Dy Sydney M, List Donald J, Barbe Cynthia, Knight Louise
The Harry J. Duffey Family Pain and Palliative Care Program, Johns Hopkins Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
The Harry J. Duffey Family Pain and Palliative Care Program, Johns Hopkins Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2014 Jul;48(1):127-31. doi: 10.1016/j.jpainsymman.2013.08.012. Epub 2013 Nov 15.
Subacute rehabilitation may not be appropriate for many patients with advanced cancer. We evaluated outcomes of cancer center inpatients transferred to subacute rehabilitation, implemented a multidisciplinary intervention to improve appropriateness of referrals, and evaluated its potential impact.
Percentage of patients who returned for further anticancer treatment after subacute rehabilitation (preintervention) and percentage of patients who were referred and transferred to subacute rehabilitation (pre and post).
Stakeholder engagement; feedback about outcomes to faculty and staff; increased communication between therapy, social work, nursing, and physicians about therapy referrals; and goals of care at daily prerounds meeting.
Potential reduction in subacute rehabilitation referrals and transfers. Intensive intervention was difficult to maintain, but team is continuing efforts at improved communication.
CONCLUSIONS/LESSONS LEARNED: Intervention may have improved outcomes short-term but was complicated and difficult to maintain. Addressing appropriateness of subacute rehabilitation referrals can occur within a multidisciplinary approach to improving communication about goals of care for patients with advanced disease.
亚急性康复可能不适用于许多晚期癌症患者。我们评估了转至亚急性康复机构的癌症中心住院患者的结局，实施了多学科干预以提高转诊的适宜性，并评估了其潜在影响。
亚急性康复后返回接受进一步抗癌治疗的患者百分比（干预前），以及被转诊并转至亚急性康复机构的患者百分比（干预前后）。
利益相关者参与；向教职员工反馈结局；加强治疗、社会工作、护理和医生之间关于治疗转诊的沟通；以及在每日查房会议上确定护理目标。
亚急性康复转诊和转院可能减少。强化干预难以维持，但团队仍在继续努力改善沟通。
结论/经验教训：干预可能在短期内改善了结局，但过程复杂且难以维持。解决亚急性康复转诊的适宜性问题可通过多学科方法进行，以改善对晚期疾病患者护理目标的沟通。
