为越来越多的在医院急诊科(ED)就诊的精神病患者提供护理是一个具有挑战性的问题。这篇综述旨在综合与改善ED护理结果的策略相关的研究证据。经验,以及患有精神疾病的成年人的表现。
我们系统地回顾了基于ED的精神疾病干预措施对患者预后影响的证据。患者体验,和系统性能,使用旨在识别已发表的实证研究的全面搜索策略。Scopus中的系统搜索,OvidEmbase,CINAHL,和Medline于2023年9月进行(从开始;审查方案在ProsperoCRD42023466062中前瞻性注册)。合格标准如下:(1)初级研究,以英文发表;和(2)(A)报告了在医院ED背景下实施的护理或系统变更模型,(b)侧重于成人精神疾病的陈述,和(C)评估系统性能,患者结果,患者体验,或员工经验。成对的审稿人独立评估研究题目,摘要,和全文根据预先确定的纳入标准,差异由第三审稿人解决。独立审稿人使用Covidence(2023)从收录的论文中提取数据,纳入研究的质量使用JoannaBriggs研究所一套关键评估工具进行评估.
■对纳入的46项研究进行了叙事合成,包括pre-post(n=23),准实验(n=6),描述性(n=6),随机对照试验(RCT;n=3),队列(n=2),横截面(n=2),定性(n=2),现实主义评价(n=1),和时间序列分析研究(n=1)。11篇文章专注于与物质使用障碍相关的陈述,9专注于自杀和故意的自我伤害陈述,26例报告了一般的精神疾病。报告的策略包括护理模式(例如,ED启动的阿片类药物使用障碍,ED发起的社会支持,和故意的自我伤害),决策支持工具,排放和转移改进,案件管理,精神科联络服务的调整,心灵感应,角色和名册的变化,环境变化(例如,ED内的专业单位),教育,创建多学科团队,和护理标准化。33项研究(72%)报告了系统性能指标,报告患者预后指标的研究较少(n=19,41%),患者体验(n=10,22%),或员工经验(n=14,30%)。很少有干预措施报告了所有四个领域的结果。研究样本的异质性,战略,和评估的结果使得采用现有的战略具有挑战性。
■精神疾病的护理是复杂的,特别是在紧急情况下。提供护理的策略必须使ED系统目标与患者目标和员工经验保持一致。
UNASSIGNED: Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This
review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness.
UNASSIGNED: We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception;
review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools.
UNASSIGNED: A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging.
UNASSIGNED: Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.