Nishikawa Yuichi, Taito Shunsuke, Sarada Kazuhiro, Ota Kohei, Tanabe Yuko, Hosomi Naohisa, Takahashi Tetsuya, Maruyama Hirofumi, Kimura Hiroaki, Matsumoto Masayasu
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan.
Prog Rehabil Med. 2016 Dec 22;1:20160010. doi: 10.2490/prm.20160010. eCollection 2016.
Team-based approaches involving the cooperation of various professionals have the power to improve the quality of medical care by utilizing the specialized knowledge and skills of each professional. A multidisciplinary pain, agitation, and delirium (PAD) management team was established in Hiroshima University Hospital. Herein, we describe smooth patient mobilization achieved by enabling discussions among members of this multidisciplinary management team.
The patient was a 72-year-old Japanese woman with acute exacerbation of interstitial pneumonia and respiratory failure. We identified a suspected alveolar hemorrhage by bronchofiberscopy on the patient's first day in the intensive care unit (ICU). This finding required the patient to be placed on bed rest. Therefore, her physiotherapy program was restricted to mobilization. In team rounds during the patient's 5th day in the ICU, we discussed her mobilization. Discussions among the multidisciplinary medical staff led to mobilization and a reduction in sedation medication administered because of the suspected alveolar hemorrhage. The patient underwent a second bronchofiberscopy by emergency medical doctors to assess the alveolar hemorrhage immediately after PAD rounds. The suspected alveolar hemorrhage was not confirmed. Therefore, the physiotherapy program was amended to include standing exercises and sitting in a wheelchair; the new program was initiated the same day. The patient did not experience worsening symptoms during her hospitalization and was discharged from the hospital 95 days after initial admission.
By discussing treatment options within a multidisciplinary medical team, we achieved smooth patient mobilization and administered reduced levels of sedation medication.
涉及多专业人员合作的团队式方法，有能力通过利用每个专业人员的专业知识和技能来提高医疗质量。广岛大学医院成立了一个多学科疼痛、躁动和谵妄（PAD）管理团队。在此，我们描述了通过促成该多学科管理团队成员之间的讨论而实现的患者平稳活动。
患者为一名72岁的日本女性，患有间质性肺炎急性加重和呼吸衰竭。在患者入住重症监护病房（ICU）的第一天，我们通过支气管纤维镜检查发现疑似肺泡出血。这一发现要求患者卧床休息。因此，她的物理治疗计划仅限于活动。在患者入住ICU的第5天进行团队查房时，我们讨论了她的活动问题。多学科医护人员之间的讨论促成了活动，并减少了因疑似肺泡出血而使用的镇静药物。在PAD查房后，急诊医生立即对患者进行了第二次支气管纤维镜检查，以评估肺泡出血情况。疑似肺泡出血未得到证实。因此，物理治疗计划修改为包括站立练习和坐轮椅；新计划于当天开始实施。患者在住院期间症状未加重，初次入院95天后出院。
通过在多学科医疗团队内讨论治疗方案，我们实现了患者的平稳活动，并减少了镇静药物的使用量。
