Lifeboat ethics: considerations in the discharge of inpatients for the creation of hospital surge capacity.
Lifeboat ethics: considerations in the discharge of inpatients for the creation of hospital surge capacity.
复制标题
救生艇伦理：住院病人出院时的考虑因素，以建立医院增援能力。
DOI：
10.1097/dmp.0b013e318065c4ca
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发表时间：
2007
影响因子：
2.7
通讯作者：
Kelen,GaborD
中科院分区：
文献类型：
--
作者：
Kraus,ChaddK;Levy,Frederick;Kelen,GaborD
在严重后果事件(如自然灾害、恐怖袭击、传染病暴发)期间，卫生系统内的医院就像救生艇，能力有限，无法满足每个需要医院一级护理的人的医疗需求。救生艇伦理是20世纪70年代首次使用的一个短语，用于讨论向与长期饥荒作斗争的贫困国家分配有限的粮食供应。1、2然而，对应急准备和反应的日益重视，使救生艇伦理在卫生保健中有了新的背景：获得和分配有限或稀缺的救生资源。在重大事件期间，医院和卫生系统在照顾已在医院的患者和管理额外数量的与事件相关的疾病或受伤患者之间取得平衡。医疗机构认证联合委员会建议，医院有能力“迅速到位”，拥有长达3天的独立运营能力。3、4然而，大多数医院和卫生系统每天在有限的能力下运作，使医院面临着没有能力增加能力和资源，包括工作人员、用品和住院床位的救生艇情况。5、6提出了多种提高医疗浪涌能力的技术。这些措施包括取消选择性手术和入院，开放有执照但无工作人员的床位，将其他医院空间转换为可用患者护理区域，以及创建“非现场”医疗场所。这些技术中的大多数都需要在没有工作人员、由于灾难本身而减少工作人员、或公共卫生系统为其他需要而增派工作人员时增加工作人员。容量管理的一种新方法，反向分诊，专注于已在医院的患者的安全出院，允许医院资源重新集中于更有需要的人。7反向分流允许在绝对增量不切实际或不可能时创建相对增量的浪涌容量。
During a high-consequence event (eg, natural disaster, terrorist strike, infectious disease outbreak), hospitals within health systems function as a lifeboat with a limited capacity to accommodate the medical needs of everyone requiring hospital-level care. Lifeboat ethics was a phrase used first in the 1970s to discuss the distribution of limited food supplies to poverty-stricken nations battling chronic famines. 1, 2 The growing focus on emergency preparedness and response, however, has given lifeboat ethics a new context within health care: the access to and distribution of limited or scarce lifesaving resources. During a highconsequence event hospitals and health systems balance caring for patients already in the hospital with managing an additional volume of patients with illness or injury related to the event. The Joint Commission on Accreditation of Healthcare Organizations recommends that hospitals have the ability to “surge in place,” with stand-alone operating capacity for up to 3 days. 3, 4 However, most hospitals and health systems operate daily under constrained capacity, leaving hospitals to face lifeboat situations without the ability to augment capacity and resources, including staff, supplies, and inpatient beds. 5, 6Many techniques to augment medical surge capacity have been suggested. These include canceling elective surgeries and admissions, opening licensed but unstaffed beds, converting other hospital space to usable patient care areas, and creating “offsite” medical venues. Most of these techniques require increased staffing at a time when staff are not available, staffing is degraded because of the disaster itself, or staff are co-opted by the public health system for other needs. One novel approach to capacity management, reverse triage, focuses on the safe discharge of patients already in the hospital, allowing a refocus of hospital resources to those in even greater need. 7 Reverse triage allows the creation of a relative increment in surge capacity at times when an absolute increment is impractical or impossible.