急诊科只需要医护?美国医生:Not Enough

2018-04-28 15:10 来源:丁香智汇 作者:
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上一期,我们聊了美国急诊科概况:

请戳→急诊科医生是「全能手」?美国医生 Say No

这次让我们谈一谈急诊科医疗团队的组成。

在中国,我们发现大部分急诊科日常医疗工作者主要是:医生和护理人员。

而在美国,急诊科医疗团队里面还有他们……

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中美医生介绍

美国医生:侯全益医生,哈佛医学院急诊科讲师, 布列根和妇女医院急诊科医生,外科 ICU 重症监护专家。
U.S. doctor: Dr. Peter Hou is an Instructor in Emergency Medicine at Harvard Medical School, an Emergency Physician at Brigham and Women’s Hospital, and a critical care specialist in the Surgical ICU.

中国医生:宋瑞医生,曾在中国和新加坡担任内科住院医师,现为自由作家,同时在波士顿进行相关临床研究。
Chinese doctor: Dr. Rui Song, former resident physician of internal medicine in China and Singapore,  freelancer  and she is doing clinical research on Autism in Boston.

Dr. 宋:侯医生您好,我对美国急诊科的医疗团队构成很感兴趣。除了医生和护士之外,我听说团队中还有其他的医疗专业人员。你能否更详细地描述一下他们所扮演的不同角色?
Hi Dr. Hou, I am very interested in the medical team here in the US emergency departments.  Besides doctors and nurses, I heard that there are other healthcare professionals.  Could you describe more about the different roles that they perform?

Dr. 侯:当然。在急诊科,我们经常需要团队合作,因为医疗团队是由许多医疗服务提供者所共同组成。

然而,对于不同患者的照顾往往需要组合不同的医疗提供者。

我们很幸运拥有一位急诊科药剂师,这在美国大多数急诊室是不存在的。 急诊科药剂师可以帮助处理许多急性情况。例如:

1、中风患者需要溶栓治疗时,药剂师作为治疗团队的一名队员将被叫到床边,以协助恰当给药;

2、再比如对于心脏骤停或休克患者,急诊科药剂师可以帮助床旁护士获取血管加压药物。

3、对于感染并需要抗生素的患者,急诊科药剂师则会给出正确的抗生素剂量和频率。

4、最后,由于大多数医疗错误与药物相关,急诊科药剂师可以协助患者/家属进行药物指导,以确保患者服用正确的处方药物,且药物剂量和使用频率都正确。

所以,我们能有一位急诊科的药剂师是相当奢侈的。
Sure. In the ED, the medical team is composed of many providers as it often requires team work.  However, it may be various combination of different providers taking care of an individual patient. In general, we are lucky to have a pharmacist in the ED, which often does not exist in most EDs in the United States.

The ED pharmacist can help with many acute conditions.  

For examples:

1. A patient who has a stroke and needs to have thrombolysis. The pharmacist is a stroke team member who will be activated to the bedside to help facilitate appropriate medication administration.

2.As another example of a patient who presents in cardiac arrest or in shock, the ED pharmacist may be helpful in obtaining the vasopressor medications to the bedside nurse. 

3. And for someone who is infected and needs antibiotics, the ED pharmacist often facilitates correct antibiotic dosing and frequency. 

4. Lastly, as most medical error is medication related, the ED pharmacist assists with medication reconciliation with the patient and/or family members to make sure that the patient is taking the correct prescribed medication and correct dose and frequency.  

So, it is quite a luxury that we have a pharmacist in ED.

其他医疗保健专业人员还包括:社会工作者(简称社工),他们帮助患者寻求与应用社区资源。例如,由于急诊科经常照顾无家可归的人士,无家可归的患者可能会要求寻求庇护所,这时社工就会帮助协调这项要求。社工的其他角色还包括评估患者的家庭动态。其中一些情况在法律上要求必须上报,例如虐待老人和虐待儿童。这些情况都需要社工密切参与。对我们来说,能够在急诊科拥有社工也是很奢侈的,因为许多医院都有指派到医院的社工,但没有只为急诊科服务的社工。
Other healthcare professionals include the social worker, who is involved in helping the patient with resources in our community.   As a classic example since the ED often take care of the homeless population, the homeless patients may request to seek shelter and social worker will help coordinate this request.  Other role for social worker is evaluating the family dynamics of a patient.  For example, there are conditions that must be reported by law such as geriatric abuse and child abuse.  These conditions require the social worker to become intimately involved, and again for us, a luxury that we have in our ED because many hospitals have social workers designated for the hospital but are not designated for the ED only.  

另一个重要的医疗服务提供者是护理协调员或案件管理员。通常这个角色由熟悉医疗系统的护士进行,以帮助评估患者是否需要紧急住院。例如,患者最初可能来急诊科就诊后进入急诊留观室,由于大部分患者在留观室病情就会好转,可以安全地出院,(护理协调员或案件管理员可以帮助他们)安排后续的门诊服务,如探访护士和/或物理治疗师提供的服务。

护理协调员或案件管理员也可以协助患者转院去往急诊康复机构,甚至是养老院或临终关怀医院。

这些就是我们急诊科扮演不同重要角色的三种特定类型的专业人员。
Another important provider are the care coordinators or case managers.  Often the role is performed by a nurse who knows the healthcare system well and would help assess the patient whether or not acute hospitalization is required.  For example, patients may initially present to the ED and be admitted to our ED observation unit.  As most of these patients will improve their condition during the observation period, they may be safely discharged home with outpatient services such as visiting nurse and/or physical therapist(which they could help arrange).  Or they can help coordinate patients to go to acute rehabilitation facilities or even nursing home or hospice.  So, these are three specific types of professionals with different yet important roles in our ED. 

除此之外,由于我们是一所教学医院,我们还会有住院医师及医学生一起接诊患者,也会和医生助理以及医生助理学生一起看患者。其他急诊科工作人员还包括急救技术员、医疗口译员、病例录入员、看护员、运输员和志愿者。他们都是我们急诊科的重要成员。
Since we are a teaching hospital, we see patients with the residents and medical students.  Furthermore, we also see patients with physician assistants and physician assistant students.  Other ED staff include emergency service technicians, medical interpreters、scribes、 sitters、transporters、 and volunteers.  They are all very important members of our ED team.

Dr. 宋:是的,他们确实非常重要。非常感谢您和我们介绍急诊科医疗团队成员。下一期节目,我们一起聊聊贵院以及美国的急诊科住院医师培训如何?
S: Yes, they really are. Thank you very much for describing your medical team members.  As for next time, shall we talk about emergency medicine residency training in your hospital and in the US?

Dr. 侯:好的。
Sure!

下一期讲什么?

what will we talk about?

急诊科医生养成记-浅谈中美急诊科住院医师培养

The growth story of emergency physicians – Discuss the residency training system of ER in China and U.S.

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