"Taking patients as the center does not mean that doctors and nurses run around patients all day, but make full use of information platforms and the Internet to make information run more and medical care run less." "Not only in the hospital, but also in the hospital, to achieve health support throughout the life cycle." On July 22nd, 2017, Fang Qi, vice president of the First Affiliated Hospital of Soochow University, delivered a keynote speech entitled "China Medical enters the era of patient-centered whole process optimization" at the 2017 Annual Meeting of Digital Medical Branch of China Medical Equipment Association and the academic exchange meeting of "Internet and New Medical Care".
Fang Qi, Vice President of the First Affiliated Hospital of Soochow University
At the meeting, Fang Qi introduced the efforts and achievements of the First Affiliated Hospital of Suzhou University to optimize the information process and transform the patient-centered whole process management.
Practice: Take the advanced stroke center as the hub to realize the coordinated prevention and treatment of stroke area.
Establishment of Suzhou Stroke Center
According to statistics, the incidence of stroke in Suzhou in 2016 was 5.32‰, and stroke became the second leading cause of death in Suzhou.
In order to improve the efficiency of stroke treatment and protect the health of citizens, in April 2016, Suzhou Stroke Center was established with the Advanced Stroke Center of the First Affiliated Hospital of Suzhou University as the main body. As the leader of regional stroke prevention and treatment, the Advanced Stroke Center of the First Affiliated Hospital of Suzhou University is responsible for conducting strict and standardized training for other hospitals to ensure the homogenization of medical care and realize the joint treatment of single stroke and multiple hospitals.
Nowadays, the demonstration effect of the road to the construction of the advanced stroke center in the First Affiliated Hospital of Su Da has opened the "Su Fu Yi Model" for the construction of the national stroke center, and it has also become one of the stroke center construction models recommended by the Brain Prevention Committee of the National Health and Family Planning Commission.
Release the map of acute stroke in Suzhou
In April this year, "Suzhou Acute Stroke Map", which was jointly promoted by Suzhou Municipal Health Planning Commission and the First Affiliated Hospital of Suda University, was released for the first time. The first batch of stroke maps gathered 10 hospitals. After expansion, there are now 15 hospitals connected to the network, realizing the coordinated prevention and treatment of stroke areas.
There are two principles in the selection of map hospitals. First, the hospital’s treatment ability. All map hospitals can provide accurate and efficient treatment by thrombolysis and embolectomy. Second, the regional distribution corresponds to the population density. Fang Qi introduced that the stroke map has the function of round-trip intelligent navigation, and patients can be sent to the nearest hospital for treatment as soon as possible after onset. If this hospital can’t solve it, it can be sent to an advanced center for precise treatment of patients.
Intelligent docking of pre-hospital emergency system and hospital system
On-site navigation: the 120 ambulance loaded with navigation function rushed to the scene of the disease in the shortest time;
Smart hospital selection: Suzhou "stroke map" provides accurate navigation for pre-hospital emergency hospital selection, and is pre-checked and evaluated by doctors and cars;
On-the-way evaluation: before the patient arrives at the hospital, the on-site rescue and on-the-way monitoring inspection, preliminary pre-scoring, triage, pre-registration and real-time uploading will be implemented;
Greenway moving forward: the emergency green channel arrives at the pre-hospital first aid in advance, and the pre-hospital first aid system is seamlessly connected with the hospital information system.
Fang Qi said that when the patient came to the hospital, doctors often didn’t know the patient’s status, and they couldn’t figure out which hospital to send to, so they couldn’t dock. Now, through on-site navigation, intelligent hospital selection, and some scale evaluation and judgment on the ambulance, these information can be received by the emergency department in the hospital, which can let the emergency personnel arrive in advance, provide the most accurate diagnosis and treatment, and realize seamless docking between the hospital and the hospital.
Transformation of intelligent ambulance
According to Fang Qi, at present, the main equipment and information systems equipped on the ambulance of Suzhou Hospital include ECG monitor, automatic defibrillator, electrocardiograph, vehicle-mounted information integrated terminal, and intelligent navigation system for stroke. This year, there are 20 ambulances in the hospital, and all the related instruments for monitoring and diagnosis should be equipped on the ambulances to ensure that the information on the ambulances can be transmitted to the emergency room of the hospital in time. In addition, it is necessary to make the ambulance personnel know the resources of the map hospital at a glance, which is convenient for "smart hospital selection".
"With the upgrade of the ambulance system, it will be possible to rescue on the way. In the future, ambulances will be equipped with high-end testing equipment such as CT (pending application) and magnetic resonance to realize thrombolysis and blood vessel opening in ambulances. " Fang Qi said.
Helicopter air rescue
In addition to ambulance rescue, the first affiliated hospital of Suda University also carried out helicopter air rescue. Because the air rescue route is not affected by the ground traffic, flying directly to the point can expand the radius of first aid and make the treatment more efficient.
Intelligent First Aid for Stroke with Green Channel as the Core —— Multidisciplinary Cooperation
Fang Qi said that the time node of stroke rescue is very important. Each node has the task of each node, and then it is seamlessly connected, including the handover of doctors and nurses, and the handover of teams. Before the patient is admitted to the hospital, it is necessary to rely on the information transmitted by the ambulance and the remote access system through the mobile APP to prepare for treatment, including which disciplines are needed to participate in the treatment, so as to open a green channel for intelligent first aid for patients.
Carry out community screening and follow-up management of stroke.
Patient-centered whole process management, in addition to pre-hospital first aid, in-hospital first aid and other links, there are two important links-early identification and post-hospital follow-up Fang Qi believes that no matter how well the first-aid green channel is built and how well the technology is mastered, if the patient doesn’t know that he is ill, he can’t identify it early, or he will be delayed in timely treatment. To this end, the First Affiliated Hospital of Suda University actively carried out activities such as "Multidisciplinary Stroke Theme Education and Free Clinic Activities" and "Love" Red Vest "to make the concept of early prevention and treatment of stroke go deep into the people" to do a good job in screening before onset.
In addition, the First Affiliated Hospital of Suda University has also established a stroke follow-up management system, which realizes two-way referral, graded diagnosis and treatment, and follow-up information sharing with primary medical units, and provides continuous treatment and health management services for patients, dynamically tracking the health status of discharged patients and preventing stroke recurrence.
Building a regional stroke cloud database
Under the guidance and technical support of NCPC-China Stroke Data Center and Suzhou Municipal Government, the First Affiliated Hospital of Suda University is building a China-Suzhou Stroke Sub-center to promote the nationwide networking of stroke cloud database, realize the localization and sharing linkage of database resources, and help more stroke patients get timely treatment.
Results: The time from onset to treatment was effectively shortened.
In the speech, Fang Qi introduced the golden rule of stroke first aid: intravenous thrombolysis within 4.5 hours and arterial thrombolysis/embolectomy within 6 hours. Nowadays, by relying on information construction to build the whole process management of stroke, the time for rescue and retrieval of tethers in Suzhou Stroke Center is getting shorter and shorter, and it takes 20 minutes to dissolve tethers. In the future, the rescue system of Suzhou Stroke Center will complete the thrombolytic treatment from onset to hospital, and it will be completed within one hour at the earliest.
Fang Qi said that the era of patient-centered, information-based, and health-oriented whole-process optimized medical care has arrived. How to provide patients with optimized whole-process health services based on information construction is the top priority of current work, and further efforts are needed.
(Original title: Case sharing of patient-centered whole-process medical service in the First Affiliated Hospital of Su Da)