Palliative Care Needs in the Neuro-ICU.
Palliative Care Needs in the Neuro-ICU.
复制标题
神经ICU中的姑息治疗需求。
DOI：
10.1097/ccm.0000000000001018
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发表时间：
2015-08
影响因子：
8.8
通讯作者：
Curtis JR
中科院分区：
文献类型：
--
作者：
Creutzfeldt CJ;Engelberg RA;Healey L;Cheever CS;Becker KJ;Holloway RG;Curtis JR
入住神经或神经外科重症监护病房（神经- icu）的患者可能有姑息治疗需求。该项目的目标是鼓励ICU团队确定患者及其家属的姑息治疗需求以及满足这些需求的潜在方法。采用平行组前瞻性队列设计的质量改进项目。一个大型学术医疗中心的神经重症监护室。所有患者于2013年9月1日至2013年11月30日入住神经icu。我们开发了一个由4个问题组成的姑息治疗需求筛选工具：(1)患者是否有令人痛苦的身体或心理症状？(2)患者或家属是否有特殊的支持需求？(3)治疗方案是否符合以患者为中心的目标？(4)团队和家庭之间是否存在分歧？我们在两个神经危重症护理服务中的一个的早晨查房中实施了这种每日筛查工具，这些服务交替入院到单个神经icu。我们调查了姑息治疗需求的流行程度和性质，以及为满足这些需求而采取的行动，比较了有和没有筛查的服务。在3个月的时间里，130名患者接受了筛查，132名患者未接受筛查。两组在年龄、性别、格拉斯哥昏迷评分或诊断方面没有差异。62%的筛查患者（80/130）确定了姑息治疗需求。需求主要是社会支持（53%）和确定护理目标（28%）。筛查与更多记录在案的家庭会议（p=0.019）和更多姑息治疗咨询的趋势相关（p=0.056）。我们开发了一个简短的姑息治疗需求筛选工具，确定了62%的神经icu患者的姑息治疗需求。该工具与满足这些需求的行动有关，可能会改善对患者及其家属的护理。
Patients admitted to the neurological or neurosurgical intensive care unit (neuro-ICU) are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs. Quality improvement project using a parallel-group prospective cohort design. Single neuro-ICU at a large, academic medical center. All patients admitted to the neuro-ICU from September 1, 2013 to November 30, 2013. We developed a Palliative Care Needs Screening Tool consisting of 4 questions: (1) Does the patient have distressing physical or psychological symptoms? (2) Are there specific support needs for patient or family? (3) Are treatment options matched with patient-centered goals? (4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for 1 of 2 neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening. Over the 3-month period, 130 patients were admitted to the service with screening, and 132 patients to the service without screening. The two groups did not differ in regards to age, gender, Glasgow coma scale or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p=0.019) and a trend towards more palliative care consultations (p=0.056). We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.