Dawson S, Runk J A
APACHE Medical Systems, 1650 Tysons Boulevard, Suite 300, McLean, VA 22102, USA.
AACN Clin Issues. 2000 Aug;11(3):375-85. doi: 10.1097/00044067-200008000-00005.
Key issues addressing appropriateness of triage decisions and the tools needed to support those decisions are identified in this article. The limitations of current approaches to appropriate utilization such as admission and continued-stay criteria, medical management models, bed control and bed management strategies, and rounding practices are discussed, and a systemic model to examine the placement of patients is proposed. Determining which patients can benefit from critical care and which can benefit from an alternative level of care is analyzed through the use of clinical decision support tools that provide both retrospective analysis of current patterns and predictive models to assist the clinician in making continued-stay decisions. Patient populations who are considered for alternative placement are defined. Those populations identified as having the potential to gain limited benefit from the level of intensity of an intensive care unit are managed in alternative sites. The role played by the advanced practice clinician in using clinical decision support tools is discussed.
本文确定了分诊决策适宜性的关键问题以及支持这些决策所需的工具。讨论了当前适当利用方法的局限性，如入院和持续住院标准、医疗管理模式、床位控制和床位管理策略以及查房实践，并提出了一个用于检查患者安置情况的系统模型。通过使用临床决策支持工具来分析确定哪些患者可从重症监护中获益，哪些患者可从其他护理级别中获益，这些工具既能对当前模式进行回顾性分析，又能提供预测模型以协助临床医生做出持续住院决策。明确了考虑进行替代安置的患者群体。那些被确定从重症监护病房的护理强度中获益有限的人群在其他场所接受管理。讨论了高级执业临床医生在使用临床决策支持工具中所起的作用。
