Vig Elizabeth K
1 Geriatrics and Extended Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
2 Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA.
Am J Hosp Palliat Care. 2019 Apr;36(4):290-293. doi: 10.1177/1049909118795478. Epub 2018 Aug 22.
: Patients in medical intensive care units (MICUs) are medically complex. This complexity can lead to uncertainty about patient goals and prognosis. Ethical dilemmas arise when there is uncertainty about the clinically and ethically appropriate actions for managing seriously ill patients. Ethics and palliative care involvement may promote improved quality of care and reduced staff moral distress.
: In this clinical project, a physician with ethics, palliative care, and geriatrics expertise attended morning rounds with the MICU team weekly. Data on the logistics and impact from the first 2 years of the project were collected.
: Rounds lasted approximately 1.75 hours per week. The rounder was present for discussion of approximately 200 patients per year and made comments on nearly half of the patients. The comments were categorized as 25% ethics, 40% palliative care, 10% geriatrics, and 25% a combination or other topic. Attending physicians rated the project as helpful. The number of ethics and palliative care consults from the MICU increased in the first 2 years. Downstream impact has included a dietician reviewing Physician Orders for Life Sustaining Treatment forms with teams throughout the hospital and routine review of advance directives of newly admitted patients.
: Weekly MICU rounding provides an opportunity to briefly teach staff and trainees about relevant ethics, palliative care, and geriatrics issues. It also provides a forum for discussion of ethically challenging cases. Considerations when starting a similar program are discussed.
医疗重症监护病房（MICU）的患者病情复杂。这种复杂性可能导致患者目标和预后的不确定性。当在管理重症患者的临床和伦理适当行动方面存在不确定性时，就会出现伦理困境。伦理和姑息治疗的参与可能会提高护理质量并减轻工作人员的道德困扰。
在这个临床项目中，一位具备伦理、姑息治疗和老年医学专业知识的医生每周与MICU团队一起参加早查房。收集了该项目前两年的后勤数据和影响数据。
查房每周持续约1.75小时。查房医生每年参与讨论约200名患者，并对近一半的患者发表意见。这些意见的分类为：25%是伦理方面，40%是姑息治疗方面，10%是老年医学方面，25%是综合或其他主题。主治医生对该项目给予了好评。在头两年中，MICU的伦理和姑息治疗会诊数量有所增加。下游影响包括一名营养师与全院各团队一起审查维持生命治疗医嘱表，以及对新入院患者的预先指示进行常规审查。
每周的MICU查房为向工作人员和实习生简要传授相关伦理、姑息治疗和老年医学问题提供了机会。它还为讨论具有伦理挑战性的病例提供了一个论坛。文中讨论了启动类似项目时的注意事项。
