應用整合性醫療資訊系統進行SARS院內監測－以南部某醫學中心為例

Using an Integrated Medical Information System for In-patient Surveillance of Severe Acute Respiratory Syndrome-The Experience at a Medical Center in Southern Taiwan

林宏榮(Hung-Lung Lin) ； 吳澤民(Che-Min Wu) ； 陳冠州(Guan-Zhou Chen) ； 劉德明(Der-Ming Liou) ； 陳郁慧(Yu-Hui Chen) ； 鄭高珍(Kuo-Chen Cheng) ； 張晉民(Chin-Ming Chang) ； 莊銀清(Yin-Ching Chuang)

《感染控制雜誌》 14卷3期 (2004/06) Pp. 150-160

https://doi.org/10.6526/ICJ.200406_14(3).0003

摘要

要控制SARS這種新興傳染疾病，必須有更快速的警報系統，打破傳統的監測系統與提供及時回應的報告系統，才能及早發現SARS病患，給予應有的隔離、及時預防院內感染。南部某醫學中心於今年國內SARS流行期間，經三階段逐步改良建立SARS整合性醫療資訊系統，以病患的發燒作為電腦登錄的基礎，用卽即時傳呼通知醫師與感染管制委員會，並進行後續的處理、線上報告與監測作業。自2003年5月27日至6月30日為止，某醫學中心共有29,114次之病患體溫登錄，其中4,911次為發燒（體溫大於38℃）之登錄，占16.87%，發燒病患個數共2,847人。在系統建構完成之第三階段6月20日至30日內共有病患發燒次數1,857次，其中290筆(12.17%)符合異常條件而必須進行發燒處置登錄。在290筆資料中，其中226筆(77.93%)為初次發燒或新發燒，44筆(15.17%)為三日內發燒，20筆(6.90%)為四日內發燒。第三階段因發燒登錄由系統進行強制傳呼共492次，37位病患因此接受SARS專任醫師會診。在第三階段處置結果於二十四小時內登錄之比率自初期之60%快速上升、最後達100%，平均為94.8%。所有接受發燒篩檢與處置之病患最後證實均未感染SARS，但已提供寶貴的經驗，可在SARS再來時應用此系統篩檢住院中疑似SARS病患，並可於單位內有二人以上發燒時，自動產生警示、偵測群突發之可能性。

關鍵字

SARS ； 整合性醫療資訊系統 ； 院內感染管制

並列摘要

To control a highly contagious emerging infectious disease, such as severe acute respiratory syndrome, an effective in-patient surveillance system would be very useful. During the SARS epidemic in Taiwan, we developed an integrated medical information system based on the electronic recording of fever cases by nurses and automatically paged physicians for subsequent management, and formed a daily surveillance report. During the period between May 27 and June 30, 2003, there were 29,114 in-patient electronic temperature records. Among them, there were 4,911 fever episodes (16.87%) in 2,847 patients. In the last stage of the epidemic between July 20 and July 30, there were 1,857 fever episodes. According to the protocol, unus-ual fever episodes included the first or new fever episode, relapsing fever episodes within 3 days and relapsing fever episodes within 4 days. The first fever episode was defined as the first episode of fever after admission. The new fever episode was defined as the patient has fever after being afebrile for 48 hours during hospitalization. Relapsing fever episodes within 3 days were defined as the patient has fever episodes in 2 days or more of 3 consecutive days. Relapsing fever episodes within 4 days were defined as the patient has fever episodes in 2 days or more of 4 consecutive days. Among them, 290 (12.17%) were considered ”unusual”. Among the 290 cases, 226 (77.93%) were classified as the ”first or new fever episode”; 44 (15.17%) as the ”relapsing fever episode within 3 days”; and 20 (6.90%) as the ”relapsing fever episode within 4 days”. Then based on the fever records, the system automatically paged physicians for 492 times, and the physicians consulted SARS-surveillance specialists for ”unusual fever episode” 37 times. The physicians were required to complete a surveillance report for the ”unusual fever episode” within 24 hours. The completion rate was. 60% initially and within 2 days increased to near 100%, averaging 94.8%. No patient turned out to have acquired SARS. Such a surveillance information system should be valuable in early control of the epidemic.

並列關鍵字

SARS ； integrated information system ； inpatient infection control