Triage support at the point of care: Methodologies for ubiquitous systems in the emergency department

无处不在的计算的出现，以及对电子患者特定信息和循证知识的访问增加，为如何在护理点提供临床决策支持创造了新的机会。我们的目标是研究和开发一种新的计算和决策支持范例，使用儿科阴囊疼痛和儿科哮喘急性发作的急诊科分诊作为可以从这种类型的支持中受益的临床模式。一个具体的假设是，一个无处不在的支持模型，只有成功地实现，如果决策支持系统的设计，以适应急诊科的工作流程和不同群体的临床用户的需求。具体目标是：1）创建儿科急诊分诊支持功能的通用本体模型（使用两个演示文稿作为示例）。基于现有的回顾性图表数据，我们将开发一种共同的“语言”来表示基本概念，以及它们之间的关系，包括支持需求; 2）为哮喘急性发作和阴囊疼痛分诊支持创建一个无处不在的决策支持框架。借鉴本体驱动的设计，我们将开发一个决策支持系统，为临床医生提供安全的支持功能，在护理点; 3）评估决策模型和决策支持系统在急诊科设置。我们将设计并进行我们的理论解决方案的试点评估试验，以估计其性能，分析其与工作流程的匹配，并评估临床医生的接受程度。我们的多学科团队将研究的关键主题包括知识表示，临床决策支持，数据挖掘和工作流程调整。摘要：医生在评估和治疗患者时可以获得越来越多的复杂信息。通过将这些信息和计算机生成的建议带到床边，可以改善患者护理和医疗保健服务。我们希望通过建立一个便携式决策支持系统来帮助医生做出更好的决策，用于儿童紧急情况（使用哮喘和阴囊疼痛作为案例研究）。这项研究的进展可用于其他临床问题和设置。

The emergence of ubiquitous computing and increased access to electronic patient-specific information and evidence-based knowledge have created new opportunities for how clinical decision support can be provided at the point of care. Our goal is to study and develop a novel computing and decision support paradigm, using the Emergency Department triage of pediatric scrotal pain and pediatric asthma exacerbations as the clinical modalities that could benefit from this type of support. A specific hypothesis is that a ubiquitous support model can only be successfully implemented if the decision support system is designed to fit the Emergency Department workflow and needs of a diverse group of clinical users. The specific aims are: 1) To create a general ontological model of the triage support functionality for pediatric emergencies (using two presentations as examples). Based on existing retrospective chart data, we will develop a common "language" to represent basic concepts, and the relationships among them, including support requirements; 2) To create a ubiquitous decision support framework for the asthma exacerbation and scrotal pain triage support. Drawing from the ontology-driven design, we will develop a decision support system to provide clinicians with secure support functionality at the point of care; 3) To evaluate the decision model and decision support system in the Emergency Department setting. We will design and conduct a pilot evaluation trial of our theoretical solution in order to estimate its performance, analyze its fit with the workflow, and assess acceptance by clinicians. Key themes to be studied by our multidisciplinary team include knowledge representation, clinical decision support, data mining, and workflow alignment. LAY ABSTRACT: An increasing amount of complex information is available to doctors as they assess and treat patients. Patient care and health care delivery may be improved by bringing this information and computer-generated advice to the bedside. We want to help doctors make better decisions by building a portable decision support system for childhood emergencies (using asthma and scrotal pain as the case studies). Advances of this research can be used for other clinical problems and settings.