Elmufdi Firas S, Burton Susan L, Sahni Nishant, Weinert Craig R
1 University of Minnesota, Regions Hospital, St Paul, MN.
2 University of Minnesota, Minneapolis, MN.
Am J Med Qual. 2018 Jul;33(4):391-396. doi: 10.1177/1062860617748739. Epub 2017 Dec 19.
In-hospital medical emergencies occur frequently. Understanding how clinicians respond to deteriorating patients outside the intensive care unit (ICU) could improve "rescue" interventions and rapid response programs. This was a qualitative study with interviews with 40 clinicians caring for patients who had a "Code Blue" activation or an unplanned ICU admission at teaching hospitals over 7 months. Four study physicians independently analyzed interview transcripts; refined themes were linked to the transcript using text analysis software. Nine themes were found to be associated with clinicians' management of deteriorating patients. Multiple human biases influence daily care for deteriorating hospitalized patients. A novel finding is that "moral distress" affects escalation behavior for patients with poor prognosis. Most themes indicate that ward culture influences clinicians to wait until the last minute to escalate care despite being worried about the patients' condition.
院内医疗紧急情况频繁发生。了解临床医生如何应对重症监护病房（ICU）以外病情恶化的患者，有助于改进“救援”干预措施和快速反应计划。这是一项定性研究，对40名在7个月内于教学医院照顾过经历“蓝色代码”激活或非计划入住ICU患者的临床医生进行了访谈。四名研究医生独立分析访谈记录；使用文本分析软件将提炼出的主题与记录相联系。发现九个主题与临床医生对病情恶化患者的管理有关。多种人为偏差影响着对住院病情恶化患者的日常护理。一个新发现是，“道德困扰”会影响对预后不良患者的升级护理行为。大多数主题表明，尽管担心患者病情，但病房文化会影响临床医生等到最后一刻才升级护理。
