一个临终关怀的过渡计划为患者在急诊室的病人
Christopher W Baugh1, Kei Ouchi1, Jason K Bowman1,2
1Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA network open
|July 8, 2024
概括
一个新的多学科计划显著增加了临终关怀的急诊室患者的临终关怀使用. 这一举措改善了临终关怀的过渡,降低了住院死亡率,使护理与患者目标保持一致.
科学领域:
- 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
- 提高质量 提高质量
背景情况:
- 临终期患者的急诊室 (ED) 访问是常见的,往往导致住院和错误的护理目标.
- 延迟过渡到临终关怀可能导致住院患者的死亡,这与患者的愿望相反.
研究的目的:
- 评估一项新的多学科计划,旨在加快临终治疗中心临终期患者的临终治疗中心识别和招生.
- 评估该计划与增加住院利用率的关联.
主要方法:
- 在一个学术医疗中心进行了一项前后质量改进研究.
- 该干预涉及正式的护理过渡途径,包括警报,培训,供应商扩张和数据跟踪.
- 在控制期 (2018年9月至2020年1月) 和干预期 (2021年8月至2022年12月) 期间,收集了接近生命终点的成年患者的数据.
主要成果:
- 干预组显示,在96小时内没有住院住院的临终关怀过渡率显著增加 (54.1%对22.6%,P <.001).
- 该计划与更高的临终关怀过渡概率相关 (调整后赔率比,5.02).
- 在干预期内,住院死亡率下降 (48.5% vs 64.4%,P < .001),住院时间长度没有变化.
结论:
- 一个多学科计划有效地增强了急诊室患者的临终关怀过渡.
- 调查结果表明,该计划有可能改善终身护理的协调性,并降低死亡率.
- 需要进一步的研究来证实可通用性和长期可持续性.
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