Palliative Care Consultation Is Underutilized in Critically Ill General Surgery Patients
Palliative Care Consultation Is Underutilized in Critically Ill General Surgery Patients
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DOI：
10.1177/1049909119864025
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发表时间：
2019-07-17
影响因子：
1.9
通讯作者：
Galanos, Anthony N.
中科院分区：
文献类型：
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作者：
Evans, Brooke A.;Turner, Megan C.;Galanos, Anthony N.
背景：美国外科医生学会建议姑息治疗，外科医生合作护理预后不良的患者。这些合作是为了讨论症状管理和护理目标。然而，当代外科患者姑息咨询的实践模式并不明确。我们的目标是描述姑息治疗咨询的使用，在我们的机构的外科服务住院期间死亡的患者。方法：在杜克企业数据统一内容浏览器2014至2016年间查询在普外科住院期间死亡的患者。次要指标包括住院时间、会诊时间、从会诊到死亡的天数以及护理计划的执行情况。结果：在确认的105名患者中，6名在入院当天死亡，39名(37%)接受了姑息治疗咨询。我们的数据显示，接受咨询的患者通常是年龄较大、白人和有保险的患者。姑息咨询至死亡之间的中位天数为3天(四分位数范围：1-8)。在62.5%的患者中，护理目标对话是咨询的适应症。在66.7%的案例中，顾问提出的计划与主要团队一致。结论：姑息治疗咨询在外科患者中未得到充分利用，这些患者在我们机构的普通外科服务期间死亡。当咨询姑息治疗时，初级手术团队和姑息团队的计划是一致的。确定咨询的障碍，并在外科团队中推广姑息治疗的好处是有必要的。
Background: American College of Surgeons recommends palliative care and surgeons collaborate on the care of patients with poor prognoses. These collaborations are done to discuss symptom management and goals of care. However, contemporary practice patterns of palliative care consultation for surgical patients are poorly defined. We aim to describe the use of palliative care consultation for patients admitted to our institution's surgical services who died during their index hospital admission. Methods: The Duke Enterprise Data Unified Content Explorer 2014 to 2016 was queried for patients admitted to general surgery services who died during their admission. Secondary measures included length of stay, time spent in consultation, days from consultation to death, and execution of a care plan. Results: Of the 105 patients identified, 6 died on the day of admission, and 39 (37%) received palliative care consultation. Our data showed that patients who received consultation were generally older, white, and insured. Median number of days between palliative consult and death was 3 days (interquartile range: 1-8). Goals-of-care conversations were the indication for consultation in 62.5% of patients. The proposed plan by the consultants was congruent with the primary team in 66.7% of cases. Conclusions: Palliative care consultations were underutilized in surgical patients who died while admitted to the general surgical service at our institution. When palliative care is consulted, the plan of the primary surgical team and the palliative team align. Identification of barriers to consultation and promotion of the benefits of palliative care among surgical teams is warranted.