Discordance of Patient-Reported and Clinician-Ordered Resuscitation Status in Patients Hospitalized With Acute Decompensated Heart Failure.
Discordance of Patient-Reported and Clinician-Ordered Resuscitation Status in Patients Hospitalized With Acute Decompensated Heart Failure.
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DOI：
10.1016/j.jpainsymman.2016.11.010
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发表时间：
2017-04
影响因子：
4.7
通讯作者：
Dunlay SM
中科院分区：
文献类型：
--
作者：
Young KA;Wordingham SE;Strand JJ;Roger VL;Dunlay SM
入院时心肺复苏偏好的准确记录对于确保患者接受复苏或不按照其意愿进行复苏至关重要。我们试图识别和描述急性失代偿性心力衰竭（ADHF）住院患者中患者报告的复苏状态和临床医生命令的复苏状态之间的不一致性。明尼苏达州东南部因ADHF住院的居民前瞻性地参加了一项研究，该研究包括2014年1月至2016年2月的面对面问卷调查。在入组时使用经验证的问题评估患者报告的复苏状态。从电子病历中提取入院时临床医生要求的复苏偏好。在400名进行问卷调查的患者中，213名（53.3%）表示他们的复苏偏好为完整代码，166名（41.5%）不复苏（DNR），21名（5.3%）不确定。相比之下，263例（65.8%）患者的临床医生命令的复苏状态为完全代码，133例（33.3%）患者为DNR，4例（1.0%）患者未记录。在20%的患者中，患者报告的复苏状态和医生医嘱的复苏状态不一致，其中5.6%的患者通过问卷选择了完整代码并有DNR临床医生医嘱，14.4%的患者通过问卷选择了DNR但有完整代码临床医生医嘱。观察到复苏偏好不一致与一致患者在年龄、合并症、健康知识、婚姻状况、完成预先指令、住院时间和出院目的地方面的差异。在20%的ADHF住院患者中，患者报告的复苏偏好和临床医生命令的复苏偏好不一致。这些不一致的潜在病因可能反映了患者犹豫不决或患者与临床医生沟通不畅等因素，需要进一步探索。
Accurate documentation of preferences for cardiopulmonary resuscitation at hospital admission is critical to ensure that patients receive resuscitation or not in accordance with their wishes. We sought to identify and characterize inconsistencies in patient-reported and clinician-ordered resuscitation status in patients hospitalized with acute decompensated heart failure (ADHF). Southeastern Minnesota residents hospitalized with ADHF were prospectively enrolled into a study that included the administration of face-to-face questionnaires from January 2014 through February 2016. Patient-reported resuscitation status was assessed at enrollment using a validated question. Clinician-ordered resuscitation preferences at hospital admission were abstracted from the electronic medical record. Of the 400 patients administered the questionnaire; 213 (53.3%) stated their resuscitation preference as Full Code, 166 (41.5%) do-not-resuscitate (DNR), and 21 (5.3%) were unsure. In comparison, clinician-ordered resuscitation status was Full Code in 263 (65.8%) patients, DNR in 133 (33.3%), and not documented in 4 (1.0%). Patient-reported and clinician-ordered resuscitation status was discordant in 20% of patients, of whom 5.6% elected Full Code by questionnaire and had a DNR clinician order, and 14.4% elected DNR by questionnaire but had a Full Code clinician order. Differences in age, comorbidities, health literacy, marital status, completion of advance directives, hospital length of stay, and discharge destination in patients with discordant versus concordant resuscitation preferences were observed. Patient-reported and clinician-ordered resuscitation preferences were discordant in 20% of patients hospitalized with ADHF. The underlying etiology of these inconsistencies may reflect factors such as patient indecisiveness or patient-clinician miscommunication, and requires further exploration.