急診部醫護輔助平台研究 - 某國立大學醫學中心個案分析

Abstract

在門診、急診、開刀與住院等各項醫療照護之中，急診面對的挑戰是最不可預測的，其中包括不可預估的來診量、輕重緩急不同的多樣性疾病、因住院病房短缺而無法立即轉出的三大基本問題，於是擁擠與忙碌便成為各大醫學中心急診部的共通現象，直接造成：病人等待時間延長、醫護人員忙碌不堪與分身乏術，也間接影響病人安全與降低醫療品質。 國外有不少文獻針對急診部擁擠問題提出分析，包含擁擠情形的存在與產生的影響、擁擠程度的評量研究到擁擠的解決方法。而本研究針對華人特殊就醫文化，引用NTU游張松BI(Business Intelligence) Lab的模組化(BI modularization)研究為基礎，包含「儀表板人機界面(Dashboard interface)、一維與二維條碼(1D&2D barcode)、無線射頻辨識(RFID)、行動運算裝置使用情境(Mobility scenario)」等各個模組，針對急診部的特殊性質，發展出專屬急診部的醫護人員助理平台 - Doctors and Nurses’Assistant Platform，以下簡稱DNA。 本研究長期駐點於某醫學中心急診部，除了現場觀察病人與醫護人員的互動流程，分析現有急診部作業流程與電資系統，也於期間訪談管理階層與第一線醫護人員，專心聆聽病人與其家屬的心聲，嘗試從使用者最關心的需求(User demand)中，找出電資技術的切入應用點，加上現代科技管理的觀點，以期能重新設計一套專屬於急診部的電資管理平台(DNA)，來輔助管理階層與醫護人員即時掌握各式狀況，進而做出最適切的管理決策與醫療處置。 接著本研究從商業智能BI角度，針對急診流程中各種事件(Events)，定義出基本資料結構《人物、事件、時間、地點、物件》log data，研究收集《人事時地物》資料的各種方法(如Barcode、RFID)，並使用視覺化(直覺化)軟體介面設計(如Dashboard)，呈現出與傳統上使用「文字與條列式」的當今各式醫院系統(如HIS、LIS)截然不同的人機介面設計，並以行動運算裝置(如iPad、iPhone)為基本考量，最後DNA提供醫護人員下列各項功能：視覺化直覺性感受病人情況(Visualization)、搜尋病人與設備(Search)、主動顯示病人的重要訊息(Push critical information)、隨時調閱病人相關資料(Pull needed information)、資料採礦(Data-mining)與關鍵指標(KPI)。 本研究在游張松教授帶領下，以「先導發展設計階段 - A pilot exploration & design」著手，於一年以上的時間建構出DNA原型系統(Prototype)並獲致相關研究成果，而於急診部實地測試DNA之後的結果顯示：DNA可以增加醫護人員對病人情況掌握度，可以使管理階層易於監控各項營運關鍵指標，開始解決急診部長久以來面對的各式問題，例如醫護人員與家屬找病人、走道臨時床位快速移入清潔完畢的空床位、床位利用率分析…等。 本研究提供從醫療面、人性面、科技面與管理面的廣角度思維架構，提供給未來繼續發展專屬於急診部醫療照護智能系統(Medical-care intelligence system)的實用參考範例。

Among outpatient, emergency, operation and other hospital services, the emergency department has the most unpredictable challenges which include three major problems, the unpredictable quantity of the incoming patients, the diversities of diseases, and the ward shortage. Thus, the most common situation of the emergency departments of those large medical centers is jam-packed and bustling. This directly causes the longer patient waiting time and the busier medical personnel, and also affects the quality of the medical care and patient safety. Based on the research in Business Intelligence Lab leading by NTU professor, Chang-Sung Yu, Ph.D., which includes the dashboard interface, 1D&2D barcode, RFID and the mobile device scenarios, this research spent two years working with the medical staff. We not only observed the mutual interaction between the patients and the medical staff, analyzed the current working flow and the information system, but also talked to the patients and families. We discovers the most needed demands and finds the cutting point which can be used to design a customized DNA for the emergency department to help the medical staff to be able to control the situations and furthermore to be able to make the suitable medical actions and management decisions. And then, from the BI point of view, this research has defined the data structure of the log data used in the varied events in the working flow of the emergency department. Compared to the traditional text-based information used in the current systems such as HIS and LIS, this research uses the visualized interface (such as dashboard) with the mobile devices scenarios (such as iPad or iPhone) to provide the medical staff the following functions which includes visualized monitoring of the patient situation, locating to the patients and equipments, push critical information to medical staff, pull needed information anytime, data-mining and KPI. After testing DNA in the emergency department, we found that the medical staff can gain more control over the situation of the patients, and the management staff can monitor the KPI easier. Last but not least, DNA solves many kinds of long-standing issues such as medical staff looking for patients or vice versa, utilization rate of the beds, etc. We developed a framework from the broad perspectives of medical operation, humanity, technology and hospital management, and hope to provide a practical example for the future development of the medical-care intelligence system in the emergency department.