Polt Günter, Weixler Dietmar, Bauer Norbert
LKH Hartberg, Rotkreuzplatz 2, 8230, Hartberg, Österreich.
LKH Horn, Horn, Österreich.
Wien Med Wochenschr. 2019 Nov;169(15-16):356-363. doi: 10.1007/s10354-019-0681-3. Epub 2019 Feb 6.
In palliative medicine planning in advance is important for critical care situations. It is highly significant to make useful and by the patient and his relatives desired decisions. These concern transport in a situation of crisis and the venue of death (either death at home or transfer to a hospital).In this study the effect of a new Emergency Information Form about the place of death was examined. The used Emergency Information Form enabled the patient to express a wish on transfer in the case of crisis in advance and communicate this wish to the Emergency system.A total of 858 patients, taken care of by the mobile palliative-team Hartberg/Weiz/Vorau in the period from 2010 to 2015, were included in the study. The Intervention group-the patients for whom an Emergency Information Form was established-counted 38 patients. Data analysis was retrospective, pseudo anonymized and external.The 4 most important results were:1) The Emergency Information Form increased the probability for the intervention group to die at home (intervention group: 72.2%, controll group 1: 53.0%, controll group 2: 56.6%).2) Important in this change was, that the opinion of the patients was considered. The decision made in the Emergency Information Form correlated with a high significance (p = 0.01) with the actual place of death.3) Furthermore, it came clear that the Emergency Information Form was a useful tool to handle the utilization of special facilities. Within the intervention group young patients (with a lot of symptoms) died in a special facility more often than old patients. These, rather geriatric people, were mostly brought to a general hospital.4) There was no significant relation between the duration of care and the probability that an Emergency Information Form was established (p = 0.63). However, there was a high significance between the number of home visits and the probability that an Emergency Information Form was written (p = 0.02).Due to the fact that there was a small intervention group restricted to only one palliative team further studies could help to make clear advises for palliative teams regarding scope, duration and frequency of home-visits. Thus the term "care continuity" could be concretized in the guidelines.The study brought forward that numerous (and short) contacts with the patient were more convenient than less but long home-visits in order to fulfil the patients wish concerning his place of death.
在姑息医学中，提前规划对于重症护理情况至关重要。做出对患者及其亲属有用且期望的决定非常重要。这些决定涉及危机情况下的转运以及死亡地点（在家中死亡或转至医院）。在本研究中，考察了一种关于死亡地点的新型紧急信息表的效果。所使用的紧急信息表使患者能够提前表达在危机情况下的转运意愿，并将此意愿传达给急救系统。
本研究纳入了2010年至2015年期间由哈特贝格/魏茨/沃劳移动姑息治疗团队照料的858名患者。干预组——即建立了紧急信息表的患者——有38名。数据分析是回顾性的、伪匿名的且由外部进行。
4个最重要的结果如下：
紧急信息表增加了干预组在家中死亡的概率（干预组：72.2%，对照组1：53.0%，对照组2：56.6%）。
这一变化中重要的是，考虑了患者的意见。紧急信息表中做出的决定与实际死亡地点高度相关（p = 0.01）。
此外，很明显紧急信息表是处理特殊设施使用的有用工具。在干预组中，年轻患者（症状较多）在特殊设施中死亡的频率高于老年患者。而这些老年患者大多被送往综合医院。
护理时长与建立紧急信息表的概率之间无显著关系（p = 0.63）。然而，家访次数与填写紧急信息表的概率之间存在高度相关性（p = 0.02）。
由于干预组规模较小且仅限于一个姑息治疗团队，进一步的研究有助于为姑息治疗团队就家访的范围、时长和频率提出明确建议。这样，“护理连续性”这一术语在指南中就可以具体化。
该研究提出，为了满足患者关于死亡地点的意愿，与患者进行多次（且短暂）接触比进行较少但较长时间的家访更为便利。
