临床输血评估评价全程闭环智能路径构建及其应用

发布时间：2018-10-30 20:44

【摘要】：目的通过构建临床输血评估评价全程闭环智能路径,以实现单病种个体化循证输血评估评价,有效提升患者血液管理和科学安全有效用血水平。方法以三级组织管理和三级临床输血评估评价为基本架构,贯穿于临床用血全程闭环智能路径,路径间无缝对接,智能实时控制与信息共享。结果 1)临床输血评估评价全程闭环智能路径涵盖了输血前、输血过程中评估与输血多学科诊疗,输血疗效评价及质量评价与持续改进的全过程;2)具有全程组织管理、多部门全员参与,评估评价的个体化、系统性、全面性,过程控制的智能路径化与信息实时共享,质量持续改进智能化分析等特点,实现了临床输血评估评价的多部门全员参与、事前主动评价、全程闭环路径实时控制与质量持续改进。3)应用数据显示,医院输血前评估率、输血后评价率、输血合理率、自体输血率、术中自体输血率、微创手术率等均呈持续上升趋势,分别由2013年的93.30%、89.72%、96.01%、20.01%、57.77%、25.45%上升到2015年的98.60%、95.87%、99.43%、27.36%、75.59%、28.97%(P0.01),医院出院患者输血率、异体输血率分别由2013年的9.13%,7.84%下降到2015年的5.92%,4.77%(P0.01),出院患者均异体RBC量和均RBC量、手术台均异体RBC量和台均RBC量分别由2013年的0.26 U、0.36 U,0.18 U、0.42 U下降到2015年的0.21 U、0.29 U,0.08 U、0.31 U,均呈持续下降趋势。结论临床输血评估评价全程闭环智能路径对提升患者血液管理和科学安全有效用血水平,减少患者输血需求,指导单病种个体化循证输血与质量持续改进有着良好的应用前景。
[Abstract]:Objective to construct a closed loop intelligent path for evaluation of clinical blood transfusion evaluation in order to realize the evaluation of individual evidence-based blood transfusion of single disease, and to effectively improve the blood management and the level of scientific, safe and effective blood use of patients. Methods three levels of tissue management and evaluation of clinical blood transfusion were used as the basic framework, which ran through the closed loop intelligent path of clinical blood use, seamlessly docked between paths, intelligent real-time control and information sharing. Results 1) the whole closed-loop intelligent path for evaluation of clinical blood transfusion includes the whole process of evaluation and multi-disciplinary diagnosis and treatment of blood transfusion, evaluation of blood transfusion efficacy, evaluation of quality and continuous improvement before blood transfusion; 2) it has the characteristics of whole process organization and management, multi-department and all-staff participation, individuation, systematicness and comprehensiveness of evaluation, intelligent path of process control and real-time sharing of information, continuous improvement of quality and intelligent analysis, etc. The evaluation of clinical blood transfusion was carried out with the participation of multi-department, the active evaluation in advance, the real-time control of the whole closed-loop path and the continuous improvement of the quality. 3) the application data showed that the rate of pre-transfusion evaluation, post-transfusion evaluation and reasonable blood transfusion were obtained. The rate of autologous blood transfusion, the rate of intraoperative autotransfusion and the rate of minimally invasive surgery were all on the rise, rising from 93.30% in 2013 to 98.60% in 2015, respectively, from 93.30% to 89.72% and 96.01% to 20.01% and 57.77%, respectively, in 2013. 95.8799. 430.27.36% (P 0.01). The blood transfusion rate of discharged patients and the rate of allogeneic blood transfusion decreased from 9.137.84% in 2013 to 5.92% in 2015, respectively. 4.77% (P0.01). The volume of allogeneic RBC and average RBC, the volume of allogeneic RBC and the volume of RBC on the operating table decreased from 0.26 U / 0.36 U / 0.18 U / 0.42 U in 2013 to 0.21 U in 2015, respectively. 0.29 U, 0.08 U, 0.31 U, all showed a continuous downward trend. Conclusion the evaluation of clinical blood transfusion evaluation has a good prospect in improving blood management, scientific, safe and effective use of blood, reducing patients' need for blood transfusion, guiding individual evidence-based blood transfusion and continuous improvement of quality of patients with single disease.
【作者单位】：南昌大学第一附属医院;江西先锋信息产业有限公司;
【基金】：江西省科技重大项目(20144BBG70001)
【分类号】：R457.1;R197.323

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