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Methods Inf Med 1980; 19(02): 93-98
DOI: 10.1055/s-0038-1635264
Original Article
Schattauer GmbH

A Hierarchical Modular Design for Treatment Protocols [*] [*] [*]

EIN HIERARCHISCHER MODULARER ENTWURF FÜR BEHANDLUNGSPROTOKOLLE
M. Ben-Bassat
1   From the Division of Critical Care Medicine and the Institute of Critical Care Medicine, University of Southern California School of Medicine, and the Center for the Critically III, Hollywood Presbyterian Medical Center, Los Angeles, California
,
R. W. Carlson
1   From the Division of Critical Care Medicine and the Institute of Critical Care Medicine, University of Southern California School of Medicine, and the Center for the Critically III, Hollywood Presbyterian Medical Center, Los Angeles, California
,
V. K. Puri
1   From the Division of Critical Care Medicine and the Institute of Critical Care Medicine, University of Southern California School of Medicine, and the Center for the Critically III, Hollywood Presbyterian Medical Center, Los Angeles, California
,
M. H. Weil
1   From the Division of Critical Care Medicine and the Institute of Critical Care Medicine, University of Southern California School of Medicine, and the Center for the Critically III, Hollywood Presbyterian Medical Center, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
15 February 2018 (online)

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We view a treatment protocol as a hierarchical structure of therapeutic modules. The lowest level of this structure consists of individual therapeutic actions. Combinations of individual actions define higher level modules, which we call routines. Routines are designed to manage limited clinical problems, such as the routine for fluid loading to correct hypovolemia. Combinations of routines and additional actions, together with comments, questions, or precautions organized in a branching logic, in turn, define the treatment protocol for a given disorder.

Adoption of this modular approach may facilitate the formulation of treatment protocols, since the physician is not required to prepare complex flow charts. This hierarchical approach also allows protocols to be updated and modified in a flexible manner. By use of such a standard format, individual components may be fitted together to create protocols for multiple disorders. The technique is suited for computer implementation. We believe that this hierarchical approach may facilitate standardization of patient care as well as aid in clinical teaching. A protocol for acute pancreatitis is used to illustrate this technique.

Wir betrachten ein Behandlungsprotokoll als hierarchische Struktur therapeutischer Moduln. Die niedrigste Stufe dieser Struktur besteht aus einzelnen therapeutischen Handlungen. Kombinationen einzelner Handlungen bestimmen Moduln auf höherer Ebene, die wir Routinen nennen. Routinen werden entworfen, um begrenzte klinische Probleme zu handhaben, wie z.B. die Routine für Flüssigkeitszufuhr, um eine Hypovolämie auszugleichen. Kombinationen von Routinen und zusätzlichen Handlungen, zusammen mit Kommentaren, Fragen oder Vorsorgemaßnahmen, in einer baumartigen logischen Struktur bestimmen das Behandlungsprotokoll bei einer gegebenen Störung.

Die Übernahme dieses modularen Ansatzes kann die Formulierung von Behandlungsprotokollen erleichtern, da der Arzt nicht gehalten ist, komplizierte Flußdiagramme vorzubereiten. Dieser hierarchische Ansatz ermöglicht es auch, die Protokolle auf flexible Weise auf dem laufenden zu halten und zu modifizieren. Durch die Benutzung eines solchen Standardformats können einzelne Komponenten zusammengesetzt werden, um Protokolle für mehrfache Störungen herzustellen. Die Technik ist für eine Implementierung auf dem Rechner geeignet. Wir glauben, daß dieser hierarchische Ansatz die Standardisierung der Patientenversorgung erleichtern und auch bei der klinischen Ausbildung nützlich sein kann. Ein Protokoll für akute Pankreatitis wird benutzt, um diese Technik zu illustrieren.

Key-Words:

Treatment Protocols - Decision-Making System - Modular Hierarchical Design

Schlüssel-Wörter:

Behandlungsprotokolle - Entscheidungssysteme - Modular-hierarchischer Ansatz

* This study was supported in part by the United States Public Health Service Research Grant GM-16462 from the National Institute of General Medical Sciences, ENG 77-24007 from the National Science Foundation, RO 1 HL 23015 from the National Heart, Lung, and Blood Institute, the National Aeronautics and Space Administration of Kennedy Space Center, and the Cardiopulmonary Laboratory Research Foundation.


** Published, in part, in the Proceedings of the 2nd Annual Symposium on Computer Applications in Medical Practice, Washington, DC November 5, 1978.


 

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