Crofts Linda
Department of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, United Kingdom.
Intensive Crit Care Nurs. 2006 Dec;22(6):362-9. doi: 10.1016/j.iccn.2006.03.006. Epub 2006 Aug 8.
This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.
本文描述了作为重症监护领导力项目一部分进行关键病例回顾的过程。在两年时间里，对五家不同医院的45个病例进行了回顾，并寻求当地研究伦理委员会以及研究与发展委员会的许可，以便将这些讨论视为研究数据。典型的病例是那些有复杂需求且护理过程不顺利的患者。病例回顾中出现的关键主题有：病例回顾本身存在：专业团队之间、专业人员自身之间、医护人员与家属之间、病房与科室之间以及不同医院之间的沟通失败。文档记录往往也不尽人意。团队在作为一个整体协作时常常存在问题，不同专业人员对团队其他成员往往有不同期望。个人行动可能弥补正式临床风险系统中的不足。病例回顾本身展示了医疗服务每天面临的困难以及有效沟通的挑战。病例回顾提供了一个有效媒介，既能解决这些困难，又能示范团队有效管理和沟通患者护理问题的方法。此外，其作为学习工具的优势归因于团队学习是变革的强大催化剂。
