Heufel Melissa, Kourouche Sarah, Curtis Kate
Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Susan Wakil School of Nursing and Midwifery, 88 Mallet St, Camperdown, NSW 2006, Australia.
Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Crown St, Wollongong, NSW, Australia.
Int J Nurs Stud Adv. 2023 Jul 14;5:100143. doi: 10.1016/j.ijnsa.2023.100143. eCollection 2023 Dec.
Emergency departments frequently care for patients at the end of life and should have robust processes for reviewing delivery of care. The aim of this scoping review is to examine and collate the chart audit tools available to assess the quality of end of life care of patients who die in the emergency department, or, in the subsequent hospital admission.
A scoping review of the literature using the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and the methodological framework outlined by Arksey and O'Malley was conducted. Primary and secondary research, along with grey literature were searched. Both adult and paediatric populations were included. Databases Ovid Emcare, CINAHL and Medline were searched from 1961 to December 2022; followed by screening and appraisal. Articles were compared and data synthesised into categories.
Fifty-eight articles were included generating three categories; contexts for end of life audit use, development and evaluation of audit tools, and audit characteristics / components. Four tools focused on the emergency department, however, did not comprehensively review both end of life and emergency department specific data. A draft audit tool for the emergency department was developed that consisted of the common elements to evaluate end of life care as identified in this review, emergency department-specific quality of care measures and the integration of the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) tool.
No audit tool to comprehensively review end of life care provided for patients at the end of life in the emergency department was found. We developed an audit tool based on best available evidence that now needs testing for validity, feasibility, and usability to evaluate end of life in the emergency department setting is required.
急诊科经常为临终患者提供护理，应具备完善的流程来审查护理服务的提供情况。本范围综述的目的是检查和整理现有的图表审核工具，以评估在急诊科死亡或随后住院期间死亡的患者的临终护理质量。
采用PRISMA-ScR（系统评价和Meta分析扩展的范围综述首选报告项目）指南以及Arksey和O'Malley概述的方法框架对文献进行范围综述。检索了初级和二级研究以及灰色文献。纳入了成人和儿科人群。检索了1961年至2022年12月的Ovid Emcare、CINAHL和Medline数据库；随后进行筛选和评估。对文章进行比较，并将数据综合分类。
纳入了58篇文章，分为三类；临终审核使用的背景、审核工具的开发和评估以及审核特征/组成部分。有四种工具侧重于急诊科，但没有全面审查临终和急诊科特定数据。开发了一种急诊科审核工具草案，该草案包括本综述中确定的评估临终护理的共同要素、急诊科特定的护理质量措施以及筛选和分诊到适当替代护理标准（CriSTAL）工具的整合。
未发现有审核工具能全面审查急诊科为临终患者提供的临终护理。我们基于现有最佳证据开发了一种审核工具，现在需要对其有效性、可行性和可用性进行测试，以评估急诊科环境中的临终情况。
