Pop-up treatment plans for the urban psychiatric emergency room.
Pop-up treatment plans for the urban psychiatric emergency room.
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城市精神科急诊室的弹出治疗计划。
DOI：
10.1176/appi.ps.640602
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Mangurian,ChristinaV
中科院分区：
文献类型：
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作者：
Cheng,JasonE;Dilley,JamesW;Mangurian,ChristinaV
患有慢性精神疾病和急救服务利用率高的个人对精神科急诊科提出了挑战。与这些患者合作的策略之一是积极的社区治疗(ACT)。它的主要优势之一是，患者变得为他们的病例经理所熟知，他们反过来可以很容易地向急救服务临床医生提供全面的附带信息。这些信息促进了临床决策(如迅速出院或入院)，从而缩短了住院时间。另一个潜在的结果是总体上紧急就诊次数减少。当获取这些信息的时间出现延迟时(例如，在ACT的工作时间之外)，急诊科临床医生需要通过另一种方法访问这些信息。社区焦点(CF)是旧金山的一个项目，它使用ACT方法来治疗精神科紧急服务的高利用率。一个多学科的工作人员为该市200名这样的患者提供全面的、对文化敏感的服务。尽管有这样的报道，一些CF客户经常去旧金山综合医院(SFGH)的精神科急救服务，许多访问导致延长停留时间。为了解决这个问题，一个多学科小组开始定期开会，为这些患者制定治疗计划，其中包括来自CF和SFGH精神急救服务和管理的代表。目标是在下一次CF患者出现在精神科急救服务时执行治疗计划，从而减少这些就诊和住院时间。治疗计划是改善病人护理的既定战略。紧急服务救治小组面临的挑战是确保立即和完整地传达该计划。鉴于各种急救人员可能不会
Individuals with chronic mental illness and high utilization of emergency services present a challenge to psychiatric emergency departments. Among the strategies for working with these patients is assertive community treatment (ACT). One of its main advantages is that patients become well known to their case managers, who can in turn readily provide comprehensive collateral information to emergency services clinicians. This information promotes clinical decision making (such as to discharge or admit quickly), resulting in a reduced length of stay. Another potential outcome is fewer emergency visits overall. When a delay in obtaining this information occurs (outside ACT’s operating hours, for example), emergency department clinicians need access to this information by another method.Community Focus (CF) is a program in San Francisco that uses an ACT approach to treat high utilizers of psychiatric emergency services. A multidisciplinary staff provides comprehensive, culturally sensitive services to 200 such patients in the city. Despite this coverage, some CF clients make frequent visits to the psychiatric emergency services of San Francisco General Hospital (SFGH), and many visits result in extended stays. To address this problem, a multidisciplinary group, with representatives from CF and the SFGH psychiatric emergency service and administration, began meeting regularly to develop treatment plans for these patients. The goal was to implement the treatment plans when CF patients next presented for psychiatric emergency services, thereby decreasing these visits and lengths of stay. Treatment plans are well-established strategies to improve patient care. The challenge to the emergency services treatment team was to ensure immediate and complete communication of the plan. Given that various emergency staff may not be