Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Surgery. 2010 Jun;147(6):871-7. doi: 10.1016/j.surg.2009.11.005. Epub 2010 Jan 25.
Proactive case-finding using consultation triggers is a currently unexplored technique of increasing access to palliative care for patients in the surgical intensive care unit (SICU).
A retrospective, pre- and postintervention study examined the effect of an initiative involving palliative care consultation in a 21-bed SICU at an urban, tertiary referral center. The initiative identified patients meeting a set of consultation triggers suggested by a group of physicians with expertise in surgical palliative care. The charts of 300 patients were reviewed retrospectively before the initiative (Group I), and 344 charts were reviewed after the initiative (Group II) for the presence of a trigger and/or subsequent palliative care consultation.
Triggers were rare in both groups (Group I, 5.7%; Group II, 5.5%). Palliative care consultations were also infrequent, without change before and after the intervention (Group I, 2.3%; Group II, 3.1%). There was no difference in consultations for patients meeting a trigger after the initiative (17.6% to 27.3%; P = .704).
Implementation of triggers does not increase palliative care consultations in the SICU. As an isolated intervention, triggers occur in too few patients to improve overall access to palliative care, suggesting that other methods should be further explored.
使用咨询触发因素进行主动病例发现是一种目前尚未探索的技术，可以增加外科重症监护病房（SICU）患者获得姑息治疗的机会。
一项回顾性、干预前后研究调查了在城市三级转诊中心的 21 张床位 SICU 中实施姑息治疗咨询计划的效果。该计划确定了符合一组具有外科姑息治疗专业知识的医生提出的一组咨询触发因素的患者。在该计划之前（第 I 组），回顾性地审查了 300 名患者的病历，在该计划之后（第 II 组），审查了 344 名患者的病历，以确定是否存在触发因素和/或随后的姑息治疗咨询。
两组的触发因素都很少（第 I 组，5.7%；第 II 组，5.5%）。姑息治疗咨询也很少见，干预前后没有变化（第 I 组，2.3%；第 II 组，3.1%）。在实施该计划后，符合触发因素的患者接受咨询的比例没有差异（17.6%至 27.3%；P=0.704）。
在 SICU 中实施触发因素并不会增加姑息治疗咨询。作为一种孤立的干预措施，触发因素发生在太少的患者身上，无法改善整体姑息治疗机会，这表明应进一步探索其他方法。
