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将ICU分拣指南付诸实践:使用观察和采访的模拟研究

Inger L Abma¹, Gert J Olthuis¹, Irma T H M Maassen²

¹IQ healthcare, section Ethics of healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

|August 24, 2023

概括

荷兰的分组指南是可行的在流行病期间重症监护室 (ICU) 患者分配. 然而,团队的决策不同,强调需要明确的指导方针和实践培训,以确保一致和道德的患者优先级.

科学领域:

关键护理医学关键护理医学
卫生政策和管理卫生政策和管理

背景情况:

由于COVID-19大流行,当需求超过病床容量时,需要制定国家重症监护室 (ICU) 患者分配指南.
本研究探讨了ICU分离指南的实际应用和挑战.

研究的目的:

通过使用荷兰针对虚构患者的分拣指南,探索分拣团队的经验.
识别影响ICU分组期间决策的因素.

主要方法:

来自四家医院的八个分拣小组参与了.
虚构的患者病例被用于分拣模拟.
进行了观察,录音和焦点小组采访.
数据使用诱导性内容分析来分析.

主要成果:

荷兰的分类指南是主要的决策依据.
团队纳入了外部考虑因素,有时偏离了指导方针,以避免诸如年龄等非医学标准.
群体动态和个人对指导方针的意见影响了分拣结果.
由于他们的专业知识,密集主义者经常发挥了决定性的作用.

结论:

荷兰的分组指南是可以实施的,但在患者优先考虑方面观察到不一致.
准则的制定者应该改进标准,以防止在伦理上有疑问或不一致的患者分配.
建议对指导方针的应用和理由进行实践培训,以改善遵守.

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