临床医生用于决策的时间：一项使用心血管风险评估和Ask Mayo专家算法护理流程模型的最佳案例工作流程研究。

Clinician time used for decision making: a best case workflow study using cardiovascular risk assessments and Ask Mayo Expert algorithmic care process models.

作者信息

North Frederick, Fox Samuel, Chaudhry Rajeev

机构信息

Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.

Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, USA.

出版信息

BMC Med Inform Decis Mak. 2016 Jul 20;16:96. doi: 10.1186/s12911-016-0334-z.

BACKGROUND

Risk calculation is increasingly used in lipid management, congestive heart failure, and atrial fibrillation. The risk scores are then used for decisions about statin use, anticoagulation, and implantable defibrillator use. Calculating risks for patients and making decisions based on these risks is often done at the point of care and is an additional time burden for clinicians that can be decreased by automating the tasks and using clinical decision-making support.

METHODS

Using Morae Recorder software, we timed 30 healthcare providers tasked with calculating the overall risk of cardiovascular events, sudden death in heart failure, and thrombotic event risk in atrial fibrillation. Risk calculators used were the American College of Cardiology Atherosclerotic Cardiovascular Disease risk calculator (AHA-ASCVD risk), Seattle Heart Failure Model (SHFM risk), and CHA2DS2VASc. We also timed the 30 providers using Ask Mayo Expert care process models for lipid management, heart failure management, and atrial fibrillation management based on the calculated risk scores. We used the Mayo Clinic primary care panel to estimate time for calculating an entire panel risk.

RESULTS

Mean provider times to complete the CHA2DS2VASc, AHA-ASCVD risk, and SHFM were 36, 45, and 171 s respectively. For decision making about atrial fibrillation, lipids, and heart failure, the mean times (including risk calculations) were 85, 110, and 347 s respectively.

CONCLUSION

Even under best case circumstances, providers take a significant amount of time to complete risk assessments. For a complete panel of patients this can lead to hours of time required to make decisions about prescribing statins, use of anticoagulation, and medications for heart failure. Informatics solutions are needed to capture data in the medical record and serve up automatically calculated risk assessments to physicians and other providers at the point of care.

背景

风险计算在血脂管理、充血性心力衰竭和心房颤动中越来越常用。然后，风险评分被用于他汀类药物使用、抗凝治疗和植入式除颤器使用的决策。为患者计算风险并基于这些风险做出决策通常在医疗现场进行，这给临床医生增加了额外的时间负担，而通过任务自动化和使用临床决策支持可以减少这一负担。

方法

我们使用Morae Recorder软件，对30名负责计算心血管事件总体风险、心力衰竭猝死风险和心房颤动血栓形成事件风险的医疗服务提供者进行计时。所使用的风险计算器包括美国心脏病学会动脉粥样硬化性心血管疾病风险计算器（AHA-ASCVD风险）、西雅图心力衰竭模型（SHFM风险）和CHA2DS2VASc。我们还对这30名提供者使用Ask Mayo Expert护理流程模型基于计算出的风险评分进行血脂管理、心力衰竭管理和心房颤动管理的情况进行了计时。我们使用梅奥诊所初级保健小组来估算计算整个小组风险所需的时间。