Experiences with targeting inpatient advance care planning for emergency general surgery patients: A resident-led quality improvement project.
Experiences with targeting inpatient advance care planning for emergency general surgery patients: A resident-led quality improvement project.
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DOI：
10.1016/j.surg.2023.04.031
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发表时间：
2023-10
期刊：
影响因子：
3.8
通讯作者：
Wick, Elizabeth C.
中科院分区：
文献类型：
--
作者：
Colley, Alexis;Lin, Joseph;Pierce, Logan;Johnson, Christopher;Bongiovanni, Tasce;Finlayson, Emily;Sudore, Rebecca;Wick, Elizabeth C.
对于可能永久或暂时失去沟通偏好能力的患者，提前护理计划是指导医疗决策的关键机制，但目前在手术患者中使用不足。一个由住院医师主导的质量改进项目，包括教育和业绩衡量，进行了紧急普通外科服务，以提高完成住院预先护理规划说明使用专门的模板在电子健康记录。预先护理计划文件定义为入院前预先护理计划文件（例如，预先指示）或住院患者预先护理计划（使用电子健康记录模板）。分析了12小时以上急诊普外科入院患者的数据，并将基线数据（2020年7月至2021年6月）与干预期数据（2021年7月至2022年6月）进行了比较。病历审查评价了干预期间住院患者预先护理计划文件的内容。在干预期间，住院患者预先护理计划记录的频率增加（9.3%，n = 56至16.6%，n = 92，P <0.001），手术团队的住院患者预先护理计划记录的贡献更大（16.7%至55.4%）。内容分析表明，79.0%的住院病人预先护理计划说明列出了对维持生命治疗的偏好，78.3%列出了代孕，57.3%列出了整体健康目标，50.3%列出了针对手术的治疗目标。虽然住院医师主导的质量改进项目有助于更多地采用标准化的住院病人提前护理计划文件的急诊普外科服务，进展缓慢，并融入标准工作没有实现。需要进一步努力，以更好地了解将基本的提前护理计划要素纳入工作流程，并建立包容性的教育方案，使所有团队成员为进行和记录提前护理计划对话做好准备。
For patients who may permanently or temporarily lose their ability to communicate preferences, advance care planning is a critical mechanism to guide medical decision-making but is currently underused among surgical patients. A resident-led quality improvement project, including education and performance measurement, was conducted on an emergency general surgery service to increase the completion of inpatient advance care planning notes using a specialized template in the electronic health record. Advance care planning documentation was defined as either preadmission advance care planning documentation (eg, advance directive) or inpatient advance care planning (use of the electronic health record template). Data from patients admitted to the emergency general surgery service for 12+ hours were analyzed, and baseline data (July 2020 to June 2021) were compared with data from the intervention period (July 2021 to June 2022). The chart review evaluated the content of the inpatient advance care planning documentation from the intervention period. The frequency of inpatient advance care planning documentation increased (9.3%, n = 56 to 16.6%, n = 92, P < .001) with a greater contribution of inpatient advance care planning notes by the surgery team (16.7% to 55.4%) in the intervention period. Content analysis indicated that 79.0% of inpatient advance care planning notes listed preferences for life-sustaining therapy, 78.3% listed surrogacy, 57.3% listed overall health goals, and 50.3% listed treatment goals specific to the surgical encounter. Although a resident-led quality improvement project contributed to greater adoption of standardized inpatient advance care planning documentation on an emergency general surgery service, progress was slow, and integration into standard work was not achieved. Future efforts are needed to better understand the integration of essential advance care planning elements into workflows and to establish inclusive educational programming to prepare all team members for conducting and documenting advance care planning conversations.
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