(精选)【医学课件课件】血液成份及输血疗法教学课件.pptVIP

* Intensive communication: Four-year follow-up from a clinical practice study Ri 王信堯 Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Preface Fear, air hunger, pain, anxiety of dying Hospice care, intensive care ? End of life care, option ? Ineffective life support moving to a comfort-focused care plan Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Introduction Purpose: moving dying patients from ineffective lift support to comfort-focused care plan When to decide? Where the decision made? What memberships? Why do it? How to do? Intensive communication- the bridge between ICU support to comfort care Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Intensive communication The uniform application of a process of communication moving dying patients to comfort-focused care Noncoercive, patient and family-centered, multidisciplinary process Primary outcome variables --- length of ICU stay and mortality Secondary outcome varibles --- agreement among providers, team, patient, family Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (1) 2891 adult patients admitted to ICU during 4-yr period from Oct. 31, 1998, to Sept. 30, 2002 10-bed medical ICU 1 attending physician, 2~3 residents, 3 interns, and 45 nurses (in shifts). Admission decision: physician not part of ICU team Discharge decision: critical care physician Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (2) Initial meeting: within 72 hrs of ICU admission Criteria: 1. Predicted ICU stay = 5 days 2. Predicted mortality of 25 % 3. Function status potentially irreversible and sufficient to preclude eventual return to home Lilly: Crit Care Med, Volume 31(5) Supplement.May 2003.S394-S399 Methods (3) Memberships: attending intensivists, nurse, house officer, family, patient ( if possible) Other members: outside exp