Compliance with triage to intensive care recommendations
Compliance with triage to intensive care recommendations
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DOI：
10.1097/00003246-200111000-00014
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发表时间：
2001-11-01
影响因子：
8.8
通讯作者：
Dhainaut, JF
中科院分区：
文献类型：
--
作者：
Azoulay, É;Pochard, F;Dhainaut, JF
设计：已发布对重症监护病房(ICU)进行分诊的建议，但尚未进行评估。在这项前瞻性的多中心研究中，所有获准或拒绝进入法国重症监护学会附属的26个ICU的患者在1个月的时间内都被纳入其中。记录参与的ICU和患者的特征、分诊情况和分诊决定的描述，特别注意遵守已发表的建议。结果：在研究期间，1,009名患者和283名患者没有进入参与的ICU。被拒绝的患者更有可能年龄超过65岁(优势比[OR]，3.53；可信区间[CI]，1.98-5.32)和慢性健康状况较差(OR，3.09；CI，2.05-4.67)。入院诊断为急性呼吸或肾功能衰竭、休克或昏迷与入院有关，而慢性严重呼吸和心力衰竭或无缓解希望的转移性疾病与拒绝相关(OR，2.24；CI，1.38-3.64)。只观察到了20个分诊到ICU的建议中的4个(范围为0-8)；满病房和电话分诊与建议的遵从性显著较差(分别为0[0-2]比6[2-9]，p=.0003；1[0-6]比6[1-9]，p<；.0001；)。结论：分诊到重症监护的建议很少观察到，特别是当病房满或通过电话进行分诊时。这些建议可能需要重新设计，以提高其在现实生活条件下的实用性，并特别注意电话分流和整个单元的分流。
Design: Recommendations for triage to intensive care units (ICUs) have been issued but not evaluated.Setting. In this prospective, multicenter study, all patients granted or refused admission to 26 ICUs affiliated with the French Society for Critical Care were included during a 1-month period. Characteristics of participating ICUs and patients, circumstances of triage, and description of the triage decision with particular attention to compliance with published recommendations were recorded.Results., During the study period, 1,009 patients were and 283 were not admitted to the participating ICUs. Refused patients were more likely to be older than 65 yrs (odds ratio [OR], 3.53; confidence interval [CI], 1.98-5.32) and to have a poor chronic health status (OR, 3.09; CI, 2.05-4.67). An admission diagnosis of acute respiratory or renal failure, shock, or coma was associated with admission, whereas chronic severe respiratory and heart failure or metastatic disease without hope of remission were associated with refusal (OR, 2.24; CI, 1.38-3.64). Only four (range, 0-8) of the 20 recommendations for triage to ICU were observed; a full unit and triage over the phone were associated with significantly poorer compliance with recommendations (0 [0-2] vs. 6 [2-9], p = .0003; and 1 [0-6] vs. 6 [1-9], p < .0001; respectively).Conclusion: Recommendations for triage to intensive care are rarely observed, particularly when the unit is full or triage is done over the phone. These recommendations may need to be redesigned to improve their practicability under real-life conditions, with special attention to phone triage and triaging to a full unit.