如何做出临床决策.pptx

如何做出临床决策？;目的 Objectives;循证实践的步骤 EBP process;对某个问题仔细考虑后的评判 The passing of judgment on an issue under consideration. 得出结论或作出决定后的行动 The act of reaching a conclusion or making up ones mind. 所获得的或明确的一个结论或判断，一个定论 A conclusion or judgment reached or pronounced; a verdict.;Regardless of who makes the decision, orhow the decision is made;Be curious always, for knowledge will not acquire you; you must acquire it.” —Sudie Black;制定决策 Decision Making;知识的正规来源Formalized Sources of Knowledge;知识的实践来源Practical Sources of Knowledge;知识和病人偏好Knowledge and Patient Preferences;应用证据Applying Evidence;良好的临床决策的元素Elements of Good Clinical Judgment;临床决策与循证事件的商业性 The “Business” Side Of Decision Making and EBP 投资回报的最大化 Maximizing Return on Investment;什么是投资回报率？WHAT is ROI?;卫生保健中的意义Meaning in Healthcare;为什么重要？Why is ROI important to EBP?;不应该发生的事件Never Events ? III -IV 期压疮 III or Stage IV pressure ulcers ? 跌倒和创伤Falls and trauma: – 骨折Fracture – 关节脱位Joint dislocation – 头部外伤Head injury – 挤压伤Crushing injury – 烧伤Burn – 电休克Electric shock ? 导尿管伴随性尿路感染Catheter‐associated urinary tract infection ? 导管相关性血流感染Vascular catheter‐associated infection;临床医疗过程Clinical Process of Care ?急性心梗指标AMI indicators ?心力衰竭指标 HF indicators ? 肺炎Pneumonia – 抗生素的选择Antibiotic Selection – 静脉血栓的预防Venous thromboembolism prophylaxis;病人经验Patient Experience ? 护患交流Communication with Nurses ?医患交流 Communication with Doctors ? 医院工作人员的反应力Responsiveness of Hospital Staff ?疼痛管理 Pain Management ?用药沟通Communication about Medicines ? 医院整洁与安静Hospital Cleanliness Quietness ? 出院指导Discharge Information ? 对医院的综合评分Overall Rating of Hospital ;病人结果Patient Outcomes ? 急性心梗30天死亡率 Acute Myocardial Infarction (AMI) 30‐Day Mortality Rate (shown as survival rate) ? 心力衰竭30天死亡率 Heart Failure (HF) 30‐Day Mortality Rate (shown as survival rate) ?肺炎30天死亡率 Pneumonia (PN) 30‐Day Mortality Rate (shown as survival rate) ;提升病人结果Improved Patient Outcomes ? 最大化的报销 Maximize Reimbursement ? 声誉-优于竞争者Reputation, Outperforming Competitors ?病人满意度 Patient Satis