Construction of self-help shared platform for mechanical ventilator
Internet of Things is employed to carry out self-service sharing and borrowing of ventilator from four levels: equipment layer, perception layer, network layer, and application layer.
1. Equipment layer
Equipment layer mainly refers to the mechanical ventilator equipment used in the self-help shared mode. In this part, appropriate brand and model of mechanical ventilator is selected according to clinical usage habits and equipment characteristics. Two kinds of ventilator are chosen as shared ventilator, Servo-S of Maquet and Pb840 of Tyco, which are widely used in clinical practice and can be disinfected conveniently. The standard communication, transport protocol, and transport port of ventilator should be acquired from equipment company.
2. Perception layer
For the self-help mode of ventilator, the running status and position data of ventilator should be acquired in real time by perception layer. Tripartite data collector (“Intelligent collector” from Beijing HuiZeZhiXin Technology Co., Ltd) was chosen for real-time data collect from ventilator, and the location of the ventilator was acquired by the RFID (Radio Frequency Identification) or Bluetooth tag location.
3. Network layer
Network layer is the information channel for sharing data transmission, and it refers to the protocol of information transmission among different system levels. Network layer mainly includes four parts of network data transmission: (i) device data collector in the perception layer collects and transmits the information of device layer through device protocol by itself; (ii) device data collector in perception layer transmits collected data to the data receiving terminal through the LAN(Local Area Network) or WAN(Wide Area Network) protocols; (iii) data of devices receiving terminal transmit to the database according to the transmission protocols of Ethernet; (iv) data in the database will be transmitted to the application terminal of personal computers and mobile application Ethernet or mobile network transmission protocols.
4. Application layer
Application layer contains mobile application and personal application, which are used to carry out and supervise for the self-help process of ventilator.
Self-help ventilator shared allocation scheme
The mode of self-help shared ventilator allocation is based on the use condition of ventilator in clinical practice, mainly including equipment list and essential information, use efficiency, maintenance information, and running data of ventilator. Six specific schemes are developed, including basic security scheme, quality and control scheme for shared ventilator, guarantee of clinical operation, disinfection scheme for shared ventilator, cost estimation and performance incentive scheme, and health technology assessment scheme.
4.1 Basic security scheme
The goal of this scheme is to ensure the operability of the self-help shared process and the safety of equipment in the process. The scheme contains four contents: the setting-up of shared equipment pool, design of shared process and optimization, the development and optimization of shared software, and location management of shared equipment.
4.1.1 Setting-up shared equipment pool
Shared ventilators in the pool come from the idle equipment in clinical department. By analyzing running data collected by the data collector of the perception layer of the Internet of Things, we found that nearly half of the mechanical ventilators are idle in clinical departments, especially in ICU. We choose the commonly used ventilator in clinical. At first, 8 ventilators were selected and unified as a self-help shared ventilator into the shared pool. The difficulty to built shared pool is to consult with clinical units, so running data from Internet of Things system are very important to advice clinical units to incorporate idle equipment into shared pool.
4.1.2 Design of shared process and optimization
The process of the self-help shared ventilator is designed. We design the link of process with clinical units, hospital infection control office and application software developers. The process of sharing equipment should not be too complicated, and the characteristics of disinfection after using medical equipment should be taken into account. The optimization of the process is continuous to make the self-help process smooth.
4.1.3 Development of self-help application software
After the shared process is determined, self-help application software should be developed, which contains software in mobile application and personal computer application. In software development, backstage personnel information, equipment information, and the generation of shared reports should be considered. In this part, medical department and software developers should work closely to ensure the friendly operation interface of the software.
4.1.4 Location management of shared equipment
In the basic security scheme of the self-help ventilator shared allocation mode, it is important to against loss of the equipment after use. In this part, we guarantee the security of equipment by two ways: one is that the clinical stuff who participated in the process need background certification, and the other is the real-time location supervision and fixed-point borrowing and return of equipment in electronic fence. The medical stuff who participate in the self-help shared mode need to apply and provide the name, ID (identification) number and contact information to the administrative department.
For the real-time location management of the equipment, we provide two solutions: one is based on Bluetooth communication equipment location, and the other is based on RFID technology equipment location. Signal generators or RFID tags are installed on shared devices, and location information of the devices is received by data beacons or receivers installed between floors. Only when the shared devices enter the set electronic fence area, the borrowing and returning process can be started. The location management of equipment needs cooperation with clinical departments, information departments to smooth implementation
4.2. Quality and control scheme for shared ventilator
The implementation of this scheme is to ensure the stability of equipment performance parameters and improve the reliability of clinical operation of equipment, which contains four parts: routine quality control of shared equipment, three-level maintenance system of equipment, two-way traceability of maintenance, and online and offline training and learning. In this part, we need cooperate with medical management departments, clinical departments and equipment manufacturers to ensure the quality and safety of ventilators.
4.2.1 Routine quality control of shared equipment
Routine quality control of shared equipment is according to national ventilator measurement standards, The quality control of shared ventilator is carried out at least once annually, and parameters of ventilator are tested with VT900 flowmeter of fluke.
In daily maintenance, three-level maintenance system is formulated, and it includes three aspects: clinical use maintenance as the first level, bio-medical department maintenance as the second level, and manufacturer maintenance as the third level. The contents of the three-grade maintenance are different. Figure 3 shows the contents of three-grade maintenance.
The messages of equipment maintenance noticed by mobile application can ensure two-way traceability of equipment maintenance, keep on-line statistics of equipment failure and maintenance data, make preventive maintenance in advance, and ensure normal status of equipment.
4.2.3 Online and offline training
The manual and operation video of the ventilator can be acquired through the mobile application, and the needs of clinical stuff can feedback on App. Training videos, operation videos, brief manual, instructions and other related documents can also be uploaded to the App from clinical stuff.
4.3 Guarantee of clinical operation
The purpose of this scheme is to ensure the accuracy and safety of clinical ventilator operation in the process of clinical use. Although the ventilator selected in the shared pool is routine equipment, some medical stuff still don’t know how to set parameters according to the status of patients. In order to guarantee the clinical use of shared ventilator, the main contents of the scheme include: ICU doctor's guidance for the first use, training for operation skills of ventilator by manufacture, adding simple operation manual, and so on. In this part, the bio-medical department should be kept in communication with ICU departments and other clinical departments to ensure that the relevant technical support can be in place in time.
4.4 Disinfection scheme for shared ventilator
The purpose of this part is to ensure the effect of sharing ventilator disinfection and preventing nosocomial infection. The contents of this scheme include: establishing the disinfection guideline for shared ventilator, strengthening the training of equipment disinfection operation, supervising the use of App disinfection operation, and monitoring the disinfection effect of shared equipment. To complete scheme bio-medical departments, hospital infection control office, ICU and general clinical departments need to cooperate together to ensure the disinfection effects of shared equipment after use.
First, disinfection guidelines for shared ventilator were formulated, including the basis of the guideline, basic requirements of for cleaning and disinfection, parts disinfection requirements, stuff requirement, and the disinfection methods for shared ventilators after use. Second, based on the guidelines, special training should be carried out for medical stuff that participate in the process of shared ventilator to ensure the effectiveness of disinfection. In the mobile application the patients should be classified into infectious and noninfectious groups, which can be useful for disinfection. When returning the shared ventilator, the photos during the disinfection process must be upload to mobile application. Finally, the managers of hospital infection control office can regularly monitor the disinfection of shared equipment after use to ensure the disinfection effect of the shared ventilators.
4.5 Cost estimation and performance incentive scheme
This scheme is made to ensure the interest of departments that participate in the self-help shared process. The contents of the scheme include cost analysis of clinical ventilator use, and cost for hardware and software for the self-help shared ventilator process. To complete the scheme, hospital finance department, performance management department and clinical department should cooperate with each other.
First, the running costs for clinical use and cost allocation between clinical unit are carried out. Researchers preliminarily calculate per hour running cost of the ventilator through the activity-based costing method. After consulting with departments who take part in the process, running cost only contains the depreciation cost and maintenance cost of the units, and allocated to borrowing units as performance reward to the shared unit, which spares equipment into the shared pool.
4.6 Hospital based health technology assessment for shared allocation
The self-help shared mode is assessed with HB-HTA (hospital based health technology assessment) using real world data obtained from clinical pilot, and the aspect assessment includes technical characteristics of the self-help shared mode, the safety for clinical use, the effectiveness for clinical use, the economic assessment, and social effects assessment. The results of HB-HTA support the decision that self-help shared mode should be carried out in hospital.
4.6.1 Assessment for technical characteristics
The assessment for technical characteristics of self-help shared allocation mode compared the new equipment shared mode with traditional equipment allocation methods.
4.6.2 Assessment for safety of clinical use
In this part, the safety of clinical use is assessed from 3 aspect, the safety operation of ventilator for clinical use, the effect of disinfection of shared ventilator after use, the running reliability of shared ventilator.
4.6.3 Assessment for effectiveness of clinical use
The assessment for effectiveness is carried out from the guarantee of the hardware and software of the mode and the clinical use effectiveness.
4.6.4 Economic assessment for the self-help shared mode
The economic evaluation of the project is mainly carried out in two aspects: (1) the cost of the project implementation, and (2) the benefit of the project implementation.
4.6.5 Social effects assessment for the self-help shared mode
The self-help shared mode provides a new and effective solution for the allocation and use of emergency and life support medical equipment in emergency rescue, which may improves the success rate of emergency rescue, and the mode do not have ethical risk in clinical.
5. Data Analysis
The data of time and charges used to assess the economic performance of the project are acquired from the Internet of Things system and HIS, and they are objective to reflect the results of self-help ventilator sharing mode.