住院神经病死亡和因子与出院至临终关怀所相关的因素
Shefali Dujari1, Janet Wei2, Lironn Kraler1,3
1Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
The Neurohospitalist
|September 13, 2023
概括
许多神经病患者死于医院,而不是首选地点. 改善临终关怀退院需要解决先进指令和早期护理讨论等障碍,以加强神经病患者的终身护理.
科学领域:
- 神经学 神经学
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 住院神经病学服务体验患者死亡地点的变化.
- 临终关怀可以促进在首选地点的死亡,与患者的愿望保持一致.
- 了解患者的特征和出院障碍对于改善终身护理至关重要.
研究的目的:
- 描述在住院神经病学服务中死亡的患者.
- 探索阻碍这些患者出院至临终关怀的障碍.
主要方法:
- 在四级护理医疗中心 (I级创伤,综合性中风中心) 的回顾性研究.
- 通过住院神经病学服务出院的确定的患者 (6/2019-1/2021).
- 电子医疗记录审查医院内死亡和住院出院情况.
主要成果:
- 在研究期间,住院患者死亡69例,住院出院74例.
- 在69例死亡中,54例是随着维持生命治疗 (WLST) 的停止而发生的;14例是临终关怀转诊.
- 与临终关怀可接受的患者 (n=40) 相比,临终关怀转诊的患者 (n=88) 较少依赖ICU,并且早些时候有"不要输管"状态变化和可用的高级指令.
结论:
- 确定了改善临终关怀出院的机会:医院间转移,先进指令,早期护理目标讨论,息护理咨询和临终关怀床的可用性.
- 强调使用住院死亡率作为该患者群体的质量指标的局限性.
- 强调需要进一步研究优化神经病患者的终身护理途径.
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