Konings J W, Wendte J F, Danse J A, Ribbe M W
Vrije Universiteit, vakgroep Huisarts- en Verpleeghuisgeneskunde, Amsterdam.
Ned Tijdschr Geneeskd. 1994 Dec 31;138(53):2660-4.
To examine how the decision making to hospitalize nursing home patients proceeds, who takes the initiative, which participants are involved and how much time the consultation and decision making take.
Prospective.
Analysis of registration data about decisions to hospitalize nursing home patients, collected from nursing home physicians in 30 nursing homes.
In 76% of the cases the nursing home physician took the initiative to hospitalize. 38% of the patients had been consulted, which influenced the decision. 22% of the patients did not participate in the decision, mostly because of poor mental condition. Consultation of family members and nurses compensated only partly for this limited consultation of patients. With the other patients there had been contact, but without influence on the decision. Medical specialists to nursing home physicians were the most important participants in the decision making. Over 40% of the decisions were taken within 1 h, almost 25% between 1 h and 1 day. The duration of the decision making and the possibilities for consultation were mostly dependent of the urgency of hospitalisation.
Because of the limited possibilities for consultation of nursing home patients when hospitalisation is considered, it is important to anticipate early on such situations by discussing this with patients and family members, and to write down the patients' wishes.
探讨疗养院患者住院决策的过程、谁发起决策、涉及哪些参与者以及会诊和决策需要多长时间。
前瞻性研究。
分析从30家疗养院的疗养院医生处收集的有关疗养院患者住院决策的登记数据。
在76%的病例中，疗养院医生主动提出让患者住院。38%的患者参与了会诊，这对决策产生了影响。22%的患者没有参与决策，主要是因为精神状况不佳。与家庭成员和护士的会诊仅部分弥补了对患者有限的会诊。与其他患者有过联系，但对决策没有影响。疗养院医生与医学专家是决策中最重要的参与者。超过40%的决策在1小时内做出，近25%在1小时至1天之间做出。决策的持续时间和会诊的可能性主要取决于住院的紧迫性。
由于在考虑住院时与疗养院患者会诊的可能性有限，因此通过与患者及其家属讨论这种情况并记录患者的意愿，尽早对这种情况进行预判很重要。
