Sustainability of Palliative Care Principles in the Surgical Intensive Care Unit Using a Multi-Faceted Integration Model
Sustainability of Palliative Care Principles in the Surgical Intensive Care Unit Using a Multi-Faceted Integration Model
复制标题
DOI：
10.1177/08258597221079438
复制
发表时间：
2022-02-09
影响因子：
1.7
通讯作者：
Platnick, K. Barry
中科院分区：
文献类型：
--
作者：
Cralley, Alexis;Madsen, Helen;Platnick, K. Barry
目的：了解病人的护理目标在任何情况下都是必不可少的，尤其是在城市安全网创伤中心的外科重症监护室（SICU）。这强调了需要实施姑息治疗的原则和做法，如确定代理决策者，目标的护理讨论，和CPR指令，在SICU。方法一个务实的，质量改进的研究，利用回顾性，干预前和干预后的连续分析。干预措施包括外科医生冠军，住院医师教育和电子病历模板，称为高级护理计划（ACP）注意，用于日常查房。我们回顾了在这些干预措施之前、期间和之后入住SICU的所有成年人的图表，以确定SICU居民替代决策者文件的发生率。结果在研究期间，SICU住院医师对ACP票据的使用较早且热情。在整个研究期间，记录替代决策者的比率增加（p < 0.0001）。在图表中有ACP注释与记录的替代决策者的比率显著较高相关（p < 0.0001）。结论：通过整合有针对性的教育，姑息治疗文档的电子病历工具的标准化，并将姑息治疗的目标纳入日常查房ICU清单，我们显着增加了我们的城市一级创伤中心的SICU的代理决策者的识别。干预后一年的图表审查表明，持续致力于使用ACP说明和确定替代决策者
Objective(s) Understanding patient goals of care is essential in any setting, and especially so in an urban, safety net trauma centers' Surgical Intensive Care Units (SICU). This underscores the need for implementation of palliative care principles and practices, such as identification of surrogate decision makers, goals-of-care discussions, and CPR directives, in the SICU. Methods A pragmatic, quality improvement study utilizing a retrospective, pre- and post-intervention continuum analysis. Interventions included a surgeon champion, resident education, and an electronic medical record template, called the Advanced Care Planning (ACP) Note, for use on daily rounds. We reviewed the charts of all adults admitted to the SICU before, during, and after these interventions to identify the incidence of surrogate decision maker documentation by SICU residents. Results There was an early and enthusiastic adoption in ACP note utilization by SICU residents over the study period. Rates of documenting surrogate decision makers increased throughout the study period (p < 0.0001). Having an ACP note in the chart was associated with significantly higher rates of documented surrogate decision makers (p < 0.0001). Conclusions Through the integration of targeted education, standardization of an electronic medical record tool for palliative care documentation, and incorporation of palliative care goals into daily rounding ICU checklists, we significantly increased identification of surrogate decision makers in the SICU of our urban Level One trauma center. Chart review from one year post-intervention showed sustained commitment to the use of the ACP note and identification of surrogate decision makers