emergency Cesarean Delivery and reduce the likelihood of mishaps resulting in patient (mother and fetus) morbidity and mortality.