适用于我国临床实验室的条形码标本信息管理系统

目的 利用条形码技术，研制适合中国国情的条形码检验信息管理流程，杜绝标本采集和数据传递过程中的人为差错。方法 设计与制作不同颜色的条形码检验信息标签，各种标签的条形码号码为流水号且两位前缀代表不同专业组别或项目并与标签颜色相对应。以Windows 2000为服务器平台、Microsoft SQL Server 2000为数据库、Power Builder8．0为前台开发工具，用网卡将仪器联接成网，实现双向通讯，并入检验服务器与全院HIS系统连接。结果 通过连接电脑的条码扫描器读取标本容器上标签的条码号与来自医院信息系统的患者检验项目逐条对应，并共存于系统中。根据标本标签上的颜色将其分发到不同的检验工作站，各检验工作站将根据条码所带的检测信息给仪器发送相应的检测指令，最后将测定结果与该患者的基本信息对应形成检验报告单。结论 通过条形码检验信息标签建立的检验信息管理系统，实现了自动化仪器的双向控制；过程中无需配备条码打印机和粘贴标签，省时、省力、方便快捷，杜绝了信息采集与传递过程中的差错，提高了检验质量与管理水平。     

条形码在临床免疫学检验项目和标本管理中的应用

目的 建立一种临床免疫学检验项目和标本的信息管理方法。方法 利用条形码检验信息管理系统，编制检验项目和标本管理模块。结果 通过标本和检验信息对应关系的程序管理，实现了每天按“工作清单”指令完成测定项目，按“清库单”丢弃过期标本。结论 该模块可使检测过程有序规范，避免了手工管理标本造成的项目漏检、报告不及时等现象，提高了工作效率和管理水平。     

条形码在检验标本信息和检验项目中的应用

目的建立医院临床检验标本的信息和检验项目管理的新方法。真正实现检验工作流程的全自动化。方法目前社会上普遍使用的务码在医院检验科标本信息管理和检验项目编制模块，使用务形码化标本采集管留取标本，通过读条码器完成申请、检验、报告的自动化学数字工作流程。结果通过检验标本和检验项目信息对应关系的程序编辑，实现了每天按条形码信息指令完成测定项目。提高了工作效率，减少了在接收检验要求、报告结果和保存记录等工作中可能会出现的人为误差。结论该系统的使用畅通了检验信息的渠道，使检测过程有序规范化，减少了手工管理标本造成的人为差错，从而提高了工作效率和管理水平，是医院逐步走上科学化，规范化管理的需要。     

条形码技术在我院检验标本管理中的应用

条形码是由一组宽度不同、反射率不同的条和空按规定的编码规则组合起来,用以表示一组数据的符号[1],条形码技术因其条码的惟一性、准确性和管理使用的便捷性在仓储、超市等得到了广泛应用。我院于2009年应用条形码技术在检验标本的处理中,改变了原来的工作模式,简化了工作流程,提高了工作效率,受到临床及检验科室的欢迎,同时极大     

条形码技术在我院检验标本管理中的应用

条形码是由一组宽度不同、反射率不同的条和空按规定的编码规则组合起来,用以表示一组数据的符号[1],条形码技术因其条码的惟一性、准确性和管理使用的便捷性在仓储、超市等得到了广泛应用。我院于2009年应用条形码技术在检验标本的处理中,改变了原来的工作模式,简化了工作流程,提高了工作效率,受到临床及检验科室的欢迎,     

条形码在检验科信息化管理中的应用

条形码技术目前已广泛进入到医学实验室[1,2].本院于1997年引进美国Beckman公司Synchron CX7 Delta型全自动生化分析仪,单机使用了条形码[3],在减少差错和提高工作效率方面起到了很大作用.2000年建立了LIS系统并良好联入医院HIS系统,实现了信息共享,进一步提高了工作效率.随着业务量的递增和全面质量管理的要求,在原LIS基础上引入了条码管理系统,进一步加强了检验全过程的质量控制,提高了工作效率,减少了差错.     

条形码化检验信息标签在临床实验室中的应用

目的　研制一种能适用于我国检验领域的条形码信息标签。方法　依据检验过程中所涉及的检验标本种类以及专业分工 ,将条形码信息标签分为 14种 ,每种标签独具一种颜色和一个固定 2位数前缀的 10位流水号码。结果　此标签配合检验科信息管理系统不仅能适用于生化、免疫、血液分析仪 ,而且能涵盖所有的手工检验项目 ;不需要现场打印标签 ,甚至不需要配备条形码打印机 ;通过分辨颜色 ,工作人员可快速、准确地选择标本容器采集和传递标本 ;仪器通过条形码快速、准确、无误地进行检测。结论　这是一套完全适合我国市场运作 ,操作时既方便、快捷、无差错 ,又不增加成本的条形码信息标签     

条形码化检验信息标签在临床实验室中的应用

目的 研制一种能适用于我国检验领域的条形码信息标签。方法 依据检验过程中所涉及的检验标本种类以及专业分工，将条形码信息标签分为14种，每种标签独具一种颜色和一个固定2位数前缀的10位流水号码。结果此标签配合检验科信息管理系统不仅能适用于生化、免疫、血液分析仪，而且能涵盖所有的手工检验项目；不需要现场打印标签，甚至不需要配备条形码打印机；通过分辨颜色，工作人员可快速、准确地选择标本容器采集和传递标本；仪器通过条形码快速、准确、无误地进行检测。结论 这是一套完全适合我国市场运作，操作时既方便、快捷、无差错，又不增加成本的条形码信息标签。     

无纸化条形码检验操作系统在临床护理中的应用

在医院的临床护理工作中，某些辅助检验基础工作已成为护理内涵的重要组成部分，直接关系到护理质量。条形码在商业中已成为商品的最重要标识，如何将条形码这种特殊的标志物引入检验与护理工作中，来达到提高工作效率、减少差错的同样目的，是目前医院信息化系统建设中的重要课题。现就我院自行研制的无纸化条形码检验操作系统在护理工作的应用介绍如下。     

条形码在临床免疫学检验项目和标本管理中的应用

目的　建立一种临床免疫学检验项目和标本的信息管理方法。方法　利用条形码检验信息管理系统 ,编制检验项目和标本管理模块。结果　通过标本和检验信息对应关系的程序管理 ,实现了每天按“工作清单”指令完成测定项目 ,按“清库单”丢弃过期标本。结论　该模块可使检测过程有序规范 ,避免了手工管理标本造成的项目漏检、报告不及时等现象 ,提高了工作效率和管理水平。     

How to maintain blood supply during computer network breakdown: a manual backup system

Electronic data management systems using computer network systems and client/server architecture are increasingly used in laboratories and transfusion services. Severe problems arise if there is no network access to the database server and critical functions are not available. We describe a manual backup system (MBS) developed to maintain the delivery of blood products to patients in a hospital transfusion service in case of a computer network breakdown. All data are kept on a central SQL database connected to peripheral workstations in a local area network (LAN). Request entry from wards is performed via machine-readable request forms containing self-adhesive specimen labels with barcodes for test tubes. Data entry occurs on-line by bidirectional automated systems or off-line manually. One of the workstations in the laboratory contains a second SQL database which is frequently and incrementally updated. This workstation is run as a stand-alone, read-only database if the central SQL database is not available. In case of a network breakdown, the time-graded MBS is launched. Patient data, requesting ward and ordered tests/requests, are photocopied through a template from the request forms on special MBS worksheets serving as laboratory journal for manual processing and result report (a copy is left in the laboratory). As soon as the network is running again the data from the off-line period are entered into the primary SQL server. The MBS was successfully used at several occasions. The documentation of a 90-min breakdown period is presented in detail. Additional work resulted from the copy work and the belated manual data entry after restoration of the system. There was no delay in issue of blood products or result reporting. The backup system described has been proven to be simple, quick and safe to maintain urgent blood supply and distribution of laboratory results in case of unexpected network breakdown.     

Change in HbA1c concentration as decision parameter for frequency of HbA1c measurement

Abstract

Hemoglobin A_1c (HbA_1c) is a long-term measure for glucose concentration in plasma. Since its introduction as a diabetes monitoring tool, and its more recent application as a diagnostic tool, the number of measurements of HbA_1c have risen dramatically. However, HbA_1c change is slow, so repeating measurements should not be done too often. We use a large, unfiltered dataset from 52,017 patients to determine the possible rate of change in HbA_1c concentration. In our laboratory, the critical difference between HbA_1c measurements is 8.5%. Our data show that a 1-unit HbA_1c rise takes 4 weeks to occur, hence, at a HbA_1c concentration around 50?mmol/mol Hgb, a critically increased HbA_1c concentration cannot be determined until after 16 weeks. Conversely a critically lower HbA1c can manifest itself after 2 weeks, but after 7 weeks the dropping tendency stops. The amount of measurements that can be cancelled because they were taken sooner than 16 weeks is 23 percent.     

Improving Documentation Using a Real-Time Location System in a Pediatric Emergency Department

Background  Appropriate documentation of critical care services, including key time-based parameters, is critical to accurate severity of illness metrics and proper reimbursement. Documentation of time-based elements for critical care services performed in emergency departments (ED) remains inconsistent. We integrated electronic medical record and real-time location system (RTLS)-derived data to augment quality improvement methodology. Objective  We aimed to increase the proportion of patient encounters with critical care services performed at a pediatric ED that had appropriate documentation from a baseline of 76 to 90% within 6 weeks. Methods  The team formulated a framework of improvement and performed multiple plan-do-study-act cycles focused on key drivers. We integrated the capabilities of an RTLS for precise location tracking to identify patient encounters in which critical care services were performed and to minimize unnecessary audits and feedback. We developed an intervention using iterative revisions to address key drivers and improve documentation. The primary outcome was the proportion of patient encounters for which critical care services were performed for which a time-based attestation was documented in the medical record. Results  We analyzed 92 encounters between March 2020 and April 2020. While the proportion of eligible patient encounters with critical care documentation improved from 76 to 85%, this change was unable to be directly attributed to improvement efforts. Patients with respiratory complaints encompassed the majority of eligible encounters without appropriate documentation. Conclusion  Utilizing improvement methodology and a novel application of RTLS, we successfully identified the co-location of physicians with patients receiving critical care services and designed interventions to improve documentation of critical care services provided in a pediatric ED. While changes were not able to be attributed to improvement efforts in this project, this project demonstrates the utility of RTLS to augment and inform systematic improvement efforts.     

Computer assisted data analysis in intensive care: the ICDEV project-development of a scientific database system for intensive care

Introduction: Patient Data Management Systems (PDMS) for ICUs collect, present and store clinical data. Various intentions make analysis of those digitally stored data desirable, such as quality control or scientific purposes. The aim of the Intensive Care Data Evaluation project (ICDEV), was to provide a database tool for the analysis of data recorded at various ICUs at the University Clinics of Vienna.Settings: General Hospital of Vienna, with two different PDMSs used: Care Vue 9000 (Hewlett Packard, Andover, USA) at two ICUs (one medical ICU and one neonatal ICU) and PICIS Chart+ (PICIS, Paris, France) at one Cardiothoracic ICU.Concept and methods: Clinically oriented analysis of the data collected in a PDMS at an ICU was the beginning of the development. After defining the database structure we established a client-server based database system under Microsoft Windows NI^TM and developed a user friendly data quering application using Microsoft Visual C++^TM and Visual Basic^TM;Results: ICDEV was successfully installed at three different ICUs, adjustment to the different PDMS configurations were done within a few days. The database structure developed by us enables a powerful query concept representing an ‘EXPERT QUESTION COMPILER’ which may help to answer almost any clinical questions. Several program modules facilitate queries at the patient, group and unit level. Results from ICDEV-queries are automatically transferred to Microsoft Excel^TM, for display (in form of configurable tables and graphs) and further processing.Conclusions: The ICDEV concept is configurable for adjustment to different intensive care information systems and can be use to support computerized quality control. However, as long as there exists no sufficient artifact recognition or data validation software for automatically recorded patient data, the reliability of these data and their usage for computer assisted quality control remain unclear and should be further studied. Supported by the Scientific Fund of the Mayor of Vienna     

Acquisition of ICU data: concepts and demands

As the issue of data overload is a problem in critical care today, it is of utmost importance to improve acquisition, storage, integration, and presentation of medical data, which appears only feasible with the help of bedside computers.The data originates from four major sources: (1) the bedside medical devices, (2) the local area network (LAN) of the ICU, (3) the hospital information system (HIS) and (4) manual input. All sources differ markedly in quality and quantity of data and in the demands of the interfaces between source of data and patient database.The demands for data acquisition from bedside medical devices, ICU-LAN and HIS concentrate on technical problems, such as computational power, storage capacity, real-time processing, interfacing with different devices and networks and the unmistakable assignment of data to the individual patient.The main problem of manual data acquisition is the definition and configuration of the user interface that must allow the inexperienced user to interact with the computer intuitively. Emphasis must be put on the construction of a pleasant, logical and easy-to-handle graphical user interface (GUI). Short response times will require high graphical processing capacity. Moreover, high computational resources are necessary in the future for additional interfacing devices such as speech recognition and 3D-GUI.Therefore, in an ICU environment the demands for computational power are enrmous. These problems are complicated by the urgent need for friendly and easy-to-handle user interfaces. Both facts place ICU bedside computing at the vanguard of present and future workstation development leaving no room for solutions based on traditional concepts of personal computers.For a truely paperless documentation a new integrated computational paradigm has to be developed that might required a new dimension of computational and graphical power at the bedside.     

Using an interactive voice response system to improve patient safety following hospital discharge

BACKGROUND: Patients often experience complications when transitioning from hospital to home. These complications are frequently related to poor monitoring. An interactive voice response system (IVRS) could improve post-discharge monitoring. OBJECTIVE: To determine the feasibility and utility of an IVRS to monitor patients following hospital discharge. DESIGN: Prospective cohort study at an academic health sciences centre. PATIENTS: Consecutive internal medicine patients who had a touch-tone telephone, spoke English, had no cognitive impairments and were discharged home. MEASUREMENTS: Feasibility was defined as the proportion of patients reached by the IVRS and the proportion completing an IVRS-based survey. Utility was defined as the percentage of patients whose outcomes could have been changed by the IVRS. METHODS: We programmed the IVRS to call patients and administer a simple survey 48 hours after discharge. The survey's objective was to identify all patients with new health problems. Such patients were telephoned by a nurse to clarify and address the problem. RESULTS: We enrolled 77 patients who were predominantly male (68%), elderly (median age 65 years) and chronically ill (median number of co-morbidities = 3). The IVRS reached 45 of the 77 patients (58.4%). Forty patients (51.9%) answered all questions on the survey. Twenty patients (26%, 95% CI 17%-37%) indicated new or worsening symptoms, problems with their medications, or requested to talk to the clinic nurse. For 10 patients (13%, 95% CI 7%-22%), the IVRS could have made a difference in their outcome. CONCLUSION: Using an IVRS, we were able to identify several important new health concerns arising following hospital discharge. Subtle changes could increase the feasibility and utility of IVRS technology in improving post-discharge outcomes.