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将缓和医学纳入 COVID-19 重症治疗的影响。

The Impact of Integrating Palliative Medicine Into COVID-19 Critical Care.

机构信息

Assistant Professor, Department of Internal Medicine, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.

The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.

出版信息

J Pain Symptom Manage. 2021 Jul;62(1):153-158.e1. doi: 10.1016/j.jpainsymman.2020.12.014. Epub 2021 Feb 9.

Abstract

BACKGROUND

Ensuring high-quality patient-centered care for critically ill coronavirus disease 2019 (COVID-19) patients presents unprecedented challenges. Many patients become critically ill unexpectedly and have not previously discussed their health-care wishes. Clinicians lack experience with this illness and therefore struggle to predict patient outcomes.

MEASURES

Critical care medicine (CCM) providers were surveyed about the effectiveness and efficiency of a pilot intervention.

INTERVENTION

Proactive palliative care rounding with CCM providers on COVID-19 intensive care units.

OUTCOMES

Fifty-four percent of CCM providers responded to the survey (21/39). CCM providers rated the intervention highly across all domains. CCM providers frequently identified that early palliative involvement was critical to providing families with information and support when separated from their loved ones.

CONCLUSIONS/LESSONS LEARNED: This pilot study found that proactive rounding improves critical care provider assessments of quality of care for patients and families and allows CCM providers to focus their efforts on managing complex physiology and surges.

摘要

背景

确保患有 2019 年冠状病毒病(COVID-19)的重症患者得到高质量的以患者为中心的护理,这带来了前所未有的挑战。许多患者出乎意料地病情加重,并且之前没有讨论过他们的医疗意愿。临床医生缺乏对此疾病的经验,因此难以预测患者的预后。

措施

对重症监护医学(CCM)提供者进行了一项试点干预措施的效果和效率调查。

干预措施

在 COVID-19 重症监护病房对 CCM 提供者进行主动的姑息治疗查房。

结果

54%的 CCM 提供者对调查做出了回应(21/39)。CCM 提供者在所有领域都对干预措施给予了高度评价。CCM 提供者经常指出,当患者与其亲人分开时,早期的姑息治疗介入对于向家属提供信息和支持至关重要。

结论/经验教训:这项试点研究发现,主动查房提高了重症监护提供者对患者和家属护理质量的评估,并使 CCM 提供者能够集中精力管理复杂的生理和激增问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b83/7871105/a3468369c719/gr1_lrg.jpg

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