减少错误—增加临床试验的严谨性及临床实践的一致性（中英文）-.ppt

英文版 * Unnecessary variation and error exists in medical care Computer protocols help clinicians deliver consistent, evidence-based care with a reproducible method. * Guideline: “A systematic statement of policy rules or principles”- tells where to go, but not how to get there. Protocol: “Precise and detailed plans for ..a medical ..problem and/or.. therapy.” - tells how to get there. (An adequately explicit protocol has enough detail so different clinicians make the same patient-specific decision - it is a reproducible clinical decision method) * * 王皓在比赛中 马琳在比赛中 * Guideline “Win the point” Inadequately explicit protocol “Hit the left corner” Adequately explicit protocol “Wait for a high return and hit the ball hard with a left spin, curving to the opponent’s left, to land within 1 inch of the left corner of the table.” Goal: Blood Pressure140/90 mmHg with minimal or no adverse effects. If after 3 months, BP not at Goal, increase dose slowly. Guideline for Controlling High Blood Pressure what are minimal adverse effects? Is one episode of fainting a week minimal? what is slowly? Is it an increase daily, weekly, monthly, every 3 months? Inadequately explicit guideline example (不够明确) Reduce O2 by 10% from 90 to 80% Maintain Tidal Volume at 540ml Increase Rate from 22 to 25/minute Sample Arterial Blood at 15:40 hours Adequately Explicit recommendations for Mechanical Ventilation: A Repro- ducible Clinical-Decision Method Standardized Decisions ≠ Standardized Care * Each protocol recommendation produces at least one Standardized Decision from patient data. Each patient provides unique data. Patient Care =∑ (Standardized Decisions from unique patient data over time). The computer protocol is therefore adaptive (it responds to changes in the patient). 3 computer interface examples follow: Standardized Decisions ≠ Standardized Care * Mechanical Ventilation Protocol Computer Interface Example * IV Fluid / Hemodynamic Protocol Computer Interface Example 血糖/胰岛素