关于从门诊转移到急性护理机构的预先指令的难以获得性
R S Morrison1, E Olson, K R Mertz
1Henry L. Schwartz Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY 10029, USA.
JAMA
|August 9, 1995
概括
在急性住院期间,以前执行的预先指示往往无法访问. 一旦被认可,这些预先指示会显著影响医疗治疗决策,突出显示了患者护理可访问性的关键差距.
科学领域:
- 老年医学 老年医学
- 医疗保健的可访问性 医疗保健的可访问性
- 患者的自主权患者的自主权
背景情况:
- 预先指示是重要的法律文件,概述了患者对医疗保健的偏好.
- 在急性住院期间确保这些指令的可访问性对于以患者为中心的护理至关重要.
- 以前的研究表明,将预先指示整合到急性护理环境中存在潜在的挑战.
研究的目的:
- 调查患者在急性住院期间先前执行的预先指示的可访问性.
- 确定预先指示在临床决策中被认可和使用的速度.
- 确定在紧急护理场景中有效实施预先指示的障碍.
主要方法:
- 在三年内 (1991-1993年) 进行了180次入院的回顾性图表审查.
- 该研究包括114名老年患者,他们之前已经执行了预先指示.
- 从一个大都会教学医院,熟练护理机构和门诊老年病诊所收集的数据.
主要成果:
- 只有26%的患者在住院期间承认了他们的预先指示.
- 在缺乏决策能力的患者中,26% (14/53) 的指令得到了承认.
- 在被认可时,预先指示在86% (12/14) 的案件中影响了治疗决策.
结论:
- 以前执行的预先指令在急性住院期间的可访问性不佳.
- 认可的预先指示显著影响医疗治疗选择.
- 进一步的研究是必要的,以识别和克服障碍,以推进指令可访问性.
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