1 Department of Internal Medicine, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil .
2 Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil .
J Palliat Med. 2019 Jan;22(1):71-74. doi: 10.1089/jpm.2018.0024. Epub 2018 Sep 22.
Despite the increase in the identification of patients at the end of life after the introduction of rapid response team (RRT), there is doubt as to whether there has been an improvement in the quality of care offered to these patients. Proper end-of-life care is the next expected step after identifying patients who are dying.
To evaluate the end-of-life care after limitations of medical treatment (LOMTs) as defined by an RRT.
This is a single-center retrospective cohort study at a tertiary teaching hospital in Porto Alegre, Brazil, from July 2014 to July 2016.
SETTING/SUBJECTS: We included 242 patients with an LOMT as defined by the RRT.
Outcomes of interest included symptoms and palliative measures after RRT review.
During the study period, there were 5396 calls to 2937 patients, representing 126 calls per 1000 hospital discharges. Of these calls, 4.9% (n = 242) resulted in an LOMT. The primary care team agreed with the LOMT decision proposed by the RRT in 91.7% of cases. Regarding end-of-life symptoms, 7.4% and 5.8% of patients presented with intense or moderate pain, respectively, and 62.4% of patients presented dyspnea in the last 48 hours of hospitalization. Less than 15% of patients received attention for their spiritual needs and/or received psychological support.
Our data reinforce the important role of RRTs in the identification of end-of-life patients with clinical deterioration. Despite the increase in the identification of these patients, the quality of end-of-life care needs to be improved.
尽管快速反应团队（RRT）引入后，终末期患者的识别有所增加，但仍存在疑问，即这些患者的护理质量是否有所提高。适当的临终关怀是识别即将死亡患者后的下一步预期措施。
评估 RRT 定义的限制医疗措施（LOMT）后的临终关怀。
这是巴西阿雷格里港的一家三级教学医院的单中心回顾性队列研究，时间为 2014 年 7 月至 2016 年 7 月。
地点/对象：我们纳入了 242 例由 RRT 定义的 LOMT 患者。
感兴趣的结局包括 RRT 审查后症状和姑息治疗措施。
在研究期间，有 5396 次电话联系了 2937 名患者，每 1000 次出院有 126 次电话。这些电话中，有 4.9%（n=242）导致 LOMT。初级保健团队在 91.7%的情况下同意 RRT 提出的 LOMT 决定。关于临终症状，7.4%和 5.8%的患者分别出现剧烈或中度疼痛，62.4%的患者在住院的最后 48 小时内出现呼吸困难。不到 15%的患者的精神需求得到了关注，或接受了心理支持。
我们的数据强化了 RRT 在识别临床恶化的终末期患者中的重要作用。尽管这些患者的识别有所增加，但临终关怀的质量仍有待提高。
