急性失代偿性心力衰竭住院患者自我报告与临床医生下达的复苏状态的不一致性
Discordance of Patient-Reported and Clinician-Ordered Resuscitation Status in Patients Hospitalized With Acute Decompensated Heart Failure.
作者信息
Young Kathleen A, Wordingham Sara E, Strand Jacob J, Roger Vėronique L, Dunlay Shannon M
机构信息
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
出版信息
J Pain Symptom Manage. 2017 Apr;53(4):745-750. doi: 10.1016/j.jpainsymman.2016.11.010. Epub 2017 Jan 3.
CONTEXT
Accurate documentation of preferences for cardiopulmonary resuscitation at hospital admission is critical to ensure that patients receive resuscitation or not in accordance with their wishes.
OBJECTIVES
We sought to identify and characterize inconsistencies in patient-reported and clinician-ordered resuscitation status in patients hospitalized with acute decompensated heart failure (ADHF).
METHODS
Southeastern Minnesota residents hospitalized with ADHF were prospectively enrolled into a study that included the administration of face-to-face questionnaires from January 2014 to February 2016. Patient-reported resuscitation status was assessed at enrollment using a validated question. Clinician-ordered resuscitation preferences at hospital admission were abstracted from the electronic medical record.
RESULTS
Of the 400 patients administered the questionnaire; 213 (53.3%) stated their resuscitation preference as Full Code, 166 (41.5%) do-not-resuscitate (DNR), and 21 (5.3%) were unsure. In comparison, clinician-ordered resuscitation status was Full Code in 263 (65.8%) patients, DNR in 133 (33.3%), and not documented in four (1.0%). Patient-reported and clinician-ordered resuscitation status was discordant in 20% of patients, of whom 5.6% elected Full Code by questionnaire and had a DNR clinician order, and 14.4% elected DNR by questionnaire but had a Full Code clinician order. Differences in age, comorbidities, health literacy, marital status, completion of advance directives, hospital length of stay, and discharge destination in patients with discordant vs. concordant resuscitation preferences were observed.
CONCLUSIONS
Patient-reported and clinician-ordered resuscitation preferences were discordant in 20% of patients hospitalized with ADHF. The underlying etiology of these inconsistencies may reflect factors such as patient indecisiveness or patient-clinician miscommunication and requires further exploration.
背景
准确记录患者入院时对心肺复苏的偏好对于确保患者按照自身意愿接受或不接受复苏至关重要。
目的
我们试图识别并描述急性失代偿性心力衰竭（ADHF）住院患者中患者报告的和临床医生医嘱的复苏状态之间的不一致情况。
方法
前瞻性纳入明尼苏达州东南部因ADHF住院的居民进行一项研究，该研究包括在2014年1月至2016年2月期间进行面对面问卷调查。在入组时使用经过验证的问题评估患者报告的复苏状态。从电子病历中提取临床医生在医院入院时医嘱的复苏偏好。
结果
在400名接受问卷调查的患者中，213名（53.3%）表示其复苏偏好为完全复苏，166名（41.5%）为不复苏（DNR），21名（5.3%）不确定。相比之下，临床医生医嘱的复苏状态为完全复苏的有263名（65.8%）患者，DNR的有133名（33.3%），4名（1.0%）未记录。20%的患者患者报告的和临床医生医嘱的复苏状态不一致，其中5.6%通过问卷调查选择完全复苏但临床医生医嘱为DNR，14.4%通过问卷调查选择DNR但临床医生医嘱为完全复苏。观察到复苏偏好不一致与一致的患者在年龄、合并症、健康素养、婚姻状况、预先指示的完成情况、住院时间和出院目的地方面存在差异。
结论
20%的ADHF住院患者患者报告的和临床医生医嘱的复苏偏好不一致。这些不一致的潜在病因可能反映了诸如患者犹豫不决或患者与临床医生沟通不畅等因素，需要进一步探索。
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