Rutgers New Jersey Medical School, Newark, New Jersey, USA.
University Hospital, Newark, New Jersey, USA.
J Pain Symptom Manage. 2018 Oct;56(4):588-593. doi: 10.1016/j.jpainsymman.2018.06.010. Epub 2018 Jun 25.
Few patients with dysphagia because of stroke receive early palliative care (PC) to align treatment goals with their values, as called for by practice guidelines, particularly before enteral access procedures for artificial nutrition.
To increase documented goals of care (GOC) discussions among acute stroke patients before feeding gastrostomy tube placement.
We undertook a rapid-cycle continuous quality improvement process with interdisciplinary planning, implementation, and performance review to operationalize an upstream trigger for PC referral prompted by the speech and language pathology evaluation.
During a six-month period, 21 patients underwent gastrostomy tube placement; 52% had preprocedure GOC discussions postintervention, with the rate of compliance increasing steadily from 13% (11/87, preintervention) to 100% (2/2) in the final two months.
CONCLUSIONS/LESSONS LEARNED: We effectively increased documented GOC discussions before feeding gastrostomy tube placement among stroke patients. Systems-based tools and education will enhance this upstream trigger model to ensure early PC for stroke patients.
很少有因中风而出现吞咽困难的患者接受早期姑息治疗（PC），以使其治疗目标与价值观保持一致，这符合实践指南的要求，尤其是在进行人工营养的肠内通路程序之前。
在进行饲管喂食之前，增加急性中风患者记录的治疗目标（GOC）讨论。
我们通过跨学科的规划、实施和绩效审查，开展了快速循环持续质量改进过程，以实现通过言语和语言病理学评估触发的 PC 转介的上游触发。
在六个月的时间里，有 21 名患者接受了胃造口管放置；52%的患者在术后进行了术前 GOC 讨论，在最后两个月，依从率从 13%（11/87，干预前）稳步上升至 100%（2/2）。
结论/经验教训：我们有效地增加了中风患者在进行饲管喂食前记录的 GOC 讨论。基于系统的工具和教育将增强这种上游触发模型，以确保中风患者的早期 PC。
