Standardized languages and notations for graphical modelling of patient care processes: a systematic review

Mincarone, Pierpaolo; Leo, Carlo Giacomo; Trujillo‐Martín, María M.; Manson, Jan; Guarino, Roberto; Ponzini, Giuseppe; Sabina, Saverio

doi:10.1093/intqhc/mzx197

Cited by 19 publications

(19 citation statements)

References 27 publications

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“…The standardized description of the OHCA care process (figure 1) in business process model and notation (BPMN) [35] makes it possible to highlight the three successive decision points of the pre-hospital phase in Geneva. The second decision point (decision to attempt ALS) is very important because in general, the proportion of survivors at discharge (or at 30 days) are measured against this decision point, so the better the selection of patients for whom ALS is performed, the better the final survival rate.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Payot¹,

Fehlmann²,

Suppan³

et al. 2021

Preprint

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The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Payot¹,

Fehlmann²,

Suppan³

et al. 2021

Preprint

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“…Also, the modeling language and tool need to be selected [12]. The systematic literature review of standard languages and notations for the graphical modeling of patient care processes conducted by Mincarone et al [22] showed, that the Business Process Model and Notation (BPMN) as well as the Unified Modeling Language (UML), especially its activity and use case diagrams, are well known and used approaches in health care practice. Domain-specific modeling language extensions such as BPMN4CP, a BPMN extension for care pathway modeling [23], could be used as well.…”

Section: Procedural Modelmentioning

confidence: 99%

Patient Pathways for Comprehensive Care Networks - A Development Method and Lessons from its Application in Oncology Care

Richter¹,

Schlieter²

2021

Proceedings of the Annual Hawaii International Conference on System Sciences

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Patient pathways are recognized as a valuable tool to support standardization, comparability, quality, and transparency of care processes in comprehensive care networks. Still, existing development approaches lack real practical guidance as well as an integration of the network and patient perspectives. Therefore, a usercentered and requirements-based approach was chosen to design a patient pathway development method. It defines a role model and procedural steps. The method's innovative character lies in the development of generic patient pathway templates to be adapted to national, regional, and local conditions of specific comprehensive care networks. The method was positively assessed in terms of demonstrating its applicability and the fulfilment of user requirements with a use case from oncology care -the development of a colorectal cancer patient pathway template. This work drives the standardization of patient pathway development and their large-scale implementation in comprehensive care networks, supporting the analysis, design, and optimization of healthcare processes.

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“…Among the limitations of our study to be considered, the procedure chosen may not be one that most benefits from the use of alternatives to CTA, as a recent study by Yates et al [42] shows that the level of omissions made by experts when breaking down this procedure is less than 30%. On the other hand, even if BPMN has been applied to many surgical procedures [43], being considered intuitive, easy to understand and useful in different clinical contexts [13,14,44]; the fact that its use is advantageous for training purposes needs to be explicitly evaluated. A good approach to this is to develop a feasibility study, in order to make its comprehensibility for trainers and trainees explicit.…”

Section: Limitationsmentioning

confidence: 99%

Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes

Fuente

Fuentes

Muñoz-Gama

et al. 2020

IJERPH

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Proper teaching of the technical skills necessary to perform a medical procedure begins with its breakdown into its constituent steps. Currently available methodologies require substantial resources and their results may be biased. Therefore, it is difficult to generate the necessary breakdown capable of supporting a procedural curriculum. The aim of our work was to breakdown the steps required for ultrasound guided Central Venous Catheter (CVC) placement and represent this procedure graphically using the standard BPMN notation. Methods: We performed the first breakdown based on the activities defined in validated evaluation checklists, which were then graphically represented in BPMN. In order to establish clinical consensus, we used the Delphi method by conducting an online survey in which experts were asked to score the suitability of the proposed activities and eventually propose new activities. Results: Surveys were answered by 13 experts from three medical specialties and eight different institutions in two rounds. The final model included 28 activities proposed in the initial model and four new activities proposed by the experts; seven activities from the initial model were excluded. Conclusions: The proposed methodology proved to be simple and effective, generating a graphic representation to represent activities, decision points, and alternative paths. This approach is complementary to more classical representations for the development of a solid knowledge base that allows the standardization of medical procedures for teaching purposes.

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Standardized languages and notations for graphical modelling of patient care processes: a systematic review

Cited by 19 publications

References 27 publications

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Patient Pathways for Comprehensive Care Networks - A Development Method and Lessons from its Application in Oncology Care

Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes

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