在CICU中促进早期的护理目标对话,以一个基于问题的意外EHR工作流
Adam Ushpol1, Colby Parsons2, Sophia Golec2
1Icahn School of Medicine at Mount Sinai, 50 E 98th St, Apt 10J-3, 10029, New York, NY, USA. Adam.ushpol@icahn.mssm.edu.
BMC palliative care
|December 20, 2024
概括
将惊喜问题 (SQ) 集成到电子健康记录 (EHR) 中,显著增加了严重心脏病患者的早期护理目标 (GOC) 对话,改善了息护理的获取.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 抚慰性护理是一种缓解性护理.
背景情况:
- 惊喜问题 (SQ) 是一个验证的工具,用于预测患者在六个月内死亡率.
- 西奈山心脏重症监护室 (CICU) 将SQ集成到电子健康记录 (EHR) 工作流程中,以识别患者进行早期的息治疗 (PC) 启动.
研究的目的:
- 评估将意外问题 (SQ) 整合到EHR工作流程中的影响,以促进关怀目标 (GOC) 对话.
- 为了比较中国政府对话的频率和时间,以及在可行性试点和实施期间之间重新定向的护理目标.
主要方法:
- 在2021年12月至2022年9月期间,对所有SQ答案为"NO"的CICU入院进行了回顾性,观察性,准实验性研究.
- 该研究比较了为期3个月的可行性试点阶段 (使用Excel for SQ) 和随后的6个月的实施阶段 (使用集成的Epic EHR工作流).
- 测量结果包括中国政府对话的频率和时间,以及重定向护理目标的可能性 (代码状态更改或宿舍出院).
主要成果:
- 实施期间,与试点阶段相比,中国政府对话的频率 (81.2%与61.4%) 和早期的中国政府对话 (入学后2天内) 显著增加.
- 虽然中国政府的谈话增加了,但在两个时期之间,重新定向护理目标向舒适度或没有升级的可能性没有显著差异.
- 该研究包括了195名入院者,试点和实施队列之间的临床特征相似,尽管试点中ICU干预更频繁.
结论:
- 将意外问题 (SQ) 整合到EHR工作流程中,有效地促进了对高死亡风险的重症患者的早期治疗目标 (GOC) 对话.
- 这种与EHR集成的方法可以提高识别那些可以从早期息治疗 (PC) 讨论和干预中受益的患者的能力.
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