Development and application of dynamic scoring information system for critically ill patients

Abstract

Objective To develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947 (95%CI 0.930-0.964) , which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P<0.05) . After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002) . Conclusions The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability. Key words: Critical illness; Scoring system; Informatization; Clinical decision-making; Alarm