Hauschildt Katrina E, Hechtman Rachel K, Prescott Hallie C, Iwashyna Theodore J
Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI.
Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI.
Crit Care Explor. 2022 Jun 9;4(6):e0715. doi: 10.1097/CCE.0000000000000715. eCollection 2022 Jun.
Primary care providers (PCPs) receive limited information about their patients' ICU stays; we sought to understand what additional information PCPs desire to support patients' recovery following critical illness.
Semistructured interviews with PCPs conducted between September 2020 and April 2021.
Academic health system with central quaternary-care hospital and associated Veterans Affairs medical center.
Fourteen attending internal medicine or family medicine physicians working in seven clinics across Southeast Michigan (median, 10.5 yr in practice).
We analyzed using a modified Rigorous and Accelerated Data Reduction (RADaR) technique to identify gaps in current discharge summaries for patients with ICU stays, impacts of these gaps, and desired ICU-specific information. We employed RADaR to efficiently consolidate data in Excel Microsoft (Redmond, WA) tables across multiple formats (lists, themes, etc.).
PCPs reported receiving limited ICU-specific information in hospital discharge summaries. PCPs often spent significant time reading inpatient records for additional information. Information desired included life-support interventions provided and duration (mechanical ventilation, dialysis, etc.), reasons for treatment decisions (code status changes, medication changes, etc.), and potential complications (delirium, dysphagia, postintensive care syndrome, etc.). Pervasive discharge gaps (ongoing needs, incidental findings, etc.) were described as worse among patients with ICU stays due to more complex illness and required interventions. Insufficient information was felt to lead to incomplete follow-up on critical issues, PCP frustration, and patient harm. PCPs stated that the COVID-19 pandemic exacerbated gaps due to decreased staffing, limited visitation policies, and reliance on telehealth follow-up visits.
Our results identified key data elements sought by PCPs about patients' ICU stays and suggest opportunities to improve care through developing tools/templates to provide PCPs with ICU-specific information for outpatient follow-up.
基层医疗服务提供者（PCP）获取到的关于其患者在重症监护病房（ICU）住院情况的信息有限；我们试图了解PCP还希望获得哪些信息来支持重症疾病患者康复。
2020年9月至2021年4月期间对PCP进行半结构化访谈。
拥有中央四级医疗医院及相关退伍军人事务医疗中心的学术医疗系统。
在密歇根州东南部七个诊所工作的14名内科或家庭医学主治医生（从业中位数为10.5年）。
我们使用改良的严格加速数据缩减（RADaR）技术进行分析，以确定当前ICU住院患者出院小结中的差距、这些差距的影响以及所需的ICU特定信息。我们运用RADaR在Excel Microsoft（华盛顿州雷德蒙德）表格中高效整合多种格式（列表、主题等）的数据。
PCP报告称在医院出院小结中获得的ICU特定信息有限。PCP通常要花费大量时间阅读住院记录以获取更多信息。所需信息包括所提供的生命支持干预措施及持续时间（机械通气、透析等）、治疗决策的原因（代码状态变化、药物变化等）以及潜在并发症（谵妄、吞咽困难、重症监护后综合征等）。普遍存在的出院差距（持续需求、偶然发现等）在因病情更复杂且需要干预而入住ICU的患者中被描述得更严重。信息不足被认为会导致对关键问题的随访不完整、PCP感到沮丧以及对患者造成伤害。PCP表示，由于人员配备减少、探视政策受限以及依赖远程医疗随访就诊，新冠疫情加剧了这些差距。
我们的结果确定了PCP所寻求的关于患者ICU住院情况的关键数据要素，并提出了通过开发工具/模板为PCP提供ICU特定信息以用于门诊随访来改善护理的机会。
