使用改进科学:一种质量改进研究,在高风险的一年死亡率的患者中增加严重疾病对话
Kanishk D Sharma1, Sandip A Godambe2, Prachi P Chavan3
1Division of Geriatric Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA.
Healthcare (Basel, Switzerland)
|January 25, 2025
概括
通过查尔森并发症指数 (CCI) 评分识别的低生存概率患者的严重疾病对话 (SIC) 文件的增加,提前护理规划和息护理转诊的改进.
科学领域:
- 医学教育 医学教育
- 提高质量 提高质量
- 抚慰性护理是一种缓解性护理.
背景情况:
- 严重疾病对话 (SIC) 对于将以患者为中心的结果与医疗治疗结合起来至关重要.
- 对死亡会议的审查显示,需要更早地参与SIC和预先护理规划 (ACP).
- 这项研究旨在增强SIC及其在预后不佳的患者的文档.
研究的目的:
- 增加严重疾病对话 (SIC) 的频率和记录.
- 用更新的查尔森并发症指数 (CCI) 评分来识别具有低一年生存概率的患者.
- 改进预先护理规划 (ACP) 和以患者为中心的结果.
主要方法:
- 在一级创伤中心进行了一项质量改进研究.
- 综合护理管理人员在跨学科的回合中确定并讨论了高CCI分数.
- 鼓励提供者在EPIC电子健康记录中记录SIC在护理范围 (EOC) 的注意事项.
主要成果:
- 62名具有高CCI分数的患者中有16名 (25.81%) 记录了EOC笔记.
- 具有经过记录的EOC笔记的患者更有可能获得息治疗 (63.04%) 和临终关怀咨询 (93.48%).
- 干预后,50%的提供者进行了SIC,但EOC笔记中的文档仍然不够理想.
结论:
- SICs的文档与加大对ACP,息护理和宿舍咨询的参与有关.
- 这种干预措施有望改善终身护理讨论和决策.
- 需要进一步努力,以加强电子健康记录中SIC的文档.
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