从重症监护病房嵌入式姑息治疗模式中吸取的经验教训。
Lessons Learned from an Embedded Palliative Care Model in the Medical Intensive Care Unit.
机构信息
Brookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Brookdale Department of Geriatrics and Palliative Medicine (A.M., P.K., E.C., J.L., A.N., L.Z., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
出版信息
J Pain Symptom Manage. 2023 Apr;65(4):e321-e327. doi: 10.1016/j.jpainsymman.2022.12.011. Epub 2022 Dec 27.
OBJECTIVE
To describe a physician (MD) and registered nurse (RN) led palliative care consultation team embedded in the medical intensive care unit (MICU). To compare patterns of palliative care consultation, and rates of goals of care documentation and in-ICU mortality before and after the implementation of the embedded team.
CONTEXT
By embedding MD/RN palliative care team in the MICU, more critically ill patients with unmet palliative care needs could receive an earlier palliative care consultation.
METHODS
In a retrospective cohort study of patients admitted to the MICU who received a palliative care consultation, we compared sociodemographic and clinical characteristics of patients who received a referral-based consultation (01/01/2019-06/30/2019) and those who received an embedded MD/RN consult (09/01/2019-02/28/2020). Using the electronic health record data, we compared palliative care consultation characteristics, rates of documentation of medical decision-maker and goals of care, and percentage of in-ICU mortality between the referral group and the embedded group.
RESULTS
In a six-month period, 169 MICU patients received an embedded consultation, as compared to 52 MICU patients who received a referral-based consultation. As compared to the referral-based period, those patients who received an embedded consult were seen significantly earlier in hospitalization (median number of days from hospital admission to consult: 10 days [pre] vs. 3 days [embedded], P<0.001), more likely to have documentation of medical decision-makers (40% [pre] vs. 66% [embedded], P=0.002) and goals of care (37% [pre] vs. 71% [embedded], P<0.001) and less likely to die in the hospital (75% [pre] vs. 44% [embedded], P<0.001).
CONCLUSIONS
After embedding a palliative care MD/RN team into the MICU, patients received earlier palliative care consultation, were more likely to have medical decision-maker and goals of care documented, and less likely to die in the hospital. Future work will examine how to adapt this model to other ICUs to improve palliative care access for critically ill patients broadly.
目的
描述一个由医生（MD）和注册护士（RN）组成的姑息治疗咨询团队，该团队嵌入在医疗重症监护病房（MICU）中。比较实施嵌入式团队前后姑息治疗咨询的模式以及目标治疗记录和 ICU 内死亡率的差异。
背景
通过将 MD/RN 姑息治疗团队嵌入 MICU，可以使更多有未满足的姑息治疗需求的重症患者更早地接受姑息治疗咨询。
方法
在一项对入住 MICU 并接受姑息治疗咨询的患者进行的回顾性队列研究中，我们比较了接受基于转介的咨询（2019 年 1 月 1 日至 6 月 30 日）和接受嵌入式 MD/RN 咨询（2019 年 9 月 1 日至 2020 年 2 月 28 日）的患者的社会人口统计学和临床特征。我们使用电子健康记录数据比较了转介组和嵌入式组的姑息治疗咨询特征、医疗决策者和目标治疗记录的比例，以及 ICU 内死亡率的百分比。
结果
在六个月的时间里，有 169 名 MICU 患者接受了嵌入式咨询，而 52 名 MICU 患者接受了基于转介的咨询。与基于转介的时期相比，接受嵌入式咨询的患者在住院期间更早接受了咨询（中位数从入院到咨询的天数：10 天[前] vs. 3 天[嵌入式]，P<0.001），更有可能记录医疗决策者（40%[前] vs. 66%[嵌入式]，P=0.002）和目标治疗（37%[前] vs. 71%[嵌入式]，P<0.001），且在医院内死亡的可能性较小（75%[前] vs. 44%[嵌入式]，P<0.001）。
结论
将姑息治疗 MD/RN 团队嵌入 MICU 后，患者接受了更早的姑息治疗咨询，更有可能记录医疗决策者和目标治疗，并且在医院内死亡的可能性较小。未来的工作将研究如何将这种模式应用于其他 ICU 以广泛改善重症患者的姑息治疗机会。
Zotero 插件