肿瘤急诊环境中目标一致护理的精神护理支持

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Jayne Viets MD, Eronica C. King, Bobbie S. Andrews, Robert B. Heard, Alyssa M. Hughes, Elizabeth Stroh, Trien Vu MD, Cassandra Smith, Valda D. Page, John Stroh MD
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引用次数: 0

摘要

背景相当一部分肿瘤患者在生命的最后几个月到急诊科就诊,但往往没有预先护理计划(ACP)。目标加强对急诊科就诊肿瘤患者晚期护理计划的记录和遵守,尤其是在临终护理偏好方面。方法这是一项回顾性观察研究。数据提取自 2023 年 1 月 4 日至 2023 年 5 月 31 日期间发生的 Epic ED 就诊记录。资格标准包括患者至少年满 19 周岁,并至少具备以下条件之一:曾进行过 DNR、院外 DNR(OOHDNR)、曾出院接受临终关怀或 ACP 注释中完整代码记录为 "否"。一个包括临床医生、灵性关怀提供者、护士、社工和数据分析师在内的多学科团队发起了一个质量改进项目。该项目的重点是将精神护理提供者纳入晚期护理计划的讨论中,优化电子病历 (EMR) 以实时识别和管理患者的护理和偏好,并对医护人员进行 ACP 文档方面的培训。符合患者标准的患者总数为 276 人(5.5%)。干预措施使 ACP 备注的记录增加了 95%,之前表示希望自然死亡的患者的 "不要抢救"(DNR)指令增加了 46%。该项目强调了灵性关怀提供者在管理临终关怀讨论中作为一种关键且未得到充分利用的资源所发挥的作用。在 ACP 讨论中利用灵性照护提供者以及使用更加综合的 EMR 系统,可以改善急诊护理与肿瘤患者临终偏好的一致性,从而改善患者预后,并可能降低医疗成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Spiritual Care Support of Goal Concordant Care in the Oncologic Emergency Setting

Background

A significant portion of oncology patients visit the emergency department (ED) in the last months of their life, often without advanced care plans (ACP). This leads to fragmented care and inconsistent adherence to patients’ end-of-life wishes.

Objective

To enhance the documentation and adherence to advanced care plans for oncology patients visiting the ED, particularly in the context of end-of-life care preferences.

Methods

This was a retrospective observational study. The data was extracted from Epic ED encounters that occurred during 04/01/2023 through 05/31/2023. Eligibility criteria included patients at least 19 years of age and having at least one of the following: a previous DNR, an out of hospital DNR (OOHDNR), a previous discharge to hospice or an ACP note with Full Code documented as “No”. Descriptive statistics using proportions were used to tabulate differences between the two months of data.

A multidisciplinary team, including clinicians, spiritual care providers, nurses, social workers, and data analysts, initiated a quality improvement project. The project focused on the integration of spiritual care providers in advanced care planning discussions, the optimization of electronic medical records (EMR) for real time identification and management of patients’ care and preferences, and the training of healthcare staff in ACP documentation.

Results

During the two-month study period, a total of 5,125 ED encounters occurred with 4,985 potentially eligible patients and 2,747 (55.1%) ED to hospital admissions. The combined number of patients meeting the patient criteria was 276 (5.5%). The intervention led to a 95% increase in the documentation of ACP notes and 46% increase in Do Not Resuscitate (DNR) orders for patients who had previously expressed a preference for a natural death. It highlighted the role of spiritual care providers as a crucial and underutilized resource in managing end-of -life care discussions.

Discussion

This project underscores the importance of interprofessional collaboration in end-of-life care. The utilization of spiritual care providers in ACP discussions and the use of a more integrated EMR system can improve the alignment of emergency care with oncology patients’ end-of-life preferences, leading to better patient outcomes and potentially reduced healthcare costs.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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