Wolfe Heather A, Mack Elizabeth H
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA.
Transl Pediatr. 2018 Oct;7(4):267-274. doi: 10.21037/tp.2018.09.10.
The relatively young field of pediatric critical care has seen a shift from an approach with little consideration for the complications and adverse effects resulting from the procedures and medications to a more cautious approach with careful concern for the associated risks. Many senior pediatric intensivists recall a time when nearly every patient had a central venous line and arterial line; and hospital acquired infections, pressure injuries, unplanned extubations, and venous thromboemboli were expected costs of aggressive care. In addition to the morbidity and mortality associated with many of the health care-acquired conditions (HACs) in children, the attributable cost due to these HACs contributes to the unsustainable health care financial crisis. The Centers for Medicare and Medicaid Services (CMS) often penalize hospitals for HACs, and also are beginning to reimburse in a bundled fashion such that complications become the institution's burden. In children, payors and patients' families are often saddling this burden of costs attributable to HACs. The direct attributable costs per event are staggering. Payors, families, patients, and health care teams now demand a circumspect approach to care: do no harm, but how?
儿科重症监护这一相对年轻的领域已发生转变，从几乎不考虑诊疗操作和药物所导致的并发症及不良反应的方式，转变为更加谨慎、密切关注相关风险的方式。许多资深儿科重症监护医生都记得，曾经几乎每个患者都有中心静脉导管和动脉导管；而医院获得性感染、压疮、意外拔管和静脉血栓栓塞被视为积极治疗的预期代价。除了与儿童许多医疗保健相关状况（HACs）相关的发病率和死亡率外，这些HACs造成的可归因成本也导致了不可持续的医疗保健财政危机。医疗保险和医疗补助服务中心（CMS）经常因HACs对医院进行处罚，而且还开始采用捆绑式报销方式，使得并发症成为医疗机构的负担。在儿童中，付款方和患者家属往往要承担HACs造成的成本负担。每个事件的直接可归因成本高得惊人。付款方、家庭、患者和医疗团队现在都要求采取审慎的护理方法：不造成伤害，但该如何做到呢？
