Street Maryann, Considine Julie
Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety, Geelong, Victoria, Australia; Eastern Health - Deakin University Nursing & Midwifery Research Centre, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety, Geelong, Victoria, Australia; Eastern Health - Deakin University Nursing & Midwifery Research Centre, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
Australas Emerg Nurs J. 2016 Feb;19(1):37-43. doi: 10.1016/j.aenj.2015.10.002. Epub 2015 Nov 18.
The impact of limitation of medical treatment orders (LOMT) on patient outcomes following transfer from sub-acute care to the Emergency Department remains unclear.
Retrospective medical record review of 431 adult in-patients who required ambulance transfer following clinical deterioration during a sub-acute care admission during 2010.
Common reasons for transfer were respiratory (18.9%) or neurological (19.0%) conditions; 35.7% (154/431) were transferred within one week of sub-acute care admission. LOMT orders were in place for 37.8% (n=163) patients who were older (p<0.001), with more comorbidities (p<0.005), specifically cardiac, renal and pulmonary disease than patients without LOMT. Patients with LOMT orders had more physiological abnormalities before transfer; tachypnoea (43.7% vs 28.6%), hypoxaemia (63.5% vs 48.4%) and severe hypoxaemia (27.6% vs 14.5%). There were no differences in rates of admission, cardiac arrest, Medical Emergency Team activation or ICU admission. For admitted patients, those with LOMT orders had significantly (p≤0.005) higher mortality: in-hospital (21.9% vs 11.3%); 30 days (23.9% vs 12.3%) and 60 days (28.2% vs 13.4%).
Patients with LOMT had higher levels of comorbidity and were more acutely ill during their sub-acute care admission. Once transferred those with a LOMT had similar rates of cardiac arrest, MET activation and unplanned ICU admission, but higher mortality.
从亚急性护理机构转至急诊科后，医疗治疗指令限制（LOMT）对患者预后的影响仍不明确。
对2010年亚急性护理住院期间因临床病情恶化需要救护车转运的431例成年住院患者进行回顾性病历审查。
转运的常见原因是呼吸系统疾病（18.9%）或神经系统疾病（19.0%）；35.7%（154/431）的患者在亚急性护理入院后一周内被转运。37.8%（n = 163）的患者有LOMT指令，这些患者年龄较大（p < 0.001），合并症更多（p < 0.005），特别是与没有LOMT的患者相比，患有心脏、肾脏和肺部疾病。有LOMT指令的患者在转运前有更多的生理异常；呼吸急促（43.7%对28.6%）、低氧血症（63.5%对48.4%）和严重低氧血症（27.6%对14.5%）。入院率、心脏骤停、医疗急救团队启动或重症监护病房入院率没有差异。对于入院患者，有LOMT指令的患者死亡率显著更高（p≤0.005）：住院期间（21.9%对11.3%）；30天（23.9%对12.3%）和60天（28.2%对13.4%）。
有LOMT的患者合并症水平更高，在亚急性护理住院期间病情更严重。一旦转运，有LOMT的患者心脏骤停、医疗急救团队启动和非计划入住重症监护病房的发生率相似，但死亡率更高。
