Emergency Medicine Department, Ninewells Hospital, Dundee DD1 9SY, UK.
Emerg Med J. 2009 Nov;26(11):777-9. doi: 10.1136/emj.2008.067249.
To improve the care of patients presenting to the emergency department who are acutely dying or those in whom further disease-modifying treatment is not appropriate.
A quality improvement report on the implementation of a modified Liverpool Care Pathway for the Dying Patient (LCP) in an emergency medicine department.
The emergency medicine department of Ninewells Hospital, Dundee. Ninewells Hospital is the tertiary referral and teaching hospital for the east coast of Scotland and North East Fife.
The pathway was introduced after a 2001 study and a 2003 audit showed that the department had an increasing role in the care of the acutely dying, but some inconsistency in approach. Key measures for improvement were to improve communication between staff, improve the consistency of care and improve the perceived quality of care given. Senior decision making remains a crucial element of the pathway.
A modified LCP was developed and launched in November 2005. Change was managed via a series of meetings and a pilot process. Serial review and audit allowed ongoing quality review of the pathway and improvements.
The care of the dying patient has become a more consistent and positive endeavour. Nursing staff are very satisfied with its use, and it is hoped that the LCP pathway can be developed further within the organisation.
It has been a rewarding undertaking to improve the care of dying patients, but one which has taken time and has required consistent management of change to promote the positive outcomes.
提高急诊科急性死亡或不适合进一步疾病修正治疗患者的护理水平。
对急诊科实施改良利物浦临终关怀路径（LCP）的质量改进报告。
邓迪九井医院的急诊科。九井医院是苏格兰东海岸和法夫东北部的三级转诊和教学医院。
该路径是在 2001 年的一项研究和 2003 年的一次审计之后推出的，该研究和审计表明，该部门在急性死亡患者的护理中发挥的作用越来越大，但方法上存在一些不一致。改进的关键措施是改善员工之间的沟通，提高护理的一致性，并提高所提供护理的质量。高级决策仍然是该路径的关键要素。
2005 年 11 月开发并推出了改良的 LCP。通过一系列会议和试点流程来管理变革。连续审查和审计允许对路径和改进进行持续的质量审查。
临终患者的护理已经变得更加一致和积极。护理人员对其使用非常满意，希望该 LCP 路径能够在组织内进一步发展。
改善临终患者的护理是一项有益的工作，但需要时间和持续的变革管理，以促进积极的结果。
