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Crises in clinical care: an approach to management

机译：临床护理危机：管理方法

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 A "crisis" in health care is "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death". The daunting challenges faced by clinicians when confronted with a crisis are illustrated by a tragic case in which a teenage boy died after a minor surgical procedure. Crises are challenging for reasons which include: presentation with non-specific signs or symptoms, interaction of complex factors, progressive evolution, new situations, "revenge effects", inadequate assistance, and time constraints. In crises, clinicians often experience anxiety- and overload-induced performance degradation, tend to use "frequency gambling", run out of "rules" and have to work from first principles, and are prone to "confirmation bias". The effective management of crises requires formal training, usually simulator-based, and ideally in the inter-professional groups who will need to function as a team. "COVER ABCD–A SWIFT CHECK" is a precompiled algorithm which can be applied quickly and effectively to facilitate a systematic and effective response to the wide range of potentially lethal problems which may occur suddenly in anaesthesia. A set of 25 articles describing additional precompiled responses collated into a manual for the management of any crisis under anaesthesia has been published electronically as companion papers to this article. This approach to crisis management should be applied to other areas of clinical medicine as well as anaesthesia.
机译：卫生保健中的“危机”是“在疾病过程中发生决定性变化，导致恢复或死亡的时刻”。悲剧性的案例说明了临床医生在面对危机时所面临的艰巨挑战，其中一名少年在一次较小的外科手术后死亡。危机具有挑战性，其原因包括：呈现出非特定的症状或体征，复杂因素的相互作用，逐步发展，新情况，“复仇效应”，援助不足和时间限制。在危机中，临床医生经常会因焦虑和超负荷而导致性能下降，倾向于使用“频率赌博”，用完“规则”，必须遵循首要原则，并且容易出现“确认偏见”。有效的危机管理需要正规的培训，通常是基于模拟器的，并且理想情况下，他们需要作为团队工作的跨专业团队。 “ Cover ABCD-A SWIFT CHECK”是一种预编译算法，可以快速有效地应用，以促进系统有效地应对麻醉中可能突然发生的多种潜在致命问题。一组25篇文章描述了其他预编译的响应，并整理成手册，以管理麻醉下的任何危机，已作为本文的配套文件进行了电子版发布。这种危机处理方法应应用于临床医学和麻醉的其他领域。

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    Runciman, W; Merry, A;

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  • 年度 2005
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