Shinall Myrick C, Martin Sara F, Nelson Jill, Miller Richard S, Semler Matthew W, Zimmerman Eli E, Noblit Christy C, Ely E Wesley, Karlekar Mohana
1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA.
2 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Hosp Palliat Care. 2018 Aug;35(8):1057-1062. doi: 10.1177/1049909117751878. Epub 2018 Jan 11.
Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center.
We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017.
Over these 5 years, there were 3321 admissions to the PCU. No single underlying disease process accounted for the majority of the patients, but the largest single category of patients were those with malignancy, who accounted for 38% of admissions. Transfers from the intensive care unit accounted for 50% of admissions, with 43% of admissions from a hospital floor and 7% coming from the emergency department or a clinic. Median length of stay in the PCU was 3 days. In hospital deaths occurred for 50% of admitted patients, while 38% of patients were discharged from the PCU to hospice.
These data show that a successful PCU is enabled by buy in from a wide variety of referring specialists and by a multidisciplinary palliative care team focused on care of the actively dying patient as well as pain and symptom management, advance care planning, and hospice referral since a large proportion of referred patients do not die in house.
许多医疗中心已设立了由经过专业培训的医生和护士组成的姑息治疗病房（PCU）。本研究的目的是回顾一家大型城市学术转诊中心的PCU的5年经验。
我们回顾性分析了范德堡大学医学中心PCU在2012年至2017年成立后的前5年中所有入院患者的前瞻性收集数据库。
在这5年中，PCU共有3321例入院患者。没有单一的基础疾病过程占大多数患者，但最大的单一患者类别是恶性肿瘤患者，占入院患者的38%。从重症监护病房转入的患者占入院患者的50%，43%的入院患者来自医院病房，7%来自急诊科或诊所。在PCU的中位住院时间为3天。50%的入院患者在医院死亡，而38%的患者从PCU出院后进入临终关怀机构。
这些数据表明，一个成功的PCU得益于众多转诊专科医生的支持以及一个多学科姑息治疗团队，该团队专注于积极濒死患者的护理以及疼痛和症状管理、预先护理计划和临终关怀转诊，因为很大一部分转诊患者并非在医院死亡。
