今日，咱们来聊一聊美国急诊科医师是怎么与其他专科医师协作的呢？
Dr. 宋：Dr. Hou, our audience in China are keen to know more about How Emergency Physicians collaborate with other specialists. Let’s talk about it today.
侯医师，咱们在我国的听众想要了解急诊科医师怎么与其他专科的医师协作。今日就让咱们来谈谈这个论题吧。
Dr. 侯：Sounds good.
好的。
Dr. 宋：First let’s talk about those collaborations in ED settings. Many patients in ED need consultations from other specialties. Could you tell us more about it?
首要让咱们谈谈急诊室里的协作。许多急诊科患者需求其他专科医师的会诊。您能和咱们聊聊这方面吗？
Dr. 侯：Yes, I agree. Many patients do require subspecialty expertise in addition to their emergency care. So as background for our department, we have already set up a sort of individual attending staff physicians have liaison to the individual subspecialties such as somebody will be speaking with the cardiology representative and oncology representative.
Even among the surgical subspecialties I am currently in charge of liaising the cardiac surgery patients who may come into the ED once in a while. And we want to make sure those processes and communications of care for those patients are transparent to the primary providers.
是的，我赞同。除了急诊科的医治外，许多患者的确需求亚专科的帮忙医治。作为布景了解，咱们部分现已建立了一种主治医师个人与不同亚专科的联络。例如有人会与心脏科代表和肿瘤科代表攀谈。在外科亚专科中，我现在担任联络或许会偶然进入急诊科的心脏外科手术患者。咱们期望保证这些患者的医治进程和其间的交流对其家庭医师是通明的。
Dr. 宋：Then, are there any multi-disciplinary care for patients in ED?
那么，急诊科患者是否有多学科医治呢？
Dr. 侯：Absolutely! I think multi-disciplinary care now is such an important process for care in patients who require time sensitive interventions. For example, we already know that STEMI care, often time we require the communication with our pre-hospital ambulance, paramedic specialists who can do the 12-lead EKG pre-arrival. And if it is a good story of the chest pain and the ST elevation on the cardiogram then we actually have a process to activate the cardiac cath lab. So this is an example of multi-disciplinary care also involving pre-hospital providers.
当然！我以为多学科医治关于需求时刻灵敏干涉的患者来说是一个十分重要的进程。例如，咱们现已知道 ST 段举高心肌梗死的医治，一般咱们需求与咱们的医院前救助车中能够在抵院前做 12 导联心电图的医疗救助专家交流。假如其病史是胸痛和心电图 ST 段举高，那么咱们实践上有一个流程来激活心导管实验室。这是触及医院前医治者的多学科医治的一个比如。
Additionally, as we know stroke care with our t-PA process for patient within a time window for our stroke specialist as well as our radiologist need to be closely prepared for this kind of team effort approach to take care of the right patient and the right care at the right time. Same with our trauma care as well, often times we need our trauma colleagues and surgical colleagues of subspecialty surgeons such as orthopedic doctors, neurosurgeon or spine surgeon to be activated so that in the poly-trauma patient that we are ready to take care of the patient from multiple viewpoints in addition to the emergency care that we provide. So these are the classic examples of we do multiple disciplinary care for patients in the ED.
此外，由于咱们知道在必定时刻窗口内使用 t-PA 的卒中医治，咱们需求卒中专家及放射科医师为这种团队协作方法做好预备，以保证正确的患者在正确的时刻得到正确的医治。咱们的伤口医治也是相同，一般咱们需求激活咱们的伤口外科搭档，以及骨科医师，神经外科医师或脊柱外科医师等外科专家，以便在多伤口患者中使患者在急诊科医治以外得到多个专科的照料。这些就是咱们为急诊科患者供给多学科医治的典型比如。
Dr. 宋：I see. How about patient being admitted to the ward? Any communication on this process with other specialists?
我理解了。那么当患者收入病房时呢？此进程中是否与其他专科医师进行交流呢？
Dr. 侯：Absolutely! We often times admit patient to the ward and usually under the hospitalist service. Or maybe even the oncologist service they have their own service, or cardiologist service. So we will be communicating with cardiologist, oncologist or even other subspecialist such as a patient came in with GI bleed. So we will be communicating, letting the GI specialist know that this patient has been admitted and will require their services sooner or later depending on the clinical condition.
当然！咱们经常将患者收入病房，并且一般由医院医师担任。或许肿瘤科医师或心内科医师有自己的效劳。因而，咱们将与心内科专家，肿瘤科专家乃至其他亚专科医师进行交流。如患者呈现胃肠道出血，咱们将与消化科专家进行交流，让其知道这名患者已被收住院，并将依据临床状况需求他们的效劳。
Other subspecialty services we do get involved is infectious disease. There are a lot of patients who are unfortunately immunocompromised and maybe have chronic infections. Then we will call the specialist to titrate our antibiotic therapy more appropriately. So these are just examples that we have specially that we consult for patient who are stable to be admitted to the ward.
其他咱们触及的亚专科效劳是流行症科。有许多患者不幸免疫功用低下，或许会有慢性感染，咱们会给传染科专家打电话然后更恰当地调整抗生素医治。这些就是咱们为那些病况安稳的收住病房患者进行会诊的比如。
Dr. 宋：How about for patients being admitted to the ICU?
那么关于收住 ICU 的患者是怎样的呢？
Dr. 侯：Likewise, we speak to our intensivist colleagues closely. We have many ICUs here quite specialized to medical, coronary and other different surgical intensive care units. And respectively depending on what the patient’s condition is that require the ICU care, we will communicate to that specialty and ICU service taking care of that patient.
相同的，咱们也和咱们的重症监护科搭档亲近交流。咱们有许多重症监护病房专门用于医疗，冠状动脉和其他不同的外科重症监护病房。依据患者的病况需求什么样的 ICU 护理，咱们将与担任医治患者的该专科和 ICU 效劳团队交流。
Dr. 宋：Ok, I see. Then what is the communication between emergency physician and the primary care providers?
好的，我理解了。那么急诊科医师和初级保健供给者（家庭医师）之间的交流是什么样的呢？
Dr. 侯：Yes. This is of utmost importance for most patients who come to the ED. For example, in our ED, we admit about 30% of patients, so 70% will be discharged to go back home or go to outside of the hospital setting, and then we of course will try to understand how is their relationship with their primary care physician. And if possible if they are within our hospital network, we will communicate with them by email or even call them during business hours to close the loop with the primary care physician especially many time the primary care physician will refer their patients to the ED for acute workups, and hence our close communication is most important.
是的。这对大多数来急诊室的患者来说是最重要的。例如，在咱们的急诊科，咱们收住院 30% 的患者，所以 70% 的患者将会出院回家或去医院外，然后咱们当然会试着了解他们与他们的家庭医师的联络。假如他们在咱们的医院网络内，咱们将经过电子邮件与他们交流，乃至在作业时刻打电话给他们，以便与初级保健医师的交流构成闭环，特别是在初级保健医师许多时分将他们的患者转诊给急诊室做急性查看时，（医师间的）亲近交流是最重要的。
As an example, we also have a primary care physician group in the hospital here at Brigham, they are called the Brigham’s circle group and they are one of the more traditional primary care group onsite where in the past our PCP would take care of their patients even when they are admitted to the hospital. And this group will attend on their own patients and they have a service in our hospital taking care of them. I still remember when I started back in the mid to late 2000, the PCPs would like to be called 24 hours a day anytime a day. And often time when they call they will response in a timely manner. And in acute emergency, a lot of these PCPs within the group would physically come to see their patient in the ED and contribute to the workup because they know these patients so well over time for decades.
举一个比如，咱们在布列根和妇女医院也有一个初级保健医师组，他们被称为布列根圈子组，他们是当今较传统的初级保健组之一，曩昔假如他们的患者被收住院，这个小组的医师将去照看他们自己的患者，并且在咱们的医院为患者供给效劳。我依然记住，当我从 2000 年中后期开始时来布列根医院作业时，家庭医师每天 24 小时的任何时分都能被叫到。并且往往他们接到电话时会及时回应。在紧迫状况下，该组中的许多家庭医师将亲自到急诊科看望他们的患者，并开具查看，由于他们已了解这些患者多年。
And for example, memorably an example I have was Dr. Marshall Wolf, a Professor in Medicine at Harvard Medical School. At 2 o』clock in the morning, I had one of his patients coming in looked like ST elevation but patient was also in heart failure. So, it was kind of mimic of acute decompensate heart failure causing a STEMI, and he came in and felt that it was not a true acute coronary event, and we treated the heart failure. So that was a memorable experience for me as an attending to know these back then and still now their PCPs care for their patients this way.
举个比如，我记住哈佛医学院医学教授马歇尔沃尔夫医师在清晨 2 点呈现在医院，我的一位患者就诊时看起来像 ST 段举高性心肌梗死，但患者也呈现了心力衰竭。所以，这有点像急性失代偿性心脏衰竭引起的 ST 段举高性心肌梗死，他来医院后觉得这不是一个真实的急性冠脉事情，所以咱们医治了心力衰竭。这对当主治医师的我来说是一段难忘的阅历，我知道曩昔和现在这些家庭医师依然是以这种方法照料他们的患者。
Dr. 宋：Thank you so much for your sharing. Let’s call it a day for today’s program.
十分感谢您的共享。今日的节目就到这儿啦。
中美医师介绍
美国医师：侯全益医师，哈佛医学院急诊科讲师, 布列根和妇女医院急诊科医师，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.
我国医师：宋瑞医师，曾在我国和新加坡担任内科住院医师，现为自在作家，一起在波士顿进行自闭症相关临床研讨。
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.
修改｜晓玮
文章转载授权及协作事宜请联络「panda_wqy」
扫描下方二维码重视「丁香智汇」，阅览更多精彩文章！
