Wysham Nicholas G, Hochman Michael J, Wolf Steven P, Cox Christopher E, Kamal Arif H
Duke University School of Medicine, Durham, North Carolina, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
J Pain Symptom Manage. 2016 Dec;52(6):873-877. doi: 10.1016/j.jpainsymman.2016.05.026. Epub 2016 Sep 30.
Quality metrics for intensive care unit (ICU)-based palliative care have been proposed, but it is unknown how consultative palliative care can contribute to performance on these measures.
Assess adherence to proposed quality metrics of ICU-based palliative care by palliative care specialists.
Surrogates for 9/14 patient-level quality metrics were assessed in all patients who received an initial palliative care specialist consult while in an ICU from 10/26/2012 to 1/16/2015 in the Global Palliative Care Quality Alliance, a nationwide palliative care quality registry.
Two hundred fifty-four patients received an initial palliative care consultation in an ICU setting. Mean (SD) age was 67.5 (17.3) years, 52% were female. The most common reasons for consultation were symptom management (33%) and end-of-life transition (24%). Adherence to ICU quality metrics for palliative care was variable: clinicians documented presence or absence of advance directives in 36% of encounters, assessed pain in 52.0%, dyspnea in 50.8%, spiritual support in 62%, and reported an intervention for pain in 100% of patients with documented moderate to severe intensity pain.
Palliative care consultations in an ICU setting are characterized by variable adherence to candidate ICU palliative care quality metrics. Although symptom management was the most common reason for palliative care consultation, consultants infrequently documented symptom assessments. Palliative care consultants performed better in offering spiritual support and managing documented symptoms. These results highlight specific competencies of consultative palliative care that should be complimented by ICU teams to ensure high-quality comprehensive care for the critically ill.
已提出基于重症监护病房（ICU）的姑息治疗质量指标，但尚不清楚咨询性姑息治疗如何有助于这些指标的达成。
评估姑息治疗专家对基于ICU的姑息治疗质量指标的依从性。
在全球姑息治疗质量联盟（一个全国性的姑息治疗质量登记处）中，对2012年10月26日至2015年1月16日期间在ICU接受首次姑息治疗专家咨询的所有患者，评估了14项患者层面质量指标中的9项替代指标。
254例患者在ICU环境中接受了首次姑息治疗咨询。平均（标准差）年龄为67.5（17.3）岁，52%为女性。最常见的咨询原因是症状管理（33%）和临终过渡（24%）。对ICU姑息治疗质量指标的依从性各不相同：临床医生在36%的会诊中记录了是否存在预先指示，52.0%评估了疼痛，50.8%评估了呼吸困难，62%提供了精神支持，并且在所有记录有中度至重度疼痛的患者中，100%报告了针对疼痛的干预措施。
ICU环境中的姑息治疗咨询的特点是对候选ICU姑息治疗质量指标的依从性各不相同。尽管症状管理是姑息治疗咨询最常见的原因，但咨询医生很少记录症状评估。姑息治疗咨询医生在提供精神支持和处理记录的症状方面表现较好。这些结果突出了咨询性姑息治疗的特定能力，ICU团队应加以补充，以确保为重症患者提供高质量的综合护理。
