Medical emergencies in hospital: The role of treatment escalation plans in out-of-hours decision-making.

IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL
Tze Yi Gan, Roy Harris, D Robin Taylor
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引用次数: 0

Abstract

Background: Out-of-hours medical emergencies are common in acute hospitals, and are often attended by staff who are unfamiliar with the patient's clinical background. Information in the hospital notes may or may not include guidance about how best to deal with clinical deterioration. The use of Treatment Escalation Plans (TEPs) attempts to address these deficiencies.

Methods: This was an observational, questionnaire-based evaluation of the experience of trainee hospital doctors who attended out-of-hours medical emergencies.

Results: Sixty-five medical emergencies were evaluated by a total of 38 doctors. Thirty patients had a TEP, attended by 20 doctors, and 35 without a TEP were attended by 27 doctors. Information from medical notes to facilitate decision-making was deemed sufficient by the attending doctor in 77% of patients with a TEP, compared to 54% of patients with no TEP. Only 10% of patients with a TEP had their treatment escalated at the time of the call, whereas this occurred in 20% of patients without a TEP (NS). A TEP was deemed 'somewhat' or 'very' helpful by trainees in 21/30 of the cases who had one. In 27/35 cases who did not have a TEP, trainees deemed that it would have been helpful to have had one. Twelve of 38 participants (32%) considered that there was a discrepancy between what was 'expected' and what they considered to be 'right' when managing out-of-hours emergencies.

Conclusion: TEPs have an important role in delivering key information that shapes out-of-hours decision-making in deteriorating patients. Both objective outcomes and the subjective quality of medical decision-making are enhanced when a TEP is available.

医院医疗紧急情况:治疗升级计划在非工作时间决策中的作用。
背景:非工作时间的医疗紧急情况是常见的急症医院,往往是由不熟悉病人的临床背景的工作人员。医院记录中的信息可能包括也可能不包括如何最好地处理临床恶化的指导。使用治疗升级计划(TEPs)试图解决这些缺陷。方法:这是一项观察性的、基于问卷的评估实习医院医生参加非工作时间医疗紧急情况的经验。结果:共38名医生对65起医疗紧急事件进行了评估。30例有TEP的患者由20名医生护理,35例无TEP的患者由27名医生护理。主治医生认为77%的TEP患者的医疗记录信息足以促进决策,而没有TEP的患者的这一比例为54%。只有10%的TEP患者在通话时进行了升级治疗,而没有TEP (NS)的患者中有20%发生了这种情况。在接受TEP培训的学员中,有21/30的人认为TEP“有点”或“非常”有帮助。在27/35没有TEP的病例中,受训者认为有TEP是有帮助的。38名参与者中有12人(32%)认为,在处理非工作时间紧急情况时,“预期”和他们认为的“正确”之间存在差异。结论:tep在为病情恶化的患者提供关键信息、制定非工作时间决策方面发挥着重要作用。当TEP可用时,医疗决策的客观结果和主观质量都得到了提高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
81
审稿时长
20 weeks
期刊介绍: The Journal of the Royal College of Physicians of Edinburgh (JRCPE) is the College’s quarterly, peer-reviewed journal, with an international circulation of 8,000. It has three main emphases – clinical medicine, education and medical history. The online JRCPE provides full access to the contents of the print journal and has a number of additional features including advance online publication of recently accepted papers, an online archive, online-only papers, online symposia abstracts, and a series of topic-specific supplements, primarily based on the College’s consensus conferences.
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