以電子病歷監測醫療照護相關感染的成效

Effectiveness of Electronic Medical Record for Surveillance of Healthcare-Associated Infections

感染管制以病人安全和醫療品質為主要任務，首重風險管理與監測（例如持續性品質指標監測等），包含及早發現和釐清問題、落差分析，才能迅速有效地進行介入措施，並客觀的評估成效。現在很多病歷紀錄已資訊化，但是缺少整合的介面，造成判定醫療照護相關感染的負擔，若能妥善運用資料庫，將輕鬆收集到品管指標。所以我們開發了一系列線上的自動收案系統和指標儀表板，希望能對感染管制工作有所助益。成立跨專業軟體開發團隊，透過現有資訊庫的整合，發揮創意開發建構一系列主動、全方位的即時偵測系統。包括抗藥性微生物監測系統、醫療照護相關血流感染監測系統、醫療照護相關泌尿道感染監測系統、並導入商業智慧軟體，完成12項品管重要指標儀表板。我們調查資深感染管制護理師對系統滿意度平均為4.6±0.075（Likert scale 5分法）。因著資訊化作業大幅轉變感染管制業務時間。系統上線前，監測業務時間百分比由60.0±13.0％變成34.6±12.2％（P ＜0.0001），專案業務時間38.5±12.9％變成62.3±17.2％（P ＜0.0001）。這說明了藉由資訊的便利，省下來耗時費力的監控業務時間，使感染管制進化為優質規劃發展各項專案，在品質改善活動有更多著力，間接提昇了醫療品質與病人就醫的安全，深具成本效益。

Healthcare-associated infections (HAIs) are associated with excess mortality, morbidity and resource use. Surveillance of HAIs is an essential component of infection prevention and control (IPC) programs in healthcare settings. The goals of surveillance are to assess the disease incidence, identify the niche and opportunity for improvement, monitor the efficacy of interventions, and support the rationale behind changes in policies. However, conventional HAI surveillance systems require considerable human involvement in collecting, integrating and interpreting data and are labor intensive, performance dependent, and tend to divert time and human resources that are necessary for implementing IPC. Since the electronic medical records are launched and implemented stepwise at this teaching hospital in Taiwan, we developed a series of web-based HAI surveillance and classification systems and dashboards for quality indictors since 2007. In this study we described the architecture of developing this in-house information system which automatically detects HAI (bloodstream and urinary tract) and multidrug resistance organisms and evaluates its effectiveness. We used web services techniques based on Service-Oriented Architecture, which is suitable for integrating heterogeneous platforms, protocols, and applications. We developed a questionnaire to evaluate user satisfaction. Of the 13 senior infection control nurses surveyed, this system was highly satisfied with an average score of 4.6 ± 0.075 (Likert scale 5-point method). Of the 5 new users evaluated, it took only 1.2 hours in average in orientation. Besides, the time taken for surveillance decreased from 60.0 ± 13.0% to 34.6 ± 12.2% after implementing this system (P＜0.0001), and time taken for improvement program increase from 38.5 ± 12.9% to 62.3 ± 17.2% (P＜0.0001). In conclusion, this study showed technology acceptance and user satisfaction in implementing this system which resulted in a paradigm shift of the IPC program at this hospital.