arXiv:2509.04497cs.CLcs.AI2025-09

用临床记录分析医生倦怠,准确率超80%

A Narrative-Driven Computational Framework for Clinician Burnout Surveillance

  • 融合临床文本情感与工作负荷指标的混合分析框架
  • 在1万份病历上实现F1达0.84,优于纯数据基线
  • 可识别放射科、精神科等高风险专科群体

临床医生倦怠严重威胁患者安全,尤其在高危重症监护室(ICU)。现有研究多依赖回顾性问卷或电子健康记录(EHR)元数据,常忽略临床笔记中的叙事信息。本研究分析来自MIMIC-IV数据库的10,000份ICU出院小结,该数据集源自贝斯以色列女执事医疗中心的电子病历,包含生命体征、医嘱、诊断、操作、治疗及去标识化自由文本临床笔记。我们提出一种混合管道:结合针对临床叙事微调的BioBERT情感嵌入、专为倦怠监测设计的词汇压力词典,以及五主题潜在狄利克雷分配(LDA)与工作负荷代理变量。基于个体医师的逻辑回归分类器在分层保留集上达到精确率0.80、召回率0.89、F1分数0.84,较仅使用元数据的基线提升至少0.17的F1分数。专科分析显示放射科、精神科和神经科医师存在更高的倦怠风险。结果表明,ICU临床文本中蕴含可用于主动心理健康监测的有效信号。

原文摘要 · Abstract (English)

Clinician burnout poses a substantial threat to patient safety, particularly in high-acuity intensive care units (ICUs). Existing research predominantly relies on retrospective survey tools or broad electronic health record (EHR) metadata, often overlooking the valuable narrative information embedded in clinical notes. In this study, we analyze 10,000 ICU discharge summaries from MIMIC-IV, a publicly available database derived from the electronic health records of Beth Israel Deaconess Medical Center. The dataset encompasses diverse patient data, including vital signs, medical orders, diagnoses, procedures, treatments, and deidentified free-text clinical notes. We introduce a hybrid pipeline that combines BioBERT sentiment embeddings fine-tuned for clinical narratives, a lexical stress lexicon tailored for clinician burnout surveillance, and five-topic latent Dirichlet allocation (LDA) with workload proxies. A provider-level logistic regression classifier achieves a precision of 0.80, a recall of 0.89, and an F1 score of 0.84 on a stratified hold-out set, surpassing metadata-only baselines by greater than or equal to 0.17 F1 score. Specialty-specific analysis indicates elevated burnout risk among providers in Radiology, Psychiatry, and Neurology. Our findings demonstrate that ICU clinical narratives contain actionable signals for proactive well-being monitoring.

倦怠监测临床文本自然语言处理医疗AI

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