如何做出临床决策.pptVIP

如何做出临床决策？;目的Objectives;循证实践的步骤EBPprocess;对某个问题仔细考虑后的评判

Thepassingofjudgmentonanissueunderconsideration.

得出结论或作出决定后的行动

Theactofreachingaconclusionormakinguponesmind.

所获得的或明确的一个结论或判断，一个定论

Aconclusionorjudgmentreachedorpronounced;averdict.;Becuriousalways,forknowledgewillnotacquireyou;

youmustacquireit.”—SudieBlack;制定决策DecisionMaking;知识的正规来源

FormalizedSourcesofKnowledge;知识和病人偏好

KnowledgeandPatientPreferences;应用证据

ApplyingEvidence;临床决策与循证事件的商业性

The“Business”SideOfDecisionMakingandEBP

投资回报的最大化

MaximizingReturnonInvestment;卫生保健中的意义

MeaninginHealthcare;为什么重要？

WhyisROIimportanttoEBP?;临床医疗过程ClinicalProcessofCare

?急性心梗指标AMIindicators

?心力衰竭指标HFindicators

?肺炎Pneumonia

–抗生素的选择AntibioticSelection

–静脉血栓的预防Venousthromboembolismprophylaxis;病人经验PatientExperience

?护患交流CommunicationwithNurses

?医患交流CommunicationwithDoctors

?医院工作人员的反应力ResponsivenessofHospitalStaff

?疼痛管理PainManagement

?用药沟通CommunicationaboutMedicines

?医院整洁与安静HospitalCleanlinessQuietness

?出院指导DischargeInformation

?对医院的综合评分OverallRatingofHospital

;病人结果PatientOutcomes

?急性心梗30天死亡率

AcuteMyocardialInfarction(AMI)30‐DayMortalityRate(shownassurvivalrate)

?心力衰竭30天死亡率

HeartFailure(HF)30‐DayMortalityRate(shownassurvivalrate)

?肺炎30天死亡率

Pneumonia(PN)30‐DayMortalityRate(shownassurvivalrate)

;提升病人结果ImprovedPatientOutcomes

?最大化的报销MaximizeReimbursement

?声誉-优于竞争者Reputation,OutperformingCompetitors

?病人满意度PatientSatisfaction

?增加市场份额IncreasedMarketShare

?降低照护成本DecreasedCostofCare

?减少投诉DecreasedLitigation;提升临床结果ImprovedClinicianOutcomes

?团队凝聚力/团队工作GroupCohesion/Teamwork

?护理满意度NursingSatisfaction

?留职意愿IntenttoStay

?护士留职NurseRetention

?病人结果和满意度PatientOutcomesandSatisfaction

–声誉，优于竞争者Reputation,OutperformingCompetitors

–增加市场份额IncreasedMarketShare

–减少投诉DecreasedLitigation;你的病人与研究文献所收录的病人，有无明显差异？如，女性乳癌的研究，能否应用到男性

评估你的病人接受与研究文献所实施形同的治疗或处置，益处、害处将有多大

1.应用前景，请先修正文献结