Zuo Jessica X, Ruskin Andrea, Bauer Margaret R
University of Pennsylvania, Philadelphia.
Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Fed Pract. 2023 Nov;40(11):368-372. doi: 10.12788/fp.0434. Epub 2023 Nov 9.
At the end of life, some patients wish to be discharged directly home from the hospital, but health care teams may consider this unsafe, raising concerns for capacity and risk. However, defining risk is subjective and impacted by values, preferences, and clinical status. Accommodating patient preferences in discharge destinations can promote autonomy, dignity, and quality of life at the end of life.
We developed a risk assessment framework to help clinicians objectively identify risk factors and protective factors and develop a comprehensive discharge plan. We applied this framework to a veteran nearing the end of life and he was able to successfully return home from the hospital.
Approaching end-of-life discharges with a framework can inform discharge planning and lessen the risk of adverse events. Importantly, this framework can help clinicians communicate better and partner with patients and their loved ones in prioritizing patient values and preferences.
在生命末期，一些患者希望直接从医院出院回家，但医疗团队可能认为这不安全，从而引发对能力和风险的担忧。然而，风险的定义是主观的，且受价值观、偏好和临床状况的影响。在出院目的地方面顺应患者的偏好可以在生命末期促进自主性、尊严和生活质量。
我们制定了一个风险评估框架，以帮助临床医生客观地识别风险因素和保护因素，并制定全面的出院计划。我们将这个框架应用于一位接近生命末期的退伍军人，他得以成功从医院返回家中。
采用一个框架来处理生命末期的出院事宜可以为出院计划提供信息，并降低不良事件的风险。重要的是，这个框架可以帮助临床医生更好地沟通，并与患者及其亲人合作，以优先考虑患者的价值观和偏好。
