Budkin A, Larsen P B, Hunt D, Ally J
J Med Syst. 1979;3(3-4):133-42. doi: 10.1007/BF02225108.
The surgeon (or one of his assistants) enters, in a computer file, information on open-heart surgical procedures though a remote terminal located in the recovery room. Clinical and historical findings, complications occurring during the immediate postoperative period, and postmortem data when applicable are entered in the course of the hospital stay or after discharge. Relevant information entering the computer system in other hospital departments is automatically incorporated in the open-heart surgery file. A final multicopy operative report is printed in the recovery room shortly after the surgical procedure is completed. All information on patients in the file constitutes a permanent and dynamic data base that is accessible at any time from any remote terminal in the hospital computer system. This data base contains an average of 500 items of information per surgical procedure and is available via an on-line retrieval program for both quality control purposes and extrapolation of prognostic data on new patients.
外科医生(或其助手之一)通过位于恢复室的远程终端,在计算机文件中录入心脏直视手术程序的信息。临床和病史检查结果、术后即刻出现的并发症以及适用时的尸检数据,在住院期间或出院后录入。其他医院科室输入计算机系统的相关信息会自动并入心脏直视手术文件。手术程序完成后不久,在恢复室打印出最终的多份手术报告。文件中所有患者的信息构成一个永久且动态的数据库,可从医院计算机系统的任何远程终端随时访问。该数据库每个手术程序平均包含500项信息,可通过在线检索程序获取,用于质量控制以及推断新患者的预后数据。