Using Technology to Create a More Humanistic Approach to Integrating Palliative Care into the Intensive Care Unit
Using Technology to Create a More Humanistic Approach to Integrating Palliative Care into the Intensive Care Unit
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DOI：
10.1164/rccm.201508-1628cp
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发表时间：
2016-02-01
影响因子：
24.7
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
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作者：
Cox, Christopher E.;Curtis, J. Randall
十年前，将姑息治疗纳入重症监护病房(ICU)的主要障碍是接受过姑息治疗培训的提供者数量有限，证据基础不成熟，以及对ICU中姑息治疗的重要性缺乏认识。2016年，姑息治疗的劳动力显著增加，人们越来越认识到姑息治疗的好处，无论是由全科医生(加强治疗师、护士、社会工作者)还是姑息治疗专家提供的。然而，有证据表明，基于ICU的姑息治疗的质量往往不是最理想的。更广泛地解决这一质量问题的一个主要障碍是缺乏可扩展的基于ICU的姑息治疗模式，这种模式使用技术在ICU环境中在正确的时间向正确的患者提供高效的协作式姑息治疗。为了应对这些挑战，我们首先回顾了当前护理模式的优势和局限性，作为我们新概念框架的基础，该框架使用电子健康记录作为构建外部创新的平台，包括：(1)筛查有不良预后风险的患者，(2)整合患者和家庭报告的需求，(3)个性化护理，以及(4)指导通才和专科分诊算法。在所考虑的方法中，我们描述了当前的挑战并提出了具体的解决方案，这些解决方案使用技术来改善压力大、复杂环境中的人与人交互的质量。
A decade ago, the major obstacles to integration of palliative care into the intensive care unit (ICU) were the limited number of providers trained in palliative care, an immature evidence base, and a lack of appreciation for the importance of palliative care in the ICU. In 2016, the palliative care workforce has expanded markedly and there is growing appreciation of the benefits of palliative care, whether provided by a generalist (intensivist, nurse, social worker) or palliative care specialist. However, there is evidence that the quality of ICU-based palliative care is often suboptimal. A major barrier to more broadly addressing this quality problem is the lack of scalable ICU-based palliative care models that use technology to deliver efficient, collaborative palliative care in the ICU setting to the right patient at the right time. To address these challenges, we first review strengths and limitations of current care models as the basis for our novel conceptual framework that uses the electronic health record as a platform on which external innovations can be built, including: (1) screening for patients at risk for poor outcomes, (2) integrating patient- and family-reported needs, (3) personalizing care, and (4) directing generalist versus specialist triage algorithms. In the approaches considered, we describe current challenges and propose specific solutions that use technology to improve the quality of the human interaction in a stressful, complex environment.