Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.
Pharmaceutical Services, School of Pharmacy, University of California, San Francisco, CA.
Crit Care Med. 2018 Jun;46(6):980-990. doi: 10.1097/CCM.0000000000003067.
We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success.
Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles.
Original articles, review articles, and systematic reviews were considered.
Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles.
"Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care.
A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
我们描述了在现代重症监护医学中跨专业护理的重要性。本综述强调了跨专业护理团队中特定成员(包括患者及其家属)的重要作用,并讨论了需要跨专业合作才能成功实施的质量改进措施。
通过使用与跨专业护理、重症监护提供者类型和质量改进措施相关的各种搜索词,在 MEDLINE 搜索中确定了研究。通过对已确定文章的参考文献进行回顾,确定了其他文章。
纳入了原始文章、综述文章和系统评价。
根据精心设计的研究或关键研究和综述文章的专家意见选择纳入的手稿。
“跨专业护理”是指由一组具有重叠专业知识并欣赏其他团队成员作为共同实现共同目标的伙伴的独特贡献的医疗保健专业人员提供的护理。大量数据支持由跨专业团队提供护理时患者水平结局的改善。重症监护护士、高级实践提供者、药剂师、呼吸治疗师、康复专家、营养师、社会工作者、病例管理员、精神关怀提供者、重症监护医师和非重症监护医师都为患者护理提供独特的专业知识和观点,因此在团队中发挥重要作用,该团队必须满足 ICU 中患者和家属的多样化需求。让患者及其家属作为医疗保健合作伙伴也至关重要。许多重要的 ICU 质量改进措施都需要采取跨专业方法,包括觉醒和呼吸协调、谵妄、早期运动/活动、以及家属赋能包的实施、跨专业轮班实践、以单位为基础的质量改进措施、患者和家属咨询委员会、临终关怀、协调镇静唤醒和自主呼吸试验、院内转运以及护理交接。
大量证据支持跨专业方法是为越来越复杂和需求多样化的患者提供高质量重症监护的关键组成部分。