CN103476328B - Staged alarming method for patient monitor - Google Patents

Abstract

A kind of system (202), it uses staged alarm schemes to generate patient alarm.Described system (202) includes one or more processor (220), and described processor is programmed to: receive Physiological Score and/or physiologic parameter value；Described Physiological Score and/or described physiologic parameter value are compared with multiple alarm levels；Fall in response to Physiological Score and/or physiologic parameter value in the non-inhibited district of described alarm levels, send alarm；And after sending described alarm, the first suppression phase for described non-inhibited alarm levels is set.

Description

Staged alarming method for patient monitor

Technical field

The application relates generally to patient-monitoring.It specifically combines and reduces patient alarm application and will specifically join Examine minimizing patient alarm to be described.Make it should be appreciated, however, that the application is also applied particularly to other By situation, and necessarily it is limited to aforementioned applications.

Background technology

One period of abnormal vital signs phase is generally had before patient deterioration.So, clinicist generally uses Prognoses system assesses the probability of deterioration.Such system includes abnormal marking system, such as in early days Early warning scoring (EWS) and the EWS(MEWS revised) marking system.Abnormal marking system is by right The assessment of multiple physiological parameters of such as vital sign unitizes unified cellular system, and merges Individual assessment, to determine patient risk, it can cause preventible adverse events, such as sudden cardiac arrest Or it is dead.

For sample EWS marking system (Fig. 1), based on several vital signs, form is used to determine EWS.When vital sign is normal, being assessed as scoring is zero.Along with each vital sign Abnormality degree increases, and assesses more point for described vital sign.The overall score of all vital signs is The index of abnormality degree, and if its exceed the threshold value of preliminary election, then define follow-up action and (such as, face The consultation of doctors of bed doctor or the startup of so-called quick response teams).

Clinicist usually manually performs abnormal marking system.But, a manually challenge of scoring It is, the resource-constrained of the medical institutions of such as hospital.Therefore, it not to assess the most continually such as to exist Patient in public ward, the most every 4 to 8 hours once.In this Critical Care environment, Patient may be not noticed to deteriorating.To evening of this deterioration have found that it is likely that cause unnecessary complication, Move in intensive care unit (ICU), sudden cardiac arrest, death, etc..

In order to alleviate this point, the automatic monitoring to patient just becomes increasingly prevalent.But, automatically The significant challenge monitored is that alarm is tired.Alarm fatigue is such situation: owing to high probability is the most real The alarm of border clinical meaning, and make clinicist that clinical alert to become the situation of numbness.

The method reducing alarm burden is an up alert threshold, the most in a manual manner.But, Identical other nurses in shifts and the most in shifts are likely not to have and notice high threshold value, and by patient Illusion in good health is confused.Additionally, it reduce sensitivity and add and can not detect patient The probability deteriorated.Another method is to send, in alarm, the suppression phase that arranges afterwards, thus at satisfied weight Similar alarm is no longer sent before putting condition.In such method, described replacement condition is for subtracting Few alarm it is critical that.

Typical replacement condition is through the predetermined suppression phase from alarm trigger.This be based on the insight that Any alarm after first alarm is all based on the physiological data being similar to, and therefore not to Clinicist provides any extraneous information.If described clinicist agrees to described alarm, he or Plan takes action to dispose described patient, or he suspects the effectiveness of described alarm.At any one In situation, another alarm will be all unnecessary.Therefore, the time that further alarm is limited is suppressed Section is rational.

If the one of this replacement condition disadvantageously, the situation of patient became within the described alarm suppression phase Difference, does not haves extra alarm yet.Another shortcoming is that the predetermined amount of time is for typically PATIENT POPULATION is general.So, the predetermined amount of time is not for any specific patient customization. Additionally, the predetermined amount of time does not adapts to the dynamic of individuality.

Other challenges of automatic monitoring system come from the prediction mould typically used by automatic monitoring system Type.This forecast model is typically training on the population data of large database concept, takes this to use this The decision-making planting forecast model is general features based on big colony.Additionally, usually not in view of individuality And the difference between general training colony.Training in this way may cause unnecessary prompting and/or The patient being different from those general training colonies for some physiology specification fails to generate prompting.

A solution is healthy knowledge based on patient, or baseline, physiology are dynamic, regulate Forecast model.But, base-line data is the most unavailable, especially in ICU, at ICU In " normally " physiological function of data reflection patient that must not assume just to collect.

Another kind of solution uses the effective of the relevant issue alarm for study from clinicist Property directly feedback.But, such method for not possessing the system of this direct feedback learning, It is impossible.Additionally, if in response to the predicted events of the most several hours, and issue alarm, Then the immediate feedback from the effectiveness of the relevant alarm of clinicist is nonsensical.

The application provides and overcomes the method that is new and that improve of the problems referred to above and other problems and be System.

Summary of the invention

According to an aspect, it is provided that a kind of system using staged alarm schemes to generate patient alarm. Described system includes that one or more processor, described processor are programmed to: receive Physiological Score and/ Or physiologic parameter value；Described Physiological Score and/or described physiologic parameter value are carried out with multiple alarm levels Relatively；The non-inhibited alarm in described alarm levels is fallen in response to Physiological Score and/or physiologic parameter value Level, sends alarm；And after sending described alarm, set for described non-inhibited alarm water The first flat suppression phase.

According on the other hand, it is provided that a kind of method using staged alarm schemes to generate patient alarm. Receive Physiological Score and/or physiologic parameter value.By described Physiological Score and/or physiologic parameter value and multiple polices Report level compares.In response to Physiological Score and/or physiological parameter fall in described alarm levels non- Suppression alarm levels, sends alarm.Non-press down additionally, set after sending described alarm for described The first suppression phase of alarm levels processed.

According on the other hand, it is provided that the system of a kind of alarm levels for resetting suppression.Described system Including being programmed to receive Physiological Score and/or one or more processors of physiologic parameter value.By described Physiological Score and/or described physiologic parameter value compare with multiple alarm levels.In response to Physiological Score And/or physiologic parameter value falls into the non-inhibited alarm levels in described alarm levels, send alarm.Set For the suppression phase of non-inhibited alarm levels, and in response to setting described suppression phase, described system etc. The time of scheduled amount.Determine and whether give intervening measure during the predetermined amount of time.Ring Intervening measure and current physiology scoring and/or physiologic parameter value should be not given to compared to described in determining Physiological Score and/or physiologic parameter value have been deteriorated scheduled volume, reset the alarm levels of described suppression.

One advantage is, sensitive to the increase of patients with abnormal situation while reducing alarm burden Degree.

Another advantage is the sensitivity to absolute threshold.

Another advantage is low alarm burden.

Another advantage is the sensitivity to patient deterioration.

Another advantage is single physiological parameter and the suitability of multiple physiological parameter.

Another advantage is the parameter directly perceived that can directly adjust.

Another advantage is that the change of the bedside to alert threshold is minimized.

Another advantage is to regulate and has atypical situation for average population adapting to patient Situation.

Those of ordinary skill in the art are when reading and understanding described in detail below, it will be recognized that the present invention Further advantages.

Accompanying drawing explanation

The present invention can take the arrangement of various parts and the layout of parts and various step and step Form.Accompanying drawing is merely for the purpose of diagram preferred embodiment, and is not necessarily to be construed as limiting this Bright.

The form of Fig. 1 illustrates EWS marking system.

The graphical representations of Fig. 2 each side according to the disclosure use the measurement for vital sign Result generates the method for patient alarm.

It is alert that the abnormal scoring of use of the graphical representations of Fig. 3 each side according to the disclosure generates patient The method of report.

Fig. 4 is the block diagram of the method generating patient alarm of each side according to the disclosure.

Discrete and the EWS marking system of piece-wise linearization of the graphical representations of Fig. 5.

Signed EWS marking system figure (the discrete and piece-wise linearization of the graphical representations of Fig. 6 ).

The graphical representations of Fig. 7 suppresses the phase for difference, the police of alert threshold and every patient every day Sample relation between report number of times.

Sample between the changing relative to the alarm of every patient every day of the graphical representations of Fig. 8 EWS This relation.

The alarm of the graphical representations of Fig. 9 every patient every day from for different Δ EWS alarm it Between time between the figure of sample relation.

Figure 10 is that the figure of the unstable status of patient of diagram is described.

Figure 11 is the graphical representation of the method for the unstable status of patient of detection.

The alarm number of times of the width of the graphical representations of Figure 12 inhibition zone (ε) and every patient every day Between the figure of sample relation.

Figure 13 is the unstable status of patient of Figure 10 graphical representation in EWS-space.

The vital sign of the graphical representations of Figure 14 sample patient from the highest to the lowest change.

Every patient's alarm hourly number of times of the graphical representations of Figure 15 and in one day hour between Relation.

Figure 16 is the block diagram of the method for the replacement alarm levels of each side according to the disclosure.

Figure 17 is the graphical representation resetting alarm levels.

Figure 18 is the block diagram of the IT infrastructure of each side according to the disclosure.

Detailed description of the invention

Referring to figs. 2 and 3, it is provided that for the method using staged alarm schemes to generate patient alarm 100(sees Fig. 4) illustrative example.Suitably, patient monitor, such as wearable patient prison Visual organ, bedside patient's monitor and central patient's monitor, perform method 100.As the most detailed Discuss, by using staged alarm schemes to combine the long suppression phase, still sensitive to patient deterioration While create less alarm.Fig. 2 uses for single vital sign (such as, breathing rate) Vital sign measurement assess patient deterioration；And Fig. 3 use typically can be from vital sign Exception scoring (such as, EWS) calculated assesses patient deterioration.

Vital sign measurement includes the measurement result of such as following vital sign: heart rate, temperature, Blood oxygen saturation, level of consciousness, pain, voided volume etc..The exception of such as EWS and MEWS Vital sign measurement for multiple vital signs is merged into the mortality risk of assessment patient by scoring Scoring.Abnormal marking system provides nonlinear weight, to reach " same for each vital sign Serious " scale.In this aspect, the assessment of this scale is used to enter all vital signs of abnormal scoring, And they are added and, to obtain abnormal scoring.Typically, described life is assumed when calculating abnormal scoring Life sign is independent.But, some more abnormal than other of combination, thus exceptions of vital sign Scoring can also include the scoring of the combination for vital sign.In order to improve abnormal scoring to life entity The sensitivity levied, can give described vital sign bigger during the determination of described abnormal scoring Weight.Additionally or alternately, in order to improve sensitivity, can refine for described vital sign Scoring region.Expection can be commented for individual patient, internal medicine ward, medical institutions etc. customization is abnormal Subsystem.In certain embodiments, clinicist is by using described in user input device manual customization Abnormal marking system.In other embodiments, based on the patient from (such as) patient information system Information, customizes described abnormal marking system.

In two examples of Fig. 2 and Fig. 3, substantially at 12:30, cross initial threshold.At Fig. 2 In the case of, threshold value is to breathe for 28 times per minute, and in the case of Fig. 3, threshold value is EWS It is 2.When exceeding described initial threshold, sending alarm, long pressing down is applied in the alarm for same condition Phase processed, such as 8 hours, and improve described threshold value.Hereafter, in two examples, substantially 17: 00, cross second higher threshold value (that is, being worse off).In the case of Fig. 2, described threshold value Breathe for 30 times per minute, and in the case of Fig. 3, described threshold value be EWS be 3.Exceeding During described Second Threshold, another alarm of sounding, apply the long suppression phase for this new situation, such as 8 is little Time, and improve described threshold value.

With reference to Fig. 4, it is provided that for using the method 100 of staged alarm schemes generation patient alarm Block diagram.Receive Physiological Score and/or the physiologic parameter value of 102 one or more patients.Physiological Score It is according to physiology scoring, based at least one physiological parameter, to the physiological situation of patient (such as Hemodynamic stability or mortality risk) assessment.Physiological parameter is can to measure or observable trouble Person's feature.The example of Physiological Score includes abnormal scoring, and the example of physiological parameter includes life entity Levy.

Generally, via such as wired or wireless communication network, automatic from the sensor being associated with patient Receive Physiological Score and/or physiologic parameter value.But, in other embodiments, defeated via such as user Enter equipment and manually receive Physiological Score and/or physiologic parameter value from clinicist.Connect additionally, generally contiguous Receive described Physiological Score and/or physiologic parameter value.However, alternatively, can be in such as timer event (example Such as Periodic Timer), patient episode, manual trigger event (such as clinicist presses the button) etc. Deng event occur time receive described Physiological Score and/or physiologic parameter value.In certain embodiments, Ground connection receives described Physiological Score from described physiologic parameter value.In this respect, from described physiologic parameter value Automatically calculate described Physiological Score.Such as, calculate from vital sign measurement as discussed above EWS。

Abnormal marking system generally yields integer value.But, it is discrete that this may cause in abnormal scoring Jump, especially in the case of fluctuating around boundary value when vital sign.In order to alleviate this point, Abnormal marking system piece-wise linearization can be made.With reference to Fig. 5, it is illustrated that for breathing rate piece-wise linearization The example of EWS marking system.The described marking system of solid line instruction piece-wise linearization version, and empty Line indicates the described marking system of discrete version.In certain embodiments, linearization application is optimal intends Conjunction scheme, although it is also contemplated that other schemes.

Although additionally, the individual scoring distributing to vital sign in abnormal marking system be typically without Symbol, it is contemplated that can use signed scoring for the lowest and the highest vital sign Make a distinction between vital sign measurement.For example, it is possible to by respectively by positive sign ("+") with bear Number ("-") symbol increases to for Tai Gao and the scoring of the lowest individual life sign, carries out this Distinguish.With reference to Fig. 6, it is illustrated that for the example of the signed abnormal scoring of breathing rate.With in Fig. 5 Equally, the described marking system of solid line instruction piece-wise linearization version, and the institute of the dotted line discrete version of instruction Commentary subsystem.

When calculating Physiological Score, in fact it could happen that such situation, wherein receive described less than calculating The physiologic parameter value of all physiological parameters required for Physiological Score.Physiologic parameter value may be because of mistake Measurement result and/or observed result and lack, or may be due to measure and/or observe the poorest Different.Such as, the non-invasive blood pressure (NIBP) that the heart rate of measurement per minute was measured with every 30 minutes.To this A solution of situation is nearest by for each physiological parameter calculated needed for Physiological Score Physiologic parameter value storage 104 exists, such as in memorizer.In this respect, receiving for correspondence Before the Novel physiological parameter value of physiological parameter, use this physiologic parameter value.Other solutions are from it He is physiological parameter (such as, ECG and SpO₂Both of which can supply heart rate data) or physiological parameter Modeling composition calculates the information of disappearance.

Referring back to Fig. 4, Physiological Score and/or physiologic parameter value are compared with multiple alarm levels 106.Alarm levels can include one or more threshold value, scope, etc..Generally, by clinicist Determine and/or limited described alarm levels by the medical institutions (such as hospital) of using method 100.So And, in some embodiments it is possible to be dynamically generated 108 alarm levels.Expection can be individual suffering from Person, internal medicine ward, medical institutions etc. customize described alarm levels.In certain embodiments, clinical Doctor, by using user input device, manually customizes the parameter of physiology scoring, the most extremely The threshold value of marking system.In other embodiments, based on the trouble from (such as) patient information system Person's information, automatically customizes described physiology scoring.

Although need not specified scheme to select alarm levels, but described alarm levels should being selected as Making the sensitivity to patient deterioration maximized while, make alarm minimized.With reference to Fig. 7, it is provided that The alert threshold of EWS marking system and the average alarm number of times for patient every day different suppression phases every Between the example of relation.When selecting high alert threshold and/or long suppression phase, alarm number of times is low.Phase Instead, when selecting Low threshold, it is the sensitiveest that method 100 becomes the detection to abnormal vital signs.So And, combine with the long suppression phase, will occur without in the case of deteriorating further within the described suppression phase Alarm.

A kind of method dynamically generating 108 alarm levels is by Δ and the use of initial alarm levels. Such as, limit initial alarm levels and Δ as 0.5 for the threshold value that abnormal scoring is 3, the most initially warn Report will sound when 3.0, even and if still within the suppression phase of described alarm levels, another alarm will be Sound when 3.5.After another alarm occurs, set newly suppressing the phase for 3.5 levels, and locate Alarm levels in 4 will be next alarm levels triggered when patient deteriorates further.Can be to individual Body patient, internal medicine ward, medical institutions etc. customize described Δ.In certain embodiments, clinicist By using Δ described in user input device manual customization.In other embodiments, based on from such as suffering from The patient medical records of person's information system customizes described Δ.(such as, have relatively for more serious patient The patient of high abnormal scoring), relatively low Δ can be selected, to increase the sensitivity deteriorated.Described After the suppression phase, reduce described threshold value.

With reference to Fig. 8, it is to show between the Δ of EWS marking system and the alarm number of times of every patient every day The curve chart of example of relation.Important observation is that, by using Δ, method 100 is to patient Deteriorating further of situation is the sensitiveest, average alarm burden is had minimum negative effect simultaneously.Additionally, It is set to Δ the highest will seldom trigger new alarm, is set the least to be likely to result in short-term simultaneously Between the outburst of alarm in section.A kind of method is by marking and drawing the time difference between alarm, the conjunction of assessment Δ Reason value.With reference to Fig. 9, it is illustrated that for the example of this plotting of EWS marking system.Wherein, may be used Big peak during to see 480 minutes, it is the logic suppressing the phase of selected 480 minute (8 hours) Consequence.If selecting the value (0.5) of little Δ, then between alarm, the big peak of short time becomes visible, this It is to be caused by continuous print alarm quick during the ascendant trend of EWS.Based on to when different set The visually-perceptible of the event generated, rational Δ value is about 1-2.

Referring back to Fig. 4, fall in alarm levels 110 in response to Physiological Score and/or physiologic parameter value Non-inhibited alarm levels, generates alarm.Alarm suitably notifies that clinicist checks patient, and In some embodiment, check the severity of described alarm.Thereafter, for the alarm levels triggered, Set for 112 long suppression phases, the most several hours.In certain embodiments, the described suppression phase Also suppress the alarm of relatively low alarm levels.Do not miss alarm in order to ensure clinicist, the most only exist After described alarm obtains the confirmation of such as clinicist, set the suppression phase.The length of described suppression phase Can be variable between alarm levels.In certain embodiments, use and nurse's persistent period in shifts The suppression phase that (such as, 8 hours) are suitable.Advantageously, which ensure that for described in shifts period not , there is not alarm in the status of patient changed, again notify that the New nurse during next is in shifts is existing simultaneously Status of patient.In other embodiments, before next nurse is in shifts, the suppression phase is used.But, this Can have the disadvantage that to have a large amount of alarm to sound when each nurse starts in shifts.In other embodiments In, for higher abnormal scoring or vital sign measurement, use the shorter suppression phase.

In certain embodiments, in response to sending alarm 114, set the short suppression phase of all alarms.Change Yan Zhi, after sending alarm, sets the short suppression phase postponing all alarms.Suitably, this short presses down Phase processed is about a few minutes, such as 5-10 minute.Advantageously, this reduces alarm burden, and the most aobvious Write ground (if any) and jeopardize the health of patient, because the typical response thing of nurse in public ward Part is of about a few minutes.

Abnormal scoring has the following advantages, and it is the value being prone to exchange.Such as, ' it is 6 that patient x has EWS '.But, shortcoming is that it no longer discloses the contribution of individual life sign.This causes not examining Survey the risk of change in the composition of abnormal scoring, especially exist some vital signs start to improve with And during the deterioration of other vital signs.This is undesirably, because while vital sign has fluctuation, But assessment of scenario may be stable by constant exception scoring improperly.Therefore, implement at some In example, for the change in composition, evaluate the composition of 116 abnormal scorings, and change in response to composition Become 118, trigger alarm and suppression phase, as described above.

Figure 10 shows the composition of the exception scoring stemming from heart rate (HR) and breathing rate (RR) The example of the change in (EWS in this case).Grey area is the period of invalid data, and Cross (x) refers to alarm and will occur.Horizontal dotted line is to mark ' EWS point ' for different numerical value The border in region.Described EWS point big font indicates.Alarm for the first time occurs 23 because of HR: About 00, indicated by cross in both figures.But, described HR slightly improves, and breathes simultaneously Rate from somewhat high variation to the highest.Result is that EWS keeps constant.But, even so, still deposit In unstable situation, this makes new alarm reasonable.

Use the subgraph A to C in Figure 11 explain according to this example be used for evaluate 116(Fig. 4) group A kind of method of the exception scoring of the change become.From hereafter, the signed abnormal of Fig. 6 is marked It is particularly suited for here.Subgraph A to C shows based on (such as) breathing rate (RR) and heart rate (HR), Situation for two dimension abnormal mark (that is, EWS).The exception scoring that diagonal instruction is constant.This Outward, standout square areas 119 expression is set to generate the minimum alarm levels of alarm (at this model Example is chosen as the level of 2).

With reference to subgraph A, point 120 instruction marks 0.5 point (i.e. for the measurement result of abnormal low breathing -0.5) with for 1.7 points (i.e.+1.7) of the highest abnormal HR.Thus, total abnormal scoring is 2.2. After sending alarm, automatically select higher alarm levels, by square frame 122 prominent in subgraph B Indicated.This example assumes that Δ is 1.0.Prominent rectangular area 124(in subgraph C also referred to as suppression District) indicate extra boundary, it is set to the change that may not to be noted form preventing from mentioning before Problem.The scoring vector 126(of the upper alarm occurred i.e., the alarm of subgraph A) formed prominent The axle of rectangular area 124.If currently scoring vector 128 is offset to this region exterior, then new alarm To sound, even when next absolute system level (being 3.0 in this example) not yet occurs.Right The detection of this deviation is by checking the scoring vector 126 of current scoring vector 128 and previous alarm continuously Between vector distance complete.If this distance is more than predetermined, the level that such as user sets, alert Report will sound, and redefine prominent rectangular area 124.This calculating to described distance can use Normal vector algebraically completes.The method is being extended in the case of more vital sign, this algebraically base Keep constant in basis.

With reference to Figure 12, it is shown that alarm number of times is as the example of the function of distance ε.For initial EWS Value be 3, the value of Δ is 1, and to suppress the value of phase be 480 minutes.If it can be seen that distance ε is the highest, method 100 by composition in change sensitive, and if distance ε the lowest, due to highlight The width of rectangular area 124 becomes analogous to the normal fluctuation in vector composition of marking, and alarm number of times will Increase.Based on Figure 12 and also visual inspection based on the alarm that some are generated, for prominent rectangle The reasonable value of the width in region 124 is about 1-4.

The example of Figure 10 is also plotted in ' EWS space ', as in fig. 13.Referred to by the point of interconnection Showing measurement result, wherein arrow 130 indicates the direction of time.Indicated by circle 132 in the figure Two alarms of Figure 10.Prominent rectangular area 134(have be 2 ε) be inhibition zone, similar In above-described prominent rectangular area 124.Change big in forming due to EWS, new alarm is sent out Raw.

Figure 14 showing, the exception being derived from heart rate (HR) and breathing rate (RR) is marked (in these feelings Condition is EWS) composition in another example of change.Grey area is the period of invalid data, and And cross (x) refers to the time that alarm will occur.Horizontal dotted line is for not for ' EWS point ' scoring Border with the region of numerical value.Described EWS point big font indicates.Alarm for the first time is because of abnormal low Breathing rate and occur about when 12:15, by cross instruction (scoring 3EWS point).At 17:15 Time about, absolute EWS still marks less than 3 points, but quickly increases owing to breathing, and situation is unstable 's.If not taking technical measures, the most do not send alarm, because: 1) previous alarm is less than 8 Before hour；2) for the EWS breathed still less than in the little value being scored constantly of 12:15；And 3) Vertical dimension φ to previous alarm vector is little.

Afore-mentioned is schematically depict in the subgraph D of Figure 11.Subgraph D shows based on example The situation of as abnormal in the two dimension of breathing rate (RR) and heart rate (HR) mark (that is, EWS).Diagonal angle The constant abnormal scoring of line instruction.Additionally, prominent square areas 136 represents is set to generate alarm Little alarm levels (in this example, be chosen as the level of 2), and indicated by the square frame 138 highlighted Higher alarm levels.Even also show the scoring vector 142 of the current previous alarm of vector 140 of marking.

Include that calculating work as according to this example for the method that the exception that composition changes is marked for evaluating Inner product between the scoring vector 142 of front scoring vector 140 and previous alarm.For inner product, < 0(revolves Turn more than 90 °), should close the suppression phase, thus allow to send alarm.

With reference to Figure 15, it is shown that derive from the low alarm burden of proposed method.Initial alarm levels is 3.0, Δ is 1.0 and suppresses the phase is 8 hours.This cause every patient this day the most generally The average alarm rate of 0.02 alarm.For 25 wards, this will be similar to police in the most every 2 hours Report.

Discussion hereinafter processes and is resetting alarm levels after the time of scheduled volume.Such as, life is worked as When reason scoring and/or physiologic parameter value fall in alarm levels, trigger alarm, and set predetermined length The suppression phase suppress identical alarm levels in order to avoid triggering more alarm, until the described suppression phase terminate. It is contemplated, however, that the additive method reset.With reference to Figure 16, it is provided that the adaptive approach 150 of replacement Block diagram.

Adaptive approach 150 supposes and the typical intervening measure taked in response to alarm by clinicist Familiarity.Such as, for hemodynamic stability, the typical case's intervention taked in response to alarm Measure includes fluid, vasopressor, the bestowing of Red Blood Cells Concentrate.Additionally, adaptive approach 150 Assuming that at least one clinical data of intervening measure that prescription is taked in response to alarm by clinicist Source.Such as, such source can be patient information system, and clinicist will via user input device The data of the intervening measure about being taked provide patient information system.Even, adaptive approach 150 It is also assumed that the alarm reflection patient sent by Physiological Score and/or physiologic parameter value is in terms of physiological situation Stability (such as hemodynamic stability or nutrient stabilizing).When foregoing teachings can obtain, permissible Adaptive approach 150 is used to be used for resetting.

When physiology scoring and/or the Physiological Score of physiological parameter and/or physiologic parameter value fall into non-pressing down During alarm levels processed, trigger alarm, and suppress described alarm levels.In response to suppressing described alarm Level, adaptive approach 150 waits the time of 152 scheduled volumes, such as three hours.Generally, institute State physiology scoring and/or physiological parameter is predictability, thus the alarm generated from it is able to suffering from Person triggers before deteriorating.The time in advance that the predetermined amount of time generally corresponding to this, and generally depend on Change in described Physiological Score and/or the physiological situation of physiologic parameter value.In the predetermined amount of time After passing by, make about the determination whether giving intervening measure during the predetermined amount of time 154, to solve described alarm based on the clinical data received.This can comment based on for described physiology Point and/or the described physiological situation of physiologic parameter value, intervene the practical situation occurred, or typical previously Intervening measure.

Without giving intervening measure, adaptive approach 150 waits 156, until physiology scoring And/or the current physiology scoring of physiological parameter and/or physiologic parameter value are compared to physiology during described alarm Scoring and/or physiologic parameter value have been deteriorated 156 threshold quantities.Described threshold quantity can be fixing or variable , such as arrive described physiology scoring and/or the previous Physiological Score of physiological parameter and/or physiological parameter Distance general of value.The scoring of the most described current physiology and/or physiologic parameter value are deteriorated, reset 158 Described alarm levels.By resetting in this way, clinicist after passing by the plenty of time The shortage intervened is construed to such instruction, i.e. when the time of first time alarm the situation of patient for This particular patient is acceptable, normal or stable.Therefore, though current physiology scoring and/ Or physiologic parameter value is abnormal for population norms, or instability, described adaptive approach It is normal for practising for this patient.

If giving intervening measure, this is considered as the confirmation of clinicist, and other alarm It is unnecessary.Adaptive approach 150 waits 160 until meeting at least one replacement condition.Reset Condition includes passing by regular time section, current physiology scoring and/or physiologic parameter value compared to described Described Physiological Score during alarm and/or physiologic parameter value have been deteriorated scheduled volume, the scoring of described current physiology And/or physiologic parameter value is deteriorated more than away from previous Physiological Score and/or physiologic parameter value (the most described alarm Time Physiological Score and/or physiologic parameter value) the half of distance, from described alarm, described physiology is commented Subsystem and/or the Physiological Score of physiological parameter and/or physiologic parameter value fall fixing threshold the most at least one times Value is following, described physiology scoring and/or the Physiological Score of physiological parameter and/or physiologic parameter value fall Below the threshold value determined by the current limits of described alarm levels, and based on the intervention applied Typical case change threshold value.Described replacement condition can individually use, or combination with one another uses.Once Intervention completes, and meets at least one replacement condition, then reset alarm levels described in 158.

In certain embodiments, described physiology scoring and/or physiological parameter are vital sign index (VIX).VIX is such physiology scoring, and its typical case is low by such as current physiology parameter value Delayed data, and the high latency data of the most such as laboratory test results, and/or such as population The statistical data of statistics is combined into single value, and described value reacts the stability of the physiological situation of patient, The hemodynamic state of such as patient, the stability of lung, nutrient stabilizing, etc..Can be continuous Ground and/or when event occurs calculating VIX value, described event such as timer event, user inputs thing Part, the availability of new data, etc..Additionally, in certain embodiments, preserve described VIX value and use In historical analysis.

By the value for predictor variable being provided the VIX generating VIX value based on described predictor variable Model, calculates the described VIX value of the stability for physiological status.Described predictor variable is life entity The feature relevant to the stability determining physiological situation (such as race) levied, extract from statistical data In etc. one or more.The described VIX value produced by model is typically probability.Such as, VIX Value typically 0 to 1 scope, wherein said value is closer to 1, and patient be likely more instability. Described VIX model can use any forecast model method, such as logistic regression, multinomial logistic regression, Linear regression and vector support machine study.

In certain embodiments, described VIX model includes returning for the logic of hemodynamic stability Return model, there is following form:

$\mathrm{VIX}=\frac{1}{1+{\mathrm{\&beta;}}^{-B^2}}$

Wherein,

Z=γ+β₁*SBP+β₂*SI+…

Described model considers SBP and SI, and it is for determining that hemodynamic stability camber is significantly predicted Variable, obtains the VIX between zero and.Described VIX is the highest, and described patient is the most unstable.? In some embodiments, β₁, the coefficient of SBP, is negative.Along with SBP becomes the lowest, VIX tends to Increase, reflect that described patient is just close to relatively unsure state.Additionally, β₂, the coefficient of SI is just. Along with SI becomes the highest, VIX also tends to increase, the reduction of reaction stability again.

With reference to Figure 17, it is illustrated that the VIX of patient and corresponding input, SBP and HR were at several hours Diagram in time-histories.Owing to the described VIX value of described patient crosses described prompting threshold value, 214.5 Little generate prompting constantly.During the time-histories of three hours after reminding for the first time, do not take to do In advance.This is construed as to imply that the kinetics the time patient reminded for the first time is for this particular patient It is normal, or acceptable.Therefore, after three hours pass by, because of the VIX of described patient Not than when reminding for the first time high too much, and do not generate prompting.But, reach 222.5 hours time Between, VIX dramatically increases, therefore sends another prompting for described patient.It should be noted that 226 Little clinicist has bestowed vasopressor and has really indicated constantly, and described patient experience is the most notable Hemodynamic instability sexual behavior part.

In certain embodiments, physiology scoring and/or physiological parameter are baseline VIX(bVIX). BVIX is which kind of behavior instruction VIX has showed on the time (such as three hours) of the scheduled volume in past Physiology scoring.Can make in many ways, assess the trend of a series of VIX value.Some sides Method is finer than additive method.In certain embodiments, in bVIX value is the time of scheduled volume in the past Maximum VIX value or 90 percentile VIX values.

In view of above, by under the background of the situation of patient when sending for the first time alarm, explain about The intervening measure implemented by attending clinician, or lack the clinical data of intervening measure, it is provided that one The method planting the sensitive replacement of individual physical difference to patient.Described method can be suitably used for creating Prediction warning system, it can learn when there is not the most clinical feedback and adapt to the dynamic of individuality.

With reference to Figure 18, block diagram illustrates the one of the IT infrastructure 200 of the medical institutions of such as hospital Individual embodiment.IT infrastructure 200 includes the one or more bedside via communication network 208 interconnection Or site inspection patient monitoring system 202, patient information system 204, one or more patient information are aobvious Show system 206, etc..Expection communication network 208 includes the Internet, LAN, wide area network, wireless Network, cable network, cellular network, data/address bus, etc. in one or more.

Patient monitoring system 202 receives the physiology for the patient's (not shown) looked after by medical institutions Scoring and/or physiologic parameter value.Generally, patient monitoring system 202 receives via one or more sensings Device 210 is collected automatically, and/or from IT infrastructure 200 miscellaneous part Physiological Score and/ Or physiologic parameter value, described sensor such as electrocardiogram (ECG) electrode, pressure transducer, SpO₂ Sensor, pulse transducer, thermometer, respiration pickup, exhaled gas sensor, non-invasive blood pressure (NBP) sensor etc., the described miscellaneous part such as laboratory equipment of IT infrastructure 200 or its His patient monitoring system.But, patient monitoring system 202 can be such as via user input device 212 Receive the Physiological Score by clinicist's manual collection and/or physiologic parameter value.In certain embodiments, When described Physiological Score and/or physiologic parameter value accept from user input device, it is possible to use display 214 facilitate such user to input.Typically continuously receive Physiological Score and/or physiologic parameter value, But alternatively can receive when the event of such as timer event occurs.

When patient monitoring system receives Physiological Score and/or physiologic parameter value, corresponding deterioration detection mould Block 216 is used for application process 100, is used for using staged alarm schemes to generate patient alarm, with inspection Survey patient deterioration.In certain embodiments, based on the patient information in patient information system 204, for Patient customizes Physiological Score.As long as deterioration being detected, described patient monitoring system is generated as alarm.? In some embodiment, via such as corresponding display, described alarm is generated as sound and/or vision Warning.In other embodiments, the notice of patient deterioration is provided to another parts of IT infrastructure, Such as in patient information display system 206 one.Additionally, in certain embodiments, be different from through Spending the time of scheduled volume, the method 150 of Figure 16 is used for resetting.

In order to carry out function mentioned above, patient monitoring system 202 suitably includes one or more Memorizer 218 and one or more processor 220.The usual usage paradigm of patient monitoring system includes patient Wearable patient monitor, bedside patient's monitor, site inspection patient monitor and central authorities suffer from Person's monitor.Memorizer 218 stores in the above-mentioned functions for performing described patient monitoring system Individual or multiple executable instructions, and be appropriately carried out deteriorating detection module 216.Processor 220 is held Row is stored in the executable instruction on memorizer 218, to carry out being associated with patient monitoring system 202 Function.When patient monitoring system 202 operation is communication on communication network 208, patient-monitoring System 202 also includes one or more communication unit 222, communication unit 222 be easy to processor 220 with Communication between communication network 208.

Patient information system 204, such as central record medical data base, generally acts as in patient information Centre information bank, it includes such as, electronic health record (EMR).Additionally or alternately, patient information system System 204 reception also stores the Physiological Score for patient, life in one or more memorizer 224 Reason parameter value and clinical data in one or more.Generally, physiologic parameter value and/or Physiological Score It is via such as communication network 208, receives from the parts of IT infrastructure 200, but described survey Amount result can be manually entered via one or more user input devices 212,216.For the latter, The user interface presented via display 228 can be so that this being manually entered.Patient information system 204 The parts also allowing for IT infrastructure 200 access the data of storage, such as pin via communication network 208 EMR and/or physiologic parameter value to patient.

In order to carry out function mentioned above, patient information system 204 suitably includes one or more Communication unit 230, memorizer 224, and one or more processor 232.Communication unit 230 is just Communication between processor 232 and communication network 208.Memorizer 224 storage is used for controlling to process The executable instruction of device 232, to perform or many in the above-mentioned functions of patient information system 204 Individual.Processor 232 runs and is stored in the executable instruction on memorizer 224.

Patient information display system 206 is on communication network 208, from the parts of IT infrastructure 200 Receive the Physiological Score for the patient looked after by medical institutions and/or physiologic parameter value.Extraly or standby Selection of land, patient information display system 206 receives the alarm for the patient looked after by medical institutions.Make By received data, patient information display system 206 updates the display 234 being associated, graphically Described data are presented to clinicist and/or generate alarm by mode.For the latter, it is contemplated that such as via The sound of display 234 and/or visual alarm.Additionally, in certain embodiments, patient information is used The user input device 236 of display system 206, with to the IT infrastructure 200 generating described alarm Parts confirm alarm.

In order to realize above-mentioned functions, patient information display system 206 suitably includes one or more logical Letter unit 238, one or more memorizer 240, and one or more processor 242.Communication unit The communication that unit 238 is easy between processor 242 and communication network 208.Memorizer 240 storage can be held Row instruction, described executable instruction is used for controlling processor 242 and performs patient information display system 206 Above-mentioned functions in one or more.Processor 242 runs and is stored in holding on memorizer 240 Row instruction.

Memorizer used herein include following in one or more: non-transitory computer-readable medium； Disk or other magnetic-based storage medias；CD or other optical storage mediums；Random access memory (RAM), read only memory (ROM) or other electronic storage devices or chip or operability interconnection The set of chip；The mutual of instruction can be stored from its retrieval via the Internet/intranet or LAN Networking/intranet servers；Etc..Additionally, processor used herein include following in one Or multiple: microprocessor, microcontroller, Graphics Processing Unit (GPU), special IC (ASIC), Field programmable gate array (FPGA) etc.；User input device include following in one or more: Mouse, keyboard, touch-screen display, one or more button, one or more switch, one or Multiple triggers etc.；And display include following in one or more: LCD display, LED Display, plasma display, the projection display, touch-screen display etc..

The present invention is described by reference to preferred embodiment.Other people are reading and are understanding above detailed It is contemplated that multiple change and change during description.Such as, although described method disclosed herein and be System is to use the general ward colony considered to make, and described alarm sublevel can be employed and other Health-care sets, such as ICU, first aid or domestic monitoring.The invention is intended to be interpreted as including institute There are such change and change, as long as they fall in the range of claims and equivalence thereof.

Claims (19)

1. one kind is used for the system (200) using staged alarm schemes to generate patient alarm, described system System (202) including:

One or more processors (220), it is programmed to:

Receive Physiological Score and/or physiologic parameter value, described Physiological Score and/or physiologic parameter value bag Include and use the forecast model of hemodynamic instability from the life sign measurement with low latency Result and the calculated vital sign of data comparing described vital sign measurement high latency Index (VIX) value；

Described Physiological Score and/or described physiologic parameter value are entered with multiple staged alarm levels Row compares；

The non-inhibited police of described alarm levels is fallen in response to Physiological Score and/or physiologic parameter value In report level, send alarm；Further,

After sending described alarm, set the first suppression for described non-inhibited alarm levels Phase；

Wherein, the suppression phase is such period: during the described suppression phase, and suppression is corresponding alert Report level is in order to avoid triggering alarm.

System the most according to claim 1 (200), wherein, receives Physiological Score and/or life Reason parameter value includes calculating described Physiological Score from physiologic parameter value.

3., according to the system (200) according to any one of claim 1 and 2, wherein, use exception Marking system calculates described Physiological Score, multiple based on to described physiologic parameter value of described abnormal scoring Vital sign measurement.

4. according to the system (200) according to any one of claim 1 and 2, wherein, in response to right The confirmation of described alarm, sets the described first suppression phase.

5. according to the system (200) according to any one of claim 1 and 2, wherein, described process Device (220) is also programmed to:

The plurality of staged alarm levels is generated from initial alarm levels and increment Delta, wherein, described Multiple staged alarm levels include described initial alarm levels and the highest one or many of severity Other in individual alarm levels, described alarm levels and described initial alarm levels and described alarm levels Alarm levels separates described increment Delta.

6. according to the system (200) according to any one of claim 1 and 2, wherein, described process Device (220) is also programmed to:

In response to sending alarm, whole the plurality of staged alarm levels set the second suppression phase, The described second suppression phase is shorter than the described first suppression phase.

7. according to the system (200) according to any one of claim 1 and 2, wherein, described process Device (220) is also programmed to:

The exception scoring changing the described Physiological Score of evaluation for composition；Further,

In response to the described change of the described composition of described abnormal scoring, send the second alarm；Further,

After sending described second alarm, set the suppression phase for described non-inhibited alarm levels.

8. according to the system (200) according to any one of claim 1 and 2, wherein, described process Device (220) is also programmed to:

It is satisfied in response at least one in multiple replacement conditions, resets described non-inhibited alarm water Flat, described replacement condition includes:

First resets condition, comprising:

Have passed through the time of scheduled volume；

It is not given to intervene during the predetermined amount of time；And

Current physiology scoring and/or physiologic parameter value are compared to described Physiological Score and/or life Reason parameter value has been deteriorated scheduled volume；And,

Second resets condition, comprising:

Have passed through the predetermined amount of time；

Intervention is given during the predetermined amount of time；And

Replacement condition is satisfied.

9. according to the system (200) according to any one of claim 1 and 2, also include following in At least one:

One or more sensors (210), it measures one or more life of described physiologic parameter value Sign；

One or more user input devices (212), it receives described physiologic parameter value and/or described life The value of reason scoring；And,

Communication network (208), it is in described system (200) and is connected to described communication network (208) Miscellaneous part (202,204,206) between exchange Physiological Score and/or physiologic parameter value；

Wherein, described Physiological Score and/or described physiologic parameter value are from described sensor (210), described At least one in user input device (212) and described communication network (208) receives.

10. one kind is used for the method (100) using staged alarm schemes to generate patient alarm, described Method (100) including:

Receive (102) Physiological Score and/or physiologic parameter value, described Physiological Score and/or physiological parameter Value includes that the forecast model using hemodynamic instability is from the vital sign measurement of low latency With the data calculated vital sign index comparing described vital sign measurement high latency (VIX) value；

Described Physiological Score and/or described physiologic parameter value are compared with multiple staged alarm levels Relatively (106)；And,

The non-inhibited alarm water of described alarm levels is fallen in response to Physiological Score and/or physiologic parameter value In flat, send (110) alarm；And,

After sending described alarm, set (112) and press down for the first of described non-inhibited alarm levels Phase processed；

Wherein, the suppression phase is such period: during the described suppression phase, suppresses corresponding alarm water Flat in order to avoid triggering alarm.

11. methods according to claim 10 (100), wherein, receive (102) physiology and comment Divide and/or physiologic parameter value includes calculating described Physiological Score from described physiologic parameter value.

12., according to the method (100) according to any one of claim 10 and 11, also include:

For the change of composition, evaluate the exception scoring of (116) described Physiological Score；And,

In response to the change of the described composition of described abnormal scoring, send (188) second alarms；And,

After sending described second alarm, set (118) and press down for the described non-of described alarm levels The suppression phase in district processed.

13., according to the method (100) according to any one of claim 10 and 11, also include:

From initial alarm levels and increment Delta generation (108) the plurality of staged alarm levels, wherein, It is serious that the plurality of staged alarm levels includes that described initial alarm levels and having is gradually increased One or more alarm levels of degree, described alarm levels and described initial alarm levels and described alarm Other alarm levels in level separate one or more described increment Delta.

14., according to the method (100) according to any one of claim 10 and 11, also include:

It is satisfied in response at least one in multiple replacement conditions, resets described non-inhibited alarm water Flat, described replacement condition includes:

First resets condition, comprising:

Have passed through the time of scheduled volume；

It is not given to intervene during the predetermined amount of time；And,

Current physiology scoring and/or physiologic parameter value are joined compared to described Physiological Score and/or physiology Numerical value has been deteriorated scheduled volume；And,

Second resets condition, comprising:

Have passed through the predetermined amount of time；

Intervention is given during the predetermined amount of time；And,

Replacement condition is satisfied.

15. 1 kinds for the device using staged alarm schemes to generate patient alarm, described device bag Include:

For receiving the module of (102) Physiological Score and/or physiologic parameter value, described Physiological Score and/ Or physiologic parameter value includes that the forecast model using hemodynamic instability is from the life entity of low latency The calculated life entity of data levying measurement result and compare described vital sign measurement high latency Levy index (VIX) value；

For described Physiological Score and/or described physiologic parameter value are entered with multiple staged alarm levels Row compares the module of (106)；And,

For falling into the non-inhibited police of described alarm levels in response to Physiological Score and/or physiologic parameter value The module of (110) alarm is sent in report level；And,

For setting (112) after sending described alarm for the first of described non-inhibited alarm levels The module of suppression phase；

Wherein, the suppression phase is such period: during the described suppression phase, suppresses corresponding alarm water Flat in order to avoid triggering alarm.

16. devices according to claim 15, wherein, receive (102) Physiological Score and/or Physiologic parameter value includes calculating described Physiological Score from described physiologic parameter value.

17., according to the device according to any one of claim 15 and 16, also include:

Module for the exception scoring of change evaluation (116) the described Physiological Score for composition；With And,

For sending the mould of (188) second alarms in response to the change of the described composition of described abnormal scoring Block；And,

For setting (118) described non-for described alarm levels after sending described second alarm The module of the suppression phase of inhibition zone.

18., according to the device according to any one of claim 15 and 16, also include:

For generating (108) the plurality of staged alarm levels from initial alarm levels and increment Delta Module, wherein, the plurality of staged alarm levels include described initial alarm levels and have by One or more alarm levels of the cumulative severity added, described alarm levels and described initial alarm water Other alarm levels in gentle described alarm levels separate one or more described increment Delta.

19., according to the device according to any one of claim 15 and 16, also include:

For being satisfied the described non-inhibited alarm of replacement in response at least one in multiple replacement conditions The module of level, described replacement condition includes:

First resets condition, comprising:

Have passed through the time of scheduled volume；

It is not given to intervene during the predetermined amount of time；And,

Current physiology scoring and/or physiologic parameter value are joined compared to described Physiological Score and/or physiology Numerical value has been deteriorated scheduled volume；And,

Second resets condition, comprising:

Have passed through the predetermined amount of time；

Intervention is given during the predetermined amount of time；And,

Replacement condition is satisfied.