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特定于患者的电子信息和基于证据的知识的更多获取，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式，使用急诊科对儿童阴囊疼痛和儿童哮喘恶化的分诊作为可能受益于这种支持的临床方式。一个特定的假设是，只有当决策支持系统设计成适合急诊科的工作流程和不同临床用户组的需求时，无处不在的支持模式才能成功实施。具体目标是：1)创建儿科急诊分诊支持功能的一般本体论模型(以两个演示为例)。基于现有的回顾图表数据，我们将开发一种通用的语言来表示基本概念，以及它们之间的关系，包括支持要求；2)创建一个无处不在的决策支持框架，用于哮喘恶化和阴囊疼痛的分诊支持。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护理点支持功能；3)在急诊科环境下对决策模型和决策支持系统进行评估。我们将设计和进行我们的理论解决方案的试点评估试验，以评估其性能，分析其与工作流程的匹配性，并评估临床医生的接受度。我们的多学科团队要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：医生在评估和治疗病人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，患者护理和卫生保健服务可能会得到改善。我们希望通过为儿童紧急情况(以哮喘和阴囊疼痛为案例)建立一个便携的决策支持系统来帮助医生做出更好的决策。本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.