Lester Ethan G, Grunberg Victoria A, Bannon Sarah M, Mace Ryan A, Plys Evan, Jacobo Michelle C, Tehan Tarah, Rosand Jonathan, Vranceanu Ana-Maria
Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry and Department of Newborn Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
NEJM Catal Innov Care Deliv. 2022 Aug;3(8). doi: 10.1056/CAT.22.0103. Epub 2022 Jul 20.
More than 5 million patients are admitted to ICUs each year in the United States alone. ICUs are stressful environments given the patients' medical severity, family emotional experience, and staff burnout. However, psychosocial services are rarely offered and sustained in these settings. Multidisciplinary partnerships and innovative frameworks and services are needed to successfully integrate psychosocial care into these complex settings. To address this need, Massachusetts General Hospital developed the Recovering Together (RT) Initiative (2015-present) in its Neurosciences ICUs (Neuro-ICU). The hospital's aims were threefold: (1) to build a multidisciplinary collaboration to develop and sustain integrative care; (2) to implement a clinical, research, and training (CRT) framework to support patients, families, and staff; and (3) to develop an innovative, tailored evidence-based intervention for patient-caregiver dyads in the Neuro-ICU. The authors detail the process of developing the RT Initiative for the Neuro-ICU, including initial collaborations, psychosocial care implementation, and intervention development. This real-world approach to integrating psychosocial care in this setting was successful because of a strong multidisciplinary partnership, a feasible CRT framework, and funding to support the research and infrastructure. Physical proximity, consistent interactions and communication, mutual trust, and shared leadership priorities helped facilitate this integrated care approach. The findings provide practical guidance on how to integrate psychosocial care into medical settings. The authors hope that this approach is of value to clinicians, researchers, and health care systems working to develop and sustain integrated care models across complex medical settings.
仅在美国，每年就有超过500万患者入住重症监护病房（ICU）。考虑到患者的病情严重程度、家属的情感体验以及医护人员的职业倦怠，ICU是压力巨大的环境。然而，在这些环境中，心理社会服务很少提供且难以持续。需要多学科合作关系以及创新的框架和服务，才能成功地将心理社会护理融入这些复杂的环境。为满足这一需求，麻省总医院在其神经科学重症监护病房（神经ICU）开展了“共同康复”（RT）倡议（2015年至今）。该医院有三个目标：（1）建立多学科合作关系，以开发和维持综合护理；（2）实施临床、研究和培训（CRT）框架，以支持患者、家属和医护人员；（3）为神经ICU中的患者-照顾者二元组开发一种创新的、量身定制的循证干预措施。作者详细介绍了为神经ICU制定RT倡议的过程，包括初步合作、心理社会护理的实施以及干预措施的开发。在这种环境中整合心理社会护理的这种实际方法之所以成功，是因为有强大的多学科合作关系、可行的CRT框架以及支持研究和基础设施的资金。地理位置接近、持续的互动与沟通、相互信任以及共同的领导重点有助于推动这种综合护理方法。这些发现为如何将心理社会护理融入医疗环境提供了实用指导。作者希望这种方法对致力于在复杂医疗环境中开发和维持综合护理模式的临床医生、研究人员和医疗保健系统有价值。
