重症住院患者的默认缓解护理咨询:实用集群随机试验
Katherine R Courtright1,2,3,4, Vanessa Madden2, Brian Bayes2
1Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.
JAMA
|January 16, 2024
概括
对重病住院患者实施默认的息护理咨询增加了咨询率和改善了终身护理流程,但并没有减少住院时间.
科学领域:
- 缓和护理医学
- 医疗服务研究
- 老年医学
背景情况:
- 对住院患者提供缓解护理的优先考虑越来越高.
- 关于常规息治疗有效性的大规模证据是有限的.
- 优化重病患者的缓解护理是医疗保健的关键目标.
研究的目的:
- 对符合条件的住院患者自动订购息护理咨询的影响进行评估.
- 确定这种默认方法是否能改善结果.
- 评估对咨询率,住院时间和终身护理的影响.
主要方法:
- 在11个美国医院进行实用性,阶段性,集群性随机试验.
- 包括 65 岁以上的慢性阻塞性肺病,痴呆症或功能衰竭的患者.
- 默认缓解护理命令与常规护理的比较 (临床医生发起的命令).
主要成果:
- 默认订购显著增加了息护理咨询率 (43.9%与16.6%) 和加快时间.
- 两组住院时间没有显著差异.
- 在失败群体中增加了不复苏命令和退院的比例.
结论:
- 默认的缓解护理咨询订单提高了咨询的频率和及时性.
- 这种方法改善了重病患者的临终护理过程.
- 默认订单并没有减少住院时间,但改善了护理协调.
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