Recognition and communication of patient deterioration in a regional hospital: a multi-methods study.
Recognition and communication of patient deterioration in a regional hospital: a multi-methods study.
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DOI：
10.1016/j.aucc.2007.05.002
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发表时间：
2007-08-01
期刊：
影响因子：
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通讯作者：
Edington, John
中科院分区：
文献类型：
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作者：
Endacott, Ruth;Kidd, Tracy;Edington, John
目的：在这项研究中，我们的目的是确定线索，病房护士和医生使用，以确定病人的恶化，其次，检查评估和交流恶化的病人急性病房的区域hospital.METHODS：混合方法的案例研究设计在220张病床的区域医院。病例研究来自普通病房意外进入ICU的患者（n=17）。数据收集发生在患者入住ICU后72小时内。采访了11名护士和14名医生，17名患者的记录，24小时前，ICU进行了图表审计carried.RESULTS：结果表明依赖于生命体征的护士和医生的初步识别病人的恶化。在此之后，护士依赖于对病人身体能力的评估，而医生则进行额外的临床调查。入院类别和合并症增加了临床医生对病情恶化的识别，但评估的程度取决于地区医院、病房或特定患者类别的“惯例”。发现没有及时转诊给更高级的临床医生。图表审计发现，13例（76%）患者在ICU入院前有临床标志物，10例（56%）患者在ICU入院前24 h内有这些标志物超过2 h。结论：本研究强调了临床医生之间的沟通不足，以及缺乏确保患者在区域医院恶化时及时管理的流程。使用临时或临时工作人员谁是不太熟悉的临床文化的地区医院可能会影响识别，并应对，恶化病房病人。
OBJECTIVE: In this study we aimed to identify the cues that ward nurses and doctors use to identify patient deterioration and, secondly, examine the assessment and communication of deterioration in patients on acute wards of a regional hospital.METHODS: Mixed methods case study design in a 220 bed regional hospital. Case studies originated from patients admitted unexpectedly to ICU from general wards (n=17). Data collection occurred within 72 h of the patient's admission to ICU. Interviews with 11 nurses and 14 doctors, and chart audit of 17 patient records for the 24 h prior to ICU were undertaken.RESULTS: The results demonstrate reliance on vital signs for nurses and doctors for initial identification of patient deterioration. Subsequent to this, nurses relied on assessment of the patient's physical capabilities whilst doctors undertook additional clinical investigations. Admission category and co-morbidities increased clinicians' identification of deterioration but the extent of assessment was dictated by 'usual practice' for the regional hospital, the ward or particular patient category. A lack of timely referral to more senior clinicians was identified. Chart audit found that 13 (76%) patients had clinical markers prior to ICU admission and 10 (56%) had these markers for >2h in the previous 24h.CONCLUSIONS: This study highlights inadequate communication between clinicians and lack of process for ensuring timely management when patients deteriorate in a regional hospital. The use of casual or locum staff who are less familiar with the clinical culture of regional hospitals may influence the recognition of, and response to, deteriorating ward patients.