Sasanuma Naoki, Takahashi Keiko, Eguchi Akiyo, Yamauchi Shinya, Uchiyama Yuki, Domen Kazuhisa
Department of Rehabilitation, Hyogo Medical University Hospital, Japan.
School of Medicine, Department of the Patient Safety and Quality Management, Hyogo Medical University, Japan.
Phys Ther Res. 2024;27(1):21-34. doi: 10.1298/ptr.E10272. Epub 2024 Feb 10.
There are few analyses of the current status of and responses to acute deteriorations encountered by physiotherapists, occupational therapists, and speech-language pathologists (rehabilitation professions [RPs]). The purpose of this study was to analyze the responses of RPs to acute deterioration in patients using the functional resonance analysis method (FRAM) based on the descriptions in "the Medical Accident Database".
Subjects were 413 cases with medical incidents reported by RPs to the database from 2012 to 2021. Life-threatening cases with changes in consciousness, circulation, and respiration were selected. Descriptions regarding findings assessed by RPs and support team, and requests for assistance were extracted. We also attempted to construct appropriate respond in RPs by using the FRAM.
Thirty-nine cases of acute deterioration were included in the analysis, and descriptions by RPs of consciousness (35 cases), circulation (18 cases), and respiration (36 cases) were identified. Blood pressure and percutaneous oxygen saturation measurement were frequently presented in the assessment by RPs, whereas the support team assessed cardiac arrest and respiratory arrest in high frequency. The FRAM analysis indicated that appropriate and rapid post-response by RPs requires patient information in prior, appropriate assessment and integration/interpretation.
We attempted to identify problems analyzing the response by RPs to acute deterioration using the database and construct an appropriate response model. It resulted that RPs need to obtain patient information in advance and integrate/interpret it appropriately based on accurate assessment of conscious, circulation and respiration for rapid response. A model including integration/interpretation for appropriate post-response by RPs was constructed using the FRAM.
针对物理治疗师、职业治疗师和言语语言病理学家（康复专业人员[RPs]）所遇到的急性病情恶化的现状及应对情况，相关分析较少。本研究旨在根据“医疗事故数据库”中的描述，运用功能共振分析方法（FRAM）分析康复专业人员对患者急性病情恶化的应对情况。
研究对象为2012年至2021年康复专业人员向该数据库报告的413例医疗事件。选取了意识、循环和呼吸发生变化的危及生命的病例。提取了康复专业人员和支持团队评估的结果描述以及援助请求。我们还尝试运用FRAM构建康复专业人员的适当应对方式。
分析纳入了39例急性病情恶化病例，确定了康复专业人员对意识（35例）、循环（18例）和呼吸（36例）的描述。康复专业人员在评估中经常提及血压和经皮血氧饱和度测量，而支持团队高频评估心脏骤停和呼吸骤停。FRAM分析表明，康复专业人员要做出适当且迅速的应对后反应，需要事先掌握患者信息、进行适当评估以及整合/解读信息。
我们尝试利用该数据库识别分析康复专业人员对急性病情恶化应对情况时存在的问题，并构建适当的应对模型。结果表明，康复专业人员需要提前获取患者信息，并基于对意识、循环和呼吸的准确评估进行适当整合/解读，以便迅速做出反应。利用FRAM构建了一个包含康复专业人员适当应对后反应的整合/解读的模型。
