Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients.
Am J Med Qual
; 33(4): 391-396, 2018 07.
Article
em En
| MEDLINE
| ID: mdl-29258322
ABSTRACT
In-hospital medical emergencies occur frequently. Understanding how clinicians respond to deteriorating patients outside the intensive care unit (ICU) could improve "rescue" interventions and rapid response programs. This was a qualitative study with interviews with 40 clinicians caring for patients who had a "Code Blue" activation or an unplanned ICU admission at teaching hospitals over 7 months. Four study physicians independently analyzed interview transcripts; refined themes were linked to the transcript using text analysis software. Nine themes were found to be associated with clinicians' management of deteriorating patients. Multiple human biases influence daily care for deteriorating hospitalized patients. A novel finding is that "moral distress" affects escalation behavior for patients with poor prognosis. Most themes indicate that ward culture influences clinicians to wait until the last minute to escalate care despite being worried about the patients' condition.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Atitude do Pessoal de Saúde
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Equipe de Respostas Rápidas de Hospitais
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Tomada de Decisão Clínica
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Deterioração Clínica
Tipo de estudo:
Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article