三维仪器的单级可靠性用于三级分拣和ICU的决策-优先级-一个案例图片模拟研究
Stefan Bushuven1,2,3, Michael Bentele4, Bianka Gerber4
1Institute for Hospital Hygiene and Infection Prevention, Hegau-Jugendwerk Hospital Gailingen, Health Care Association District of Constance, Hausherrenstrasse 12, 78315, Radolfzell, Germany. S.Bushuven@gmx.de.
BMC anesthesiology
|June 20, 2023
概括
开发一个COVID-19选工具揭示了医生在患者预后和生存期的协议中的挑战. 评估者之间的可靠性很低,这突显了在重症监护资源分配中需要进行小组决策的需要.
科学领域:
- 医学伦理 医学伦理
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 随着COVID-19的流行,欧盟国家需要使用第三级分拣决策工具.
- 由于COVID-19患者呈现的顺序性质,预计会出现后期分拣场景.
- 决策者在压倒性的关键案件中面临第二受害者和道德伤害效应的风险.
研究的目的:
- 开发和验证用于重症监护的三维三级分拣仪器.
- 在德国医院的医生中评估仪器的可靠性和有效性.
主要方法:
- 一个专家组使用了德尔菲技术来设计一个三维仪器.
- 该仪器评估了估计的生存机会,自主性预后和ICU停留时间.
- 德国5家医院的47名医生接受了一项匿名在线调查,其中包括16个虚构的ICU病例简介.
主要成果:
- 发现了良好的构造有效性 (克朗巴赫的阿尔法0.735) 和内部可靠性 (科恩的卡帕0.497-0.574).
- 对于分类参数,观察到较低的分级间可靠性 (科恩卡帕0.252-0.327).
- 医生对自主性预后的评估表示担忧,特别是对于身体障碍患者.
结论:
- 应避免在压力较大,资源有限的情况下进行单一评审分类,以确保患者和提供者的安全.
- 未来的努力应集中在开发可靠的集团决策工具和算法上.
- 作为唯一的分拣参数,生存机会需要其他因素的补充,例如估计的ICU停留时间.
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