救命救急センターにおけるリハビリテーション

Rehabilitation in the Critical Care Centre

はじめに

　リハビリテーション（以下，リハ）は急性期における重要な治療アプローチの1つであり，それは急性期医療に携わる医師および医療スタッフの間で，十分に認識されている．重症患者の治療に当たる他の集中治療部門と同様に，救命救急センターにおいても，できるだけ早期からリハが開始される．そこでは，患者の全身状態が安定していない場合であっても積極的にリハを進めるため，その開始や中止の基準，内容や負荷の程度が問題となり，安全にリハを実施するための十分な配慮が求められる．

　本稿では，まず救急・集中治療領域における急性期リハの位置づけとその安全管理について概説し，救命救急センターにおけるチーム医療および当施設で行っている「多職種協働の救急チーム人材養成システム」について述べる．

Abstract : Critical care centre medical staff understand that rehabilitation is one of the important therapeutic approaches for seriously ill patients. Accordingly, we commence rehabilitation proactively to prevent disuse syndrome and improve their activity of daily life as soon as possible. From recent reports, it has become apparent that many survivors of critical illness experience poor physical, functional and cognitive outcomes, often lasting for years. Rehabilitation at the acute phase may play an important role in preventing this post-intensive care syndrome and reduction in long-term quality of life. Safety management is essential in the early rehabilitation. In our critical care centre, we use the Guideline for Safety Management and Promotion in Rehabilitation Medicine that was formulated by the Clinical Guideline Committee of the Japanese Association of Rehabilitation Medicine. Team treatment in medical care is necessary for the safety management of the patients, too. Seriously ill patients often require a multidisciplinary approach in their treatment. Moreover, it is important that medical staff have information sharing discussions in order to really harness their power as a team. We are developing an education course for personnel training designed to systematically push multidisciplinary team based medical care forward in our institution. In this education course, many medical staff participate thereby raising their communication and teamwork skills, as well as instilling leadership abilities. We have elevated the role of promoting teamwork to a profession.