背景:对紧急精神病护理的需求正在增加,但在西班牙,对于急诊部门(ED)如何优化精神病患者的护理并没有明确的建议.我们旨在就综合医院急诊科治疗有紧急精神症状的患者的要求提供专家共识建议。
方法:我们使用了一种改进的Delphi技术。一个科学委员会根据文献检索和临床经验编制了36份声明。这些声明涵盖了组织模式,设施,人员配备,安全,患者干预,和员工培训。由38名具有精神病紧急情况专业知识的精神病学专家组成的小组分两轮对问卷进行了评估。
结果:经过两轮投票,36个拟议项目中有30个(83%)得到了同意。小组同意精神病紧急情况应在综合医院进行管理,有专门的病人评估设施,直接监督有风险的患者,还有一个由精神病院管理的观察组.除了精神科医生,ED应有24/7全天候的专科护士和安全人员。社会工作者也应该随时可用。ED和咨询室的设计应确保患者和工作人员的安全。应该为有精神病症状的病人建立分诊制度,在精神病学评估之前进行医学评估。关于供应的指导,设备,还提供员工培训。
结论:综合医院的所有ED都应该有足够的资源来处理任何精神病紧急情况。本文就实现这一目标的最低要求提供了建议。
BACKGROUND: The demand for urgent
psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with
psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms.
METHODS: We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds.
RESULTS: After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that
psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with
psychiatric symptoms, with medical evaluation preceding
psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided.
CONCLUSIONS: All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal.