Nelson Eugene C, Batalden Paul B, Homa Karen, Godfrey Marjorie M, Campbell Christine, Headrick Linda A, Huber Thomas P, Mohr Julie J, Wasson John H
Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA.
Jt Comm J Qual Saf. 2003 Jan;29(1):5-15. doi: 10.1016/s1549-3741(03)29002-x.
A rich information environment supports the functioning of the small, functional, frontline units--the microsystems--that provide most health care to most people. Three settings represent case examples of how clinical microsystems use data in everyday practice to provide high-quality and cost-effective care.
At The Spine Center at Dartmouth, Lebanon, New Hampshire, a patient value compass, a one-page health status report, is used to determine if the provided care and services are meeting the patient's needs. In Summit, New Jersey, Overlook Hospital's emergency department (ED) uses uses real-time process monitoring on patient care cycle times, quality and productivity indicator tracking, and patient and customer satisfaction tracking. These data streams create an information pool that is actively used in this ED icrosystem--minute by minute, hourly, daily, weekly, and annually--to analyze performance patterns and spot flaws that require action. The Shock Trauma Intensive Care Unit (STRICU), Intermountain Health Care, Salt Lake City, uses a data system to monitor the "wired" patient remotely and share information at any time in real time. Staff can complete shift reports in 10 minutes.
Information exchange is the interface that connects staff to patients and staff to staff within the microsystem; microsystem to microsystem; and microsystem to macro-organization.
丰富的信息环境支持小型的、功能性的一线单元——微系统——的运作，这些微系统为大多数人提供了大部分医疗服务。有三种场景代表了临床微系统在日常实践中如何利用数据来提供高质量且具成本效益的医疗服务的案例。
在新罕布什尔州黎巴嫩市达特茅斯脊柱中心，一份患者价值指南，即一份单页健康状况报告，被用于确定所提供的护理和服务是否满足患者需求。在新泽西州萨米特市，俯瞰医院急诊科对患者护理周期时间进行实时流程监控，跟踪质量和生产率指标，并跟踪患者及客户满意度。这些数据流形成了一个信息池，在这个急诊科微系统中被积极利用——每分钟、每小时、每天、每周以及每年——以分析绩效模式并发现需要采取行动的缺陷。盐湖城山间医疗保健公司的创伤重症监护病房利用数据系统对“联网”患者进行远程监控，并随时实时共享信息。工作人员可以在10分钟内完成轮班报告。
信息交换是微系统内连接工作人员与患者、工作人员与工作人员；微系统与微系统；以及微系统与宏观组织的接口。
