Pulmonary, Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Clin Monit Comput. 2012 Aug;26(4):305-17. doi: 10.1007/s10877-012-9356-y. Epub 2012 Apr 11.
Unnecessary variation in clinical care and clinical research reduces our ability to determine what healthcare interventions are effective. Reducing this unnecessary variation could lead to further healthcare quality improvement and more effective clinical research. We have developed and used electronic decision support tools (eProtocols) to reduce unnecessary variation. Our eProtocols have progressed from a locally developed mainframe computer application in one clinical site (LDS Hospital) to web-based applications available in multiple languages and used internationally. We use eProtocol-insulin as an example to illustrate this evolution. We initially developed eProtocol-insulin as a local quality improvement effort to manage stress hyperglycemia in the adult intensive care unit (ICU). We extended eProtocol-insulin use to translate our quality improvement results into usual clinical care at Intermountain Healthcare ICUs. We exported eProtocol-insulin to support research in other US and international institutions, and extended our work to the pediatric ICU. We iteratively refined eProtocol-insulin throughout these transitions, and incorporated new knowledge about managing stress hyperglycemia in the ICU. Based on our experience in the development and clinical use of eProtocols, we outline remaining challenges to eProtocol development, widespread distribution and use, and suggest a process for eProtocol development. Technical and regulatory issues, as well as standardization of protocol development, validation and maintenance, need to be addressed. Resolution of these issues should facilitate general use of eProtocols to improve patient care.
临床护理和临床研究中的不必要差异降低了我们确定医疗干预措施有效性的能力。减少这种不必要的差异可以进一步提高医疗质量并进行更有效的临床研究。我们已经开发并使用电子决策支持工具（e 方案）来减少不必要的差异。我们的 e 方案已经从一个临床地点（LDS 医院）的本地开发的大型机应用程序发展到了多种语言的基于网络的应用程序，并在国际上使用。我们以 e 方案-胰岛素为例来说明这种演变。我们最初开发 e 方案-胰岛素是为了进行本地质量改进工作，以管理成人重症监护病房（ICU）中的应激性高血糖。我们扩展了 e 方案-胰岛素的使用范围，将我们的质量改进结果转化为 Intermountain Healthcare ICU 的常规临床护理。我们将 e 方案-胰岛素出口到其他美国和国际机构，以支持研究，并将我们的工作扩展到儿科 ICU。在这些转变过程中，我们不断改进 e 方案-胰岛素，并纳入了 ICU 中应激性高血糖管理的新知识。基于我们在 e 方案的开发和临床使用方面的经验，我们概述了 e 方案开发、广泛分布和使用方面的遗留挑战，并提出了 e 方案开发的流程。需要解决技术和监管问题，以及方案开发、验证和维护的标准化问题。解决这些问题应有助于广泛使用 e 方案来改善患者护理。
