Study on Establishment and Operation Results of the Critical Value Warning System
|School||Anhui Medical University,|
|Course||Public Health and Preventive Medicine|
|Keywords||Critical value Warning prevention and control system Establishment Effect Quality control|
Objective1. Through the scientific selection of early warning project, building the information platform, the establishment of clinical feedback mechanism and other measures, optimize the design of system process, to establish and operate the hospital inspection critical value warning prevention and control system.2. Analyze the historical data of critical values lists, to evaluate the effectiveness of critical value applying in the emergency department.3. Analyze the historical data of critical values lists, to evaluate the effectiveness of critical value applying in the department of neurosurgery.4. Analysis the effect of test critical value warning-feedback system quality control in our hospital.Methods1. Selection method of critical value:The experts to selected project were leaded by medical department, project discussed by clinical physicians, nurses and inspection technician, in the end to select out early warning project and the critical threshold value met the clinical needs.2. Construction of Information early warning platform:The hospital established the critical value warning prevention and control system on the basis of the early critical value reporting mechanism. Supported by the hospital information department and software development company, using the laboratory information system (LIS) and the hospital information system (HIS) network channel seamless link, perfect LIS informationization special inspection result monitoring rules(critical value monitor rule, CVMR).3. Establishing clinical disposal and feedback mechanism:Test results were transferred to the doctors and nurses workstation through the LIS and HIS system seamless connection, monitored by the information means. If the clinical medical staff were not handled, doctors and nurses workstation computers would be in a state of crash, to stop delay omission phenomenon. And the critical value report clinical disposal and feedback were implemented into the monthly quality management system, through the department comprehensive performance evaluation rules to cash rewards and punishments measures.4. Evaluating the effect of critical value warning prevention and control system: Screen out critical value lists data of2010from critical value high early-warning system, after pretreatment and transformation of data, calculate the percentage of critical value and it’s daily distribution, weekly distribution and department distribution,evaluate the turnaround time for critical value.5. Evaluating the effect of critical value warning prevention and control system running in the emergency department:Screen out135critical value of the emergency department in2011from critical value high early-warning system, after pretreatment and transformation of data, calculate the percentage of critical value and it’s daily distribution, evaluate the turnaround time and effectiveness for critical value.6. Evaluating the effect of critical value warning prevention and control system running in the department of neurosurgery:Screen out1667critical value of the Intensive care unit in2011from critical value high early-warning system, after pretreatment and transformation of data, calculate the percentage of critical value and it’s daily distribution, evaluate the turnaround time and effectiveness for critical value.7. Quality control methods of the critical value warning prevention and control system:Through the standard specimen collection delivery, monitoring critical specimen feedback aging, formulation of receiving report system to control system of quality control, we compared the disqualification specimen rate, critical value and clinical diagnosis coincidence rate, the repetition rate, emergency rescue success rate before the quality control with after the quality control.Results1. The critical value warning prevention and control system met the hospital clinical work mainly involved five content:acid-base imbalances electrolyte disorder (potassium, sodium, chloride, carbon dioxide, blood sugar, blood gas analysis PH value); Abnormal blood (leucocyte and neutrophils, red blood cell and hemoglobin, blood platelet); Blood coagulation dysfunction (PT, APTT, INR); Serious viscera function damage (the renal failure patients serum creatinine, non hepatopath transaminase, bilirubin); Important microbial detection anomaly (blood culture、 HIV positive)2. The rate of critical value was0.375%. It was mainly concentrated from9to13O’clock. Tuesday and Wednesday had mole critical value than other days. From the perspective of department, the majority critical value was from Neurosurgery department and Cardiothoracic surgical oncology department. The whole turnaround time for critical value was almost2hour.3.The rate of critical value was0.14%in the emergency department. It was mainly concentrated from9:00pm to1:00am, first aid efficiency reached100%. The whole turnaround time for critical value was almost70min.4.The rate of critical value was0.85%in ICU of the Neurosurgery department. It was mainly concentrated from9:00pm to1:00am. The whole turnaround time for critical value was almost90min. Before the system running the critically ill patients’ laboratory results return time was (69.3±18.4) min, medical interventions start-time was (48.9±11.7) min, the success rate of rescue was (53.3±9.4)%; after the system running the critically ill patients’laboratory results return time, medical interventions start-time, the success rate of rescue were (46.8±17.9) min,(22.1±7.9) min,(78.9±8.1)%. Critically ill patients’ rescue rate was significantly improved (P<0.05). 5. efore the critical value feedback system improvement, the specimen failure rate was55.8%, examination and clinical diagnosis coincidence rate was45.4%, the results agreement rate was25.8%, the success rate of rescue was76.5%.But after the improvement, the results were5.8%、85.9%、95.4%and92.6%. The results had significant difference (P<0.05).Conclusion1. The early warning and control system was close to the clinical practice, shorten the turnaround time of test results, reduce the medical risk effectively, in the end to improve the medical quality and management level.2. The early warning and control system in our hospital was successful, which could improve the laboratory and clinical work’s efficiency and quality, and satisfy the patients safety requirements.3. The application of critical values in the Intensive care unit and the emergency department was successful, which can improve the work efficiency and quality for the laboratory and emergency department and better meet patients’s needs.4. The critical value feedback system quality control in our hospital,and could greatly improve the quality of emergency department.