Mun Eluned, Umbarger Lillian, Ceria-Ulep Clementina, Nakatsuka Craig
1 Department of Physician Services, The Rehabilitation Hospital of the Pacific, Honolulu, HI, USA.
2 Department of Intensive Care Unit, Kaiser Permanente Medical Center, Honolulu, HI, USA.
Am J Hosp Palliat Care. 2018 Jan;35(1):60-65. doi: 10.1177/1049909116684821. Epub 2016 Dec 21.
Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team.
Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations.
A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria.
These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting.
Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly.
Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.
姑息治疗团队已被证明在早期识别临终关怀计划的多个方面发挥着重要作用。尽管为满足不断增加的会诊需求而增加了服务数量，但仅重症监护病房（ICU）产生的姑息治疗会诊数量就可能使现有的姑息治疗团队不堪重负，这是可以想象的。
通过将基本的姑息治疗流程纳入ICU日常工作流程，改善ICU的临终关怀，从而将姑息治疗团队留作处理棘手情况之用。
在夏威夷凯撒永久医疗中心的ICU实施并评估了一项结构化的姑息治疗质量改进计划。这包括选择触发标准、护理模式、制定指南以及制定评估标准。
这些指标包括早期识别临终关怀计划的多个特征、主动发起的ICU和姑息治疗家庭会议的数量，以及任何一次会议结束后患者抢救状态和治疗的变化。
ICU工作人员对护理目标、预先指示和抢救状态的早期识别促成了一次主动发起的ICU家庭会议，从而使抢救状态和治疗的变化有所增加。姑息治疗会诊的数量也有所上升，但幅度不大。
姑息治疗流程可以纳入ICU日常工作流程，以便系统且主动地识别临终关怀计划的各个方面。这使得姑息治疗团队可以留作处理ICU工作人员进行的姑息治疗措施无效的情况。
