Dick B, Sitter H, Blau E, Lind N, Wege-Heuser E, Kopp I
Klinik für Psychotherapeutische Medizin und Psychosomatik, Zentralinstitut für Seelische Gesundheit Mannheim.
Nervenarzt. 2006 Jan;77(1):12, 14-8, 20-2. doi: 10.1007/s00115-005-1916-7.
Implementing evidence-based clinical guidelines by means of clinical pathways is one of the key elements of continuous quality management at the University Hospital of Marburg. This paper explains how clinical pathways for suicidal ideation and suicide attempts were developed.
Based upon a review of existing guidelines and literature, optimal standards of care were defined. Step-by-step analysis of the process of care and results of a questionnaire were used to describe the actual processes. A problem-orientated comparison of the actual and the optimal process of care was the basis for developing these pathways. A consensus was achieved with all persons involved in the respective process of care taking into consideration local resources as well as barriers. The most important decisions and interventions were defined and presented as a patient-oriented process.
The lack of explicit "how to do it"-recommendations of the guidelines for the entire care processes required specific, locally tailored adaptations. Potentials for improvement were identified in the following areas: transfer of patients, consultation, information and coordination within the team, and diagnosis of suicide risk. The pathways include care-oriented algorithms, checklists and assignments of responsibility.
The development of clinical pathways as part of quality management and transsectoral integrated care in psychiatry and psychotherapy is feasible. The concept presented incorporates the potential of increasing transparency, efficiency and efficacy of care, and of improving satisfaction of those involved. It offers psychiatric hospitals the chance to guarantee optimal quality of care in face of increasing workload and costs.
通过临床路径实施循证临床指南是马尔堡大学医院持续质量管理的关键要素之一。本文阐述了自杀意念和自杀未遂临床路径的制定过程。
基于对现有指南和文献的回顾，确定最佳护理标准。通过对护理过程的逐步分析和问卷调查结果来描述实际过程。以问题为导向，对实际护理过程与最佳护理过程进行比较，以此为基础制定这些路径。综合考虑当地资源和障碍，与各护理过程涉及的所有人员达成共识。明确最重要的决策和干预措施，并将其呈现为以患者为导向的过程。
指南中缺乏针对整个护理过程的明确“如何操作”建议，因此需要进行具体的、因地制宜的调整。在以下方面发现了改进潜力：患者转诊、会诊、团队内部信息交流与协调以及自杀风险诊断。这些路径包括以护理为导向的算法、检查表和责任分配。
作为质量管理以及精神科和心理治疗跨部门综合护理一部分的临床路径开发是可行的。所提出的概念具有提高护理透明度、效率和效果以及提升相关人员满意度的潜力。它为精神病医院提供了一个机会，使其能够在工作量和成本不断增加的情况下保证最佳护理质量。
