Rapid De-Escalation and Triaging Patients in Community-Based Palliative Care
Rapid De-Escalation and Triaging Patients in Community-Based Palliative Care
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DOI：
10.1016/j.jpainsymman.2020.03.040
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发表时间：
2020-07-01
影响因子：
4.7
通讯作者：
Chan, Yvonne K.
中科院分区：
文献类型：
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作者：
Tran, David L.;Lai, Steve R.;Chan, Yvonne K.
上下文2019年冠状病毒病（COVID-19）大流行给我们的医疗系统带来了迅速而前所未有的转变。医疗服务提供者、团队和组织需要将他们的访问从面对面的访问转向远程医疗（通过电话和视频）。在社区环境中执业的姑息治疗团队面临着一项艰巨的任务：我们如何积极地对最紧急的就诊进行分流，同时确保脆弱的患者免受大流行的伤害？措施以下是帕洛阿尔托医学基金会姑息治疗和支持服务团队提出的建议，以帮助在持续的COVID-19大流行期间在社区和门诊环境中进行及时，安全和有效的姑息治疗。患者最初根据位置进行分类，然后根据病情进行分类。在个人防护设备资源有限的情况下，采用严格的感染控制指南实施跨学科护理。在指定的医疗服务提供者为患者就诊之前，我们会在多个层面对COVID-19症状进行全面筛查。我们建议积极分诊、沟通和频繁筛查社区环境中评估的姑息治疗患者的COVID-19症状。在COVID-19大流行期间，对感染风险的理解、指定提供者、患者及其家属之间的相互同意对于在提供社区姑息治疗的同时保持安全至关重要。(C)2020年美国临终关怀和姑息医学学院。爱思唯尔公司出版All rights reserved.
Context. The coronavirus disease 2019 (COVID-19) pandemic created a rapid and unprecedented shift in our medical system. Medical providers, teams, and organizations have needed to shift their visits away from face-to-face visits and toward telehealth (both by phone and through video). Palliative care teams who practice in the community setting are faced with a difficult task: How do we actively triage the most urgent visits while keeping our vulnerable patients safe from the pandemic?Measures. The following are recommendations created by the Palo Alto Medical Foundation Palliative Care and Support Services team to help triage and coordinate for timely, safe, and effective palliative care in the community and outpatient setting during the ongoing COVID-19 pandemic. Patients are initially triaged based on location followed by acuity. Interdisciplinary care is implemented using strict infection control guidelines in the setting of limited personal protective equipment resources. We implement thorough screening for COVID-19 symptoms at multiple levels before a patient is seen by a designated provider.Conclusions/Lessons Learned. We recommend active triaging, communication, and frequent screening for COVID-19 symptoms for palliative care patients been evaluated in the community setting. An understanding of infection risk, mutual consent between designated providers, patients, and their families are crucial to maintaining safety while delivering community-based palliative care during the COVID-19 pandemic. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.