Ryan Angèle, Carter Jackie, Lucas Janet, Berger Jack
LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Am J Hosp Palliat Care. 2002 May-Jun;19(3):171-80. doi: 10.1177/104990910201900308.
The majority of dying patients continue to receive care in acute, tertiary settings. This has generated the development of hospital-based palliative care (HBPC). The Symptom Management and Palliative Care Program (SMPCP) at LAC+USC Medical Center provides HBPC. The SMPCP operates as an interdisciplinary consultative service, assessing inpatients, and documenting recommendations for primary physicians. Over a 28-month period the SMPCP provided clinical recommendations, education, and research for patients, family members, and hospital staff Demographic, clinical, psychosocial, financial, and outcome information was collected on 265 patients. The SMPCP documented the attainment of defined quality end-points, including pain control within 24 hours, a Do Not Resuscitate (DNR) discussion with patient and family within 72 hours, and control of nausea and vomiting within 24 hours. Team members also documented impediments to implementing recommendations and the success of interventions to overcome impediments. Results indicated that the SMPCP achieved a high rate of quality end-point attainment when impediments were not present. The most significant impediments resulted from behaviors by primary physicians. The SMPCP's ability to overcome barrier behaviors improved the rate of end-point attainment, confirming the importance of palliative care at the end of life.
大多数临终患者仍在急性三级医疗机构接受治疗。这促使了医院姑息治疗（HBPC）的发展。洛杉矶县+南加州大学医学中心的症状管理与姑息治疗项目（SMPCP）提供HBPC。SMPCP作为一项跨学科咨询服务，对住院患者进行评估，并为初级医生记录建议。在28个月的时间里，SMPCP为患者、家属和医院工作人员提供了临床建议、教育和研究。收集了265名患者的人口统计学、临床、心理社会、财务和结果信息。SMPCP记录了既定质量终点的达成情况，包括24小时内控制疼痛、72小时内与患者及家属进行“不要复苏”（DNR）讨论，以及24小时内控制恶心和呕吐。团队成员还记录了实施建议的障碍以及克服障碍的干预措施的成功情况。结果表明，当不存在障碍时，SMPCP实现了较高的质量终点达成率。最显著的障碍来自初级医生的行为。SMPCP克服障碍行为的能力提高了终点达成率，证实了临终时姑息治疗的重要性。
