1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. 3Hartford Hospital, Hartford, CT. 4Center for Health Research, College of Nursing, Wayne State University, Detroit, MI. 5Section of Palliative Care, North Shore-Long Island Jewish Health System, Manhasset, NY. 6Department of Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, NJ. 7Department of Physiological Nursing, University of California, San Francisco, CA. 8Lehigh Valley Health Network, Allentown, PA. 9Boise, Meridian, & Mountain States Tumor Institute, St. Luke's Hospital, Boise, ID. 10Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD. 11Departments of Surgery and Health Policy, Medical College of Wisconsin, Milwaukee, WI. 12Cerebrovascular Center, Cleveland Clinic, Cleveland, OH. 13Departments of Rehabilitation Medicine, Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA. 14Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY.
Crit Care Med. 2013 Oct;41(10):2318-27. doi: 10.1097/CCM.0b013e31828cf12c.
To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU.
We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website.
Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus.
We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care.
The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU.
Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.
回顾使用筛选标准（也称为“触发因素”）作为一种机制，以便让姑息治疗顾问参与到 ICU 中危重症患者及其家属的照护中。
我们在 MEDLINE 数据库中检索了从建库到 2012 年 12 月的所有英文文章，使用的术语包括“触发因素”“筛查”“转诊”“工具”“分诊”“病例发现”“评估”“检查表”“主动”或“咨询”，以及“重症监护”或“危重病”和“姑息治疗”“支持性护理”“临终关怀”或“伦理学”。我们还手工检索了中心推进姑息治疗网站上的参考文献列表和作者文件及相关工具。
跨学科改善 ICU 姑息治疗项目咨询委员会的两名成员（一名医生和一名具有临床研究、重症监护和姑息治疗专业知识的护士）向全体委员会介绍了研究和工具，委员会通过共识做出最终选择。
我们对现有数据和工具进行了批判性回顾，以确定姑息治疗咨询的筛选标准，描述选择、实施和评估此类标准的方法，并考虑增加 ICU 患者和家庭获得高质量姑息治疗的替代策略。
改善 ICU 姑息治疗咨询委员会利用数据和经验来解决与以下内容相关的关键问题：现有的筛选标准；选择、实施和评估此类标准的最佳方法；以及特定 ICU 采用筛选方法的适宜性。
使用特定标准来主动转诊姑息治疗咨询似乎有助于在不改变死亡率的情况下减少 ICU 资源的利用，同时增加有需要的危重症患者及其家属对姑息治疗专家的参与。现有的数据和资源可用于制定此类标准，这些标准应针对特定的 ICU 量身定制，通过涉及关键利益相关者的有组织的流程来实施，并通过适当的措施进行评估。在某些情况下，可能需要采取其他策略来增加姑息治疗的可及性。
