死亡率审查委员会:了解综合癌症中心的住院病人和 30 天死亡率。

IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Journal of palliative medicine Pub Date : 2024-12-01 Epub Date: 2024-09-30 DOI:10.1089/jpm.2024.0158
Allison Soucise, Rohil Shekher, Julia Faller, Daniel Keppel, Greta Anthony, Elisabeth Dexter, Varun Kumar Chowdhry
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引用次数: 0

摘要

背景:医疗保健的 "三重目标 "是指同时追求改善个人医疗体验、人口健康和降低人均医疗成本。我院成立了死亡率审查委员会(MRC),审查住院病人的死亡率,作为持续质量改进的一部分,目的是改善目标一致的护理。本文将报告 MRC 的经验。措施/干预:2022 年 4 月,我院成立了 MRC,以评估住院病人死亡率和 30 天住院死亡率。委员会由全体医务人员组成。每次审查的主要目的是确定与死亡事件相关的护理过程中是否存在学习和/或改进的机会。改进机会包括文件记录、患者和/或护理团队之间的沟通、医学上的无用治疗或程序,以及对干预措施、不良医疗和手术并发症的考虑。结果:入院前进行过护理目标(GOC)讨论或姑息治疗访视的患者获得学习机会的几率明显较低(分别为 29% 对 51%,p < 0.001)和(37% 对 48%,p < 0.001)。在整个干预过程中,GOC对话的频率保持稳定,但安宁疗护转诊随之增加。讨论:医疗研究中心促进了跨学科团队之间的公开对话,以了解医疗系统如何才能更好地为经历医院相关死亡的患者提供服务。这些会议经常围绕文件记录和沟通展开,尤其关注患者病程中的早期 GOC 讨论和共同决策。我们的 MRC 委员会帮助促进了一种文化转变,即在患者治疗过程的早期阶段整合晚期护理/生命终结规划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mortality Review Committee: Understanding Inpatient and 30-Day Mortality at a Comprehensive Cancer Center.

Background: The Triple Aim of health care involves the simultaneous pursuit of improving the individual experience of care, population health, and reducing per capita costs of care. Our institution established a Mortality Review Committee (MRC) to review instances of inpatient mortality as part of continuing quality improvement with the goal of improving goal concordant care. In this article, we report the experience of MRC. Measures/Interventions: In April 2022, an MRC was formed to evaluate inpatient and 30-day hospital mortality mortalities at our institution. The committee was formed with representation across the entire medical staff. The primary feature of each review was to characterize if the episode of care surrounding the mortality had a learning and/or improvement opportunity associated with the episode of care. Opportunities included improvements in documentation, communication between patients and/or care team, medically futile treatments or procedures, and consideration of interventions, adverse medical and surgical complications. Results: Patients with goals of care (GOC) discussion or palliative care visit prior to admission were significantly less likely to have a learning opportunity (29% vs. 51%, p < 0.001) and (37% vs. 48%, p < 0.001), respectively. The frequency of GOC conversations remained stable throughout the course of this intervention, although an increase in hospice referrals ensued. Discussion: The MRC promoted open conversation across an interdisciplinary team to understand how the health system could have better served patients who experienced hospital associated mortality. These meetings frequently gravitated toward documentation and communication with a particular focus on earlier GOC discussions and shared decision making across a patient's disease course. Our MRC committee has helped foster a cultural shift of the integration of advanced care/end of life planning at earlier stages of patients' treatment courses.

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来源期刊
Journal of palliative medicine
Journal of palliative medicine 医学-卫生保健
CiteScore
3.90
自引率
10.70%
发文量
345
审稿时长
2 months
期刊介绍: Journal of Palliative Medicine is the premier peer-reviewed journal covering medical, psychosocial, policy, and legal issues in end-of-life care and relief of suffering for patients with intractable pain. The Journal presents essential information for professionals in hospice/palliative medicine, focusing on improving quality of life for patients and their families, and the latest developments in drug and non-drug treatments. The companion biweekly eNewsletter, Briefings in Palliative Medicine, delivers the latest breaking news and information to keep clinicians and health care providers continuously updated.
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