Research On Intelligent Checklist System For Stroke Emergency

Stroke is a clinical syndrome due to sudden rupture of blood vessels and vessel obstruction which may cause brain damage.The stroke is of high incidence rate,high mortality rate,high disability rate and high recurrence rate.In recent years,because of the aging population issue and the poor control of related risks,the number of stroke patients in China keeps increasing,which has become a major public health problem need to be solved.The key of stroke treatment is rapid and accurate diagnosis,and standardized treatment process,which demands a high-quality management of stroke treatment process to effectively decrease incidence rate and disability rate.The early treatment effect of stroke is time-dependent,and the period from onset to effective treatment is of great significance to improve the prognosis of patients.Compared with the medical scenario of hospitalization and ICU,the emergency department has limited space and high work intensity.The importance of treatment timing and efficiency makes the safety issues of stroke patients in emergency treatment process even more challenging in current work environment.Checklists have been widely used in hospital as an effective way to solve patient safety issues.At present,the checklists used in hospitals are mostly paper-based,which are fixed in content,and also difficult to integrate into the treatment process,what’s more,problems such as missing signature and supplementary signature happened.Compared with the paper checklist,the computerized intelligent checklist has the advantages ofselfadaption,individualized checking content and embeddable medical knowledge,etc.In the process of emergency treatment for stroke,it is difficult for medical staff to have enough time for checking due to the timeliness of treatment,;the traditional intelligent checklist needs to be completed at a fixed workstation,which is difficult to adapt to the characteristics of frequent movement of personnel position and urgent time in the process of emergency treatment.Therefore,using checklist in stroke emergency is very limited.In order to solve above problems,this study proposed a functional and technical architecture model of intelligent inventory system for stroke emergency scenario,and we determined a knowledge expression and construction method of the system after study.The corresponding knowledge base and intelligent checklist software system were developed for intravenous thrombolysis therapy,which verified the feasibility of the methods and availability of the software.The main research contents of this thesis contain:1.Investigate the safety risk of patients in stroke emergency,and analyze the problems that need to be solved during using checklist in stroke emergency.Through the investigation of the relevant clinical guidelines and other literature and interviews with clinicians,the basic procedure of emergency treatment of stroke was sorted out.The stroke emergency was divided into four stages: pre hospital emergency,preliminary diagnosis,disease assessment and early treatment.The roles of medical staff in each stage and their clinical tasks were summarized.Through the analysis of the safety risk of patients in stroke emergency and the investigation of the existing stroke related checklists,we summarized the key problems that need to be solved when using checklists for stroke emergency.2.The knowledge expression and construction method of intelligent checklist system are studied and determined based on the reality of stroke emergency.The information model in the knowledge module was based on the common data elements of the National Institute of neurological disorders and stroke,meanwhile,we had carried on the localization expansion transformation.We used the production rule to express the medical logic.The checklist item model was designed with the integration of the patient data and the rule,then we constructed the detailed checklist content.The "event condition action"(ECA)rule was used to express the diagnosis and treatment process,and realized the checklist trigger and the reminder.3.Analyze the safety checking requirements of stroke emergency,and put forward the function and technical framework of the mobile intelligent checklist system.On this basis,the intelligent checklist building tool and execution engine were designed and implemented.With this tool,medical institutions could rapidly develop and deploy localized intelligent checklist system;medical staff can check on the mobile terminal,which reduce the impact of check work on the efficiency of emergency.The knowledge engineers can edit the checklist content,clinical rules and publish them online.The management personnel can view the check records of medical staff and evaluate the medical quality in their institution based on quantitative data.4.Taking an example of intravenous thrombolysis therapy,one of the highest risk treatment measures,we constructed a knowledge base of intelligent checklist of intravenous thrombolysis therapy by literature research,on-site observation and expert interviews,etc.This system was built with above development tool,and the availability was also verified.The preliminary results showed that the system could help medical staff to carry out safety checking in stroke emergency.Compared with the paper checklist,the checking content is more targeted and intelligent.