在因败血症住院期间对护理评估的目标
Leigh M Cagino1, Emily Walzl2, Jakob I McSparron3
1University of Michigan Health System, Internal Medicine, Ann Arbor, Michigan, United States; caginol@med.umich.edu.
Annals of the American Thoracic Society
|April 4, 2025
概括
治疗目标 (GoC) 讨论在败血症住院期间被不一致地评估,即使是高风险患者. 医院之间存在显著的差异,强调需要改善护理协调和以患者为中心的做法.
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
- 抚慰性护理是一种缓解性护理.
背景情况:
- 败血症是导致医院死亡和发病的主要原因.
- 临床指南主张在败血症住院期间进行护理目标 (GoC) 评估,以确保以患者为中心的护理.
- 对GOC的不一致评估可能会导致与患者价值观不一致的护理.
研究的目的:
- 评估常规实践中GoC评估的频率,用于住院治疗社区发作的败血症的成年患者.
- 确定患者子组和与GOC讨论和评估相关的因素.
- 量化不同医院的GOC评估实践的差异.
主要方法:
- 一项多医院队列研究,涉及18711名社区发作的败血症 (2020-2023) 的成年患者.
- 数据来自密歇根医院医学安全联盟的败血症倡议 (HMS-sepsis).
- 主要结局包括记录的GoC讨论和基于特定临床指标推断的GoC评估;用于分析因素和变化的多层次逻辑回归.
主要成果:
- 医疗卫生委员会讨论和评估分别发生在35.7%和45.3%的败血症住院病例中.
- 只有23.8%的患者在呈现后三天内进行了GoC讨论.
- 与GoC评估相关的因素包括晚年,种族,慢性疾病,认知/功能障碍,ICU入院和生命支持接收;观察到实质性的跨医院变化 (中位数概率比2.30和2.09).
结论:
- 在败血症住院期间,甚至在高风险人群中,对护理目标的评估也不是始终执行的.
- 医院之间存在显著的实践差异,表明需要标准化的方法.
- 需要进一步的研究来确定高性能GOC评估的驱动因素,以提高护理质量.
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