研究背景：加護病房（intensive care unit, ICU）執行多職類成員查房（multi-disciplinary rounds, MDRs），可提供重症病人為中心的照護計畫，進而改善照護品質。然過去研究顯示重症病人每天都有1200筆以上資訊輸出，龐大的資訊導致團隊成員資訊負荷過大，容易造成醫療不良的事件發生。另外，ICU環境中的噪音及干擾，更是顯著阻礙多職類成員進行溝通決策。近期文獻建議運用精實管理（Lean management）再次改造MDRs工作流程，並輔以智慧醫療，期待同時增進MDRs效率與減少資訊負荷，以提升MDRs成效。
研究目的：以精實管理設計i-MDRs（i-Dashboard + MDRs），並於外科ICU測試其成效。
研究方法：採群集隨機試驗研究設計。於南部某醫學中心兩區外科加護病房，實驗組i-MDRs為標準化MDRs加上i-Dashboard，對照組為標準化MDRs。研究於兩區同時進行，兩週為一個區間後，進行兩組交替，直到完成六個區間。研究對象納入常規參與加護病房每週三次MDRs之多職類成員，排除條件為研究過程中離職者。研究資料收集，包含: MDRs前主要照顧者資料蒐集的時間、呈報病人資訊的完整性、三師（藥劑師、呼吸治療師及營養師）有效建議的次數及多職類成員滿意度。以描述性統計分析病人基本特性與嚴重程度、多職類成員基本資料、主要照顧者資料蒐集的時間、病人資料呈報完整性、三師有效建議次數及滿意度。最後，以推論性統計分析測試兩組於MDRs主要照顧者資料蒐集時間、完整性、三師有效建議次數及滿意度是否有顯著差異。
研究結果：本研究於實驗組i-MDRs及對照組MDRs比較結果發現，每人次i-MDRs比MDRs可顯著減少主要照顧者資料蒐集時間為5.8分鐘（p < 0.001）、每人次i-MDRs比MDRs未完整呈報次數平均減少4.1次（p < 0 .001）、每人次i-MDRs比MDR三師提供有效建議平均多0.38次（p = 0.011）。多職類成員對i-MDRs於準確度及有效性滿意度總和高於MDRs平均4.01分（p < 0.001）、與i-MDRs於執行之滿意度高於MDRs平均2.22分 (P < 0.001)。
結論：本研究以精實管理為基礎，設計標準化MDRs搭配i-Dashboard輔助介入措施，可有效降低主要照顧者資料蒐集的時間、增加主要照顧者呈報病人資料完整性、增加三師有效建議次數及改善多職類成員對資訊系統及MDRs之滿意度。研究結果支持利用
i-Dashboard成為合宜的ICU MDRs溝通輔助工具，達到可視化管理的目的。建議未來研究可針對i-MDRs改造後服務的品質、數量或ICU相關照護品質成效指標等，進行追蹤研究。最後，建議i-Dashboard持續優化以大數據進行常模訓練，結合人工智慧優勢能更精簡且有效率呈現重要資訊，進而擴增i-MDRs效益。

Multidisciplinary rounds (MDRs) conducted in the Intensive Care Unit (ICU) may further formulate a patient centered care plan. However, previous studies show that each patient admitted to the ICU can export up to 1200 data per day; this excessive information leads to overload for clinicians which substantially decreased the effectiveness of MDRs. The purpose of this study was to design i-MDRs (i-Dashboard + MDRs) and further examine its effectiveness in the surgical intensive care unit (SICU). The cluster randomized trial was adopted in two SICUs at a medical center in southern Taiwan. Data collection included: duration of primary caregiver pre-rounding data gathering, accuracy of the primary care nurse practitioner's oral case presentation, recommendations and satisfaction from multidisciplinary providers (respiratory therapist, pharmacist and dietitian). The results of this study showed that i-MDR group significantly decreased 5.8 minutes of primary caregiver pre-rounding data gathering, decreased 4.1 times of inaccuracy of the primary care nurse practitioner's oral case presentation, and increased 0.38 times recommendations from multidisciplinary providers than MDR group. Regarding user feedback, questionnaire survey revealed that i-MDRs group significantly increaseed satisfaction in association with efficiency and accuracy and workflow, when compared to MDRs group. This study provides substantial evidence that i-MDRs can effectively decreases duration of primary caregiver pre-rounding data gathering duration, enhance accuracy of the primary care nurse practitioner's oral case presentation, improve recommendations and satisfaction from healthcare providers.

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