推动临床医生为重症患者促进严重疾病沟通:一个实用集群随机试验
Katherine R Courtright1,2,3,4, Jaspal Singh5, Erich M Dress1
1Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA internal medicine
|March 17, 2025
概括
对重症监护室 (ICU) 临床医生的电子推动改善了宿舍出院率和更早的舒适护理订单,但没有减少重症患者住院时间或死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
- 临床交流 临床沟通
背景情况:
- 建议重症监护室 (ICU) 的临床医生与预后有限的患者讨论预后和以舒适为中心的护理.
- 对于患有慢性严重疾病的患者来说,偏好敏感的治疗决定至关重要.
研究的目的:
- 评估是否推动ICU临床医生遵循沟通指南可以改善高死亡风险或严重功能障碍的重症患者的治疗结果.
- 评估电子健康记录 (EHR) 对终身护理和资源利用的影响.
主要方法:
- 一个四臂,务实,步,集群随机试验,涉及10家医院3500名患者.
- 干预措施包括EHR推动促使6个月预后的记录和讨论以舒适为重点的治疗替代方案.
- 与常规护理对比干预措施,以住院时间为主要结果.
主要成果:
- 这项干预在75%的文件完成率下是可行的,但并没有显著减少住院时间或死亡率.
- 与常规护理 (7.3%) 相比,在替代治疗组 (10.9%) 和组合治疗组 (8.9%) 中,更多的患者被送往临终关怀.
- 治疗替代干预导致更早的舒适护理订单 (中位数为3.6 vs 4.5天).
结论:
- 通过电子方式推动ICU临床医生遵守沟通指南是可行的.
- 虽然没有影响停留时间或死亡率,但nudges改进了特定的终身护理过程,如临终关怀退院和早期舒适护理启动.
- 进一步的研究可能会探索优化这些推动,以改善更广泛的结果.
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