一种在重症监护病房优化以患者和家庭为中心护理的新方法。

A novel method of optimizing patient- and family-centered care in the ICU.

作者信息

Allen Steven R, Pascual Jose, Martin Niels, Reilly Patrick, Luckianow Gina, Datner Elizabeth, Davis Kimberly A, Kaplan Lewis J

机构信息

From the Perelman School of Medicine (S.R.A., J.P., N.M., P.R., E.D., L.J.K.), University of Pennsylvania; Philadelphia, Pennsylvania; Philadelphia VA Medical Center (S.R.A., J.P., E.D., L.J.K.), Philadelphia, Pennsylvania; and Yale School of Medicine (G.L., K.A.D.), New Haven, Connecticut.

出版信息

J Trauma Acute Care Surg. 2017 Mar;82(3):582-586. doi: 10.1097/TA.0000000000001332.

DOI:10.1097/TA.0000000000001332

PMID:28030488

Abstract

BACKGROUND

Patient- and family-centered care permeates critical care where there are often multiple teams involved in management. A method of facilitating information sharing to support shared decision making is essential in appropriately rendering care.This study sought to determine whether incorporating family members on rounds in the intensive care unit (ICU) improves patient and family knowledge and whether doing so improves team time management and satisfaction with the process.

METHODS

A nonrandomized comparative before-and-after trial of incorporating family members on rounds (July to December 2009 vs January to July 2010) in a single quarternary center's surgical ICU assessed (1) family members' knowledge, (2) nurse's and physician's satisfaction with the intervention, (3) frequency and timing of family meetings, and (4) physician's workflow.

RESULTS

Intensive care unit demographics and use were similar between time frames. Presurvey (n = 412 family members; 49 nurses) and postsurvey (n = 427 family members; 47 nurses) were coupled with presurvey (n = 5) and postsurvey (n = 6) physicians' informal feedback. Family knowledge of the clinical course and plans increased from 146 (35.4%) of 412 to 374 (87.6%) of 427 (p < 0.0001). Nurses were nearly uniformly satisfied with planned family interaction on rounds (presurvey: 9/49 [18.4%] vs postsurvey: 46/47 [97.9%]; p < 0.0001). Family meetings per week outside of rounds substantially decreased from a mean of 5.3 ± 2.7 to 0.3 ± 0.9; p < 0.001). Goals of therapy including end-of-life care became an element frequently discussed on rounds with families (presurvey: 9.4% ± 4.7% vs postsurvey: 82.5% ± 14.8%; p < 0.0001). One intensivist was dissatisfied with the process.

CONCLUSION

Incorporating family members on rounds in the ICU improves communication and satisfaction and shifts the team's time away from family communication events outside of rounds, condensing most of those activities within the rounding structure. Critical care nurses and intensivists were principally satisfied with the process.

LEVEL OF EVIDENCE

Therapeutic, level III.

摘要

背景

以患者和家庭为中心的护理贯穿于重症监护领域，在该领域的管理中通常涉及多个团队。一种促进信息共享以支持共同决策的方法对于提供适当的护理至关重要。本研究旨在确定在重症监护病房（ICU）查房时纳入家庭成员是否能提高患者和家庭的知识水平，以及这样做是否能改善团队的时间管理和对该过程的满意度。

方法

在一家单一的四级中心的外科ICU进行了一项非随机前后对照试验，在查房时纳入家庭成员（2009年7月至12月与2010年1月至7月），评估了（1）家庭成员的知识水平，（2）护士和医生对该干预措施的满意度，（3）家庭会议的频率和时间安排，以及（4）医生的工作流程。

结果

两个时间段的ICU人口统计学特征和使用情况相似。在进行调查前（412名家庭成员；49名护士）和调查后（427名家庭成员；47名护士）的同时，还收集了调查前（5名）和调查后（6名）医生的非正式反馈。家庭成员对临床病程和计划的了解从412人中的146人（35.4%）增加到427人中的374人（87.6%）（p<0.0001）。护士对查房时计划的家庭互动几乎一致满意（调查前：9/49[18.4%]，调查后：46/47[97.9%]；p<0.0001）。每周非查房时间之外的家庭会议从平均5.3±2.7次大幅减少至0.3±0.9次；p<0.001）。包括临终关怀在内的治疗目标成为与家庭在查房时经常讨论的内容（调查前：9.4%±4.7%，调查后：82.5%±14.8%；p<0.0001）。有一名重症监护医生对该过程不满意。