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在医学实践中寻找新的意义:在 COVID-19 疫情初期高峰期评估远程沟通联络项目的质量改进项目。

Finding New Meaning in the Practice of Medicine: A Quality Improvement Project Evaluating the Remote Communication Liaison Program During the Initial COVID Pandemic Surge.

机构信息

Department of Surgery and Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.

Division of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.

出版信息

J Palliat Med. 2023 Jun;26(6):807-815. doi: 10.1089/jpm.2022.0153. Epub 2023 Jan 2.

Abstract

In spring 2020, the COVID-19 pandemic overwhelmed intensive care teams with severely ill patients. Even at the end of life, families were barred from hospitals, relying solely on remote communication. A Remote Communication Liaison Program (RCLP) was established to ensure daily communication for families, while supporting overstretched intensivists. To evaluate the effectiveness and impact of the RCLP on participating liaisons and intensivists. Two quality improvement surveys were developed and administered electronically. Based in the United States, all liaisons and intensivists who participated in this program were invited to take the surveys. Descriptive statistics were used to analyze the quantitative Likert-scale data, and qualitative analysis was used to assess themes. Among respondents, all (100%) liaisons and more than 90% of intensivists agreed or strongly agreed that the RCLP provided a valuable service to families. More than 70% of intensivists agreed or strongly agreed that the program lessened their workload. More than 90% of liaisons agreed or strongly agreed that participation in the program improved their confidence and skills in end-of-life decision making, difficult conversations, and comprehension of critical care charts. Themes elicited from the liaisons revealed that participation fostered a renewed sense of purpose as physicians, meaningful connection, and opportunities for growth. RCLP successfully trained and deployed liaisons to rapidly develop skills in communication with beleaguered families during COVID-19 surge. Participation in the program had a profound effect on liaisons, who experienced a renewed sense of meaning and connection to the practice of medicine.

摘要

2020 年春季,COVID-19 疫情使重症监护团队不堪重负,接收了大量重症患者。即使在生命的最后时刻,家属也被禁止进入医院,只能进行远程交流。因此建立了远程沟通联络计划(RCLP),以确保家属能够进行日常沟通,并为过度紧张的重症监护医生提供支持。

为了评估 RCLP 对参与联络人和重症监护医生的有效性和影响。开发并通过电子方式进行了两项质量改进调查。该计划基于美国,邀请所有参与该计划的联络人和重症监护医生参加调查。使用描述性统计数据来分析定量李克特量表数据,并使用定性分析来评估主题。

在受访者中,所有(100%)联络人和超过 90%的重症监护医生都同意或强烈同意 RCLP 为家属提供了有价值的服务。超过 70%的重症监护医生同意或强烈同意该计划减轻了他们的工作量。超过 90%的联络人同意或强烈同意参与该计划提高了他们在临终决策、困难对话和理解重症监护图表方面的信心和技能。从联络人那里引出的主题表明,参与该计划培养了他们作为医生的新使命感、有意义的联系以及成长的机会。

RCLP 成功地培训和部署了联络人,以在 COVID-19 疫情高峰期迅速提高与困境中的家庭沟通的技能。该计划对联络人产生了深远的影响,他们重新感受到了医学实践的意义和联系。

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