RESUMEN
In the last decade the field of cardiac pacing and electrophysiology underwent major advancements thanks to both new ways of arrhythmia management and technological innovations. At the same time, the clinical competence and the procedural qualitative level of Cardiac Rhythm Centers have increased significantly. In 2010 an ad hoc Committee of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) and the Italian Federation of Cardiology (FIC) published a consensus document on the organization of Cardiac Rhythm Centers and on the standards of professional practice in pacing and electrophysiology in Italy. In particular, this document focused on the minimal requirements of a Center to be qualified as suitable to perform first, second and third-level cardiac pacing and electrophysiology activities. However, most of these indicators have been overcome over time. Thus, an update of the previously published organizational model appeared necessary. In this document several new requirements and indicators about the organization and performance of both operators and Cardiac Arrhythmia Centers have been introduced. These include: (i) "structural and procedural requirements" (types of diagnostic and therapeutic procedures performed, logistic structures, healthcare staff and technologies), (ii) "activity indicators" (number of procedures performed); (iii) "appropriateness indicators" (adherence to guideline recommendations); (iv) "outcome indicators" (procedural success and complications); and (v) "quality of care indicators" (management and continuity of care levels). By applying these requirements and indicators, each center can optimize its procedures, increasing its performance and effectiveness. Finally, a new model for the organization of the Italian network of Cardiac Arrhythmia Centers is also suggested.
Asunto(s)
Arritmias Cardíacas/terapia , Instituciones Cardiológicas/normas , Estimulación Cardíaca Artificial/normas , Consenso , Electrofisiología/normas , Arritmias Cardíacas/diagnóstico , Instituciones Cardiológicas/organización & administración , Instituciones Cardiológicas/estadística & datos numéricos , Cardiología/organización & administración , Cardiología/normas , Competencia Clínica , Electrocardiografía/instrumentación , Electrocardiografía/normas , Electrofisiología/organización & administración , Adhesión a Directriz , Humanos , Italia , Indicadores de Calidad de la Atención de Salud , Sociedades MédicasAsunto(s)
Instituciones Cardiológicas/normas , Protocolos Clínicos/normas , Infecciones por Coronavirus/diagnóstico , Infarto del Miocardio/terapia , Pandemias , Neumonía Viral/diagnóstico , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Feeding practices after neonatal and congenital heart surgery are complicated and variable, which may be associated with prolonged hospitalization length of stay (LOS). Systematic assessment of feeding skills after cardiac surgery may earlier identify those likely to have protracted feeding difficulties, which may promote standardization of care. METHODS: Neonates and infants ≤3 months old admitted for their first cardiac surgery were retrospectively identified during a 1-year period at a single center. A systematic feeding readiness assessment (FRA) was utilized to score infant feeding skills. FRA scores were assigned immediately prior to surgery and 1, 2, and 3 weeks after surgery. FRA scores were analyzed individually and in combination as predictors of gastrostomy tube (GT) placement prior to hospital discharge by logistic regression. RESULTS: Eighty-six patients met inclusion criteria and 69 patients had complete data to be included in the final model. The mean age of admit was five days and 51% were male. Forty-six percent had single ventricle physiology. Twenty-nine (42%) underwent GT placement. The model containing both immediate presurgical and 1-week postoperative FRA scores was of highest utility in predicting discharge with GT (intercept odds = 10.9, P = .0002; sensitivity 69%, specificity 93%, AUC 0.913). The false positive rate was 7.5%. CONCLUSIONS: In this analysis, systematic and standardized measurements of feeding readiness employed immediately before and one week after congenital cardiac surgery predicted need for GT placement prior to hospital discharge. The FRA score may be used to risk stratify patients based on likelihood of prolonged feeding difficulties, which may further improve standardization of care.
Asunto(s)
Instituciones Cardiológicas/normas , Procedimientos Quirúrgicos Cardíacos/normas , Cardiopatías Congénitas/cirugía , Unidades de Cuidado Intensivo Pediátrico/normas , Mejoramiento de la Calidad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Estudios RetrospectivosRESUMEN
Comprehensive Cardiac Center Certification is designed for hospitals with robust cardiac care facilities, with the aim of helping institutions to establish the structures, processes, and culture necessary to achieve sustained levels of effective clinical performance and patient outcomes across cardiac specialties and the continuum of care.
Asunto(s)
Instituciones Cardiológicas/normas , Certificación/normas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Estados UnidosAsunto(s)
Instituciones Cardiológicas/normas , Enfermedades de las Válvulas Cardíacas/terapia , Cirujanos/organización & administración , Cirugía Torácica/métodos , Instituciones Cardiológicas/organización & administración , Europa (Continente)/epidemiología , Implantación de Prótesis de Válvulas Cardíacas/normas , Humanos , Comunicación Interdisciplinaria , Válvula Mitral/patología , Válvula Mitral/cirugía , Grupo de Atención al Paciente/normasRESUMEN
UNLABELLED: Introduction Hospitals are meant to be places for respite and healing; however, technological advances and reliance on monitoring alarms has led to the environment becoming increasingly noisy. The coronary care unit (CCU), like the emergency department, provides care to ill patients while being vulnerable to noise pollution. The World Health Organization (WHO; Geneva, Switzerland) recommends that for optimum rest and healing, sound levels should average approximately 30 decibels (dB) with maximum readings less than 40 dB. Problem The purpose of this study was to measure and analyze sound levels in three different locations in the CCU, and to review alarm reports in relation to sound levels. METHODS: Over a one-month period, sound recorders (Extech SDL600; Extech Instruments; Nashua, New Hampshire USA) were placed in three separate locations in the CCU at the West Roxbury Veterans' Administration (VA) Hospital (Roxbury, Massachusetts USA). Sound samples were recorded once per second, stored in Comma Separated Values format for Excel (Microsoft Corporation; Redmond, Washington USA), and then exported to Microsoft Excel. Averages were determined, plotted per hour, and alarm histories were reviewed to determine alarm noise effect on total noise for each location, as well as common alarm occurrences. RESULTS: Patient Room 1 consistently had the lowest average recordings, though all averages were >40 dB, despite decreases between 10:00 pm and 7:00 am. During daytime hours, recordings maintained levels >50 dB. Overnight noise remained above recommended levels 55.25% of the period in Patient Room 1 and 99.61% of the same time period in Patient Room 7. The nurses' station remained the loudest location of all three. Alarms per hour ranged from 20-26 during the day. Alarms per day averaged: Patient Room 1-57.17, Patient Room 7-122.03, and the nurses' station - 562.26. Oxygen saturation alarms accounted for 33.59% of activity, and heart-related (including ST segment and pacemaker) accounted for 49.24% of alarms. CONCLUSION: The CCU cares for ill patients requiring constant monitoring. Despite advances in technology, measured noise levels for the hospital studied exceeded WHO standards of 40 dB and peaks of 45 dB, even during night hours when patients require rest. Further work is required to reduce noise levels and examine effects on patient satisfaction, clinical outcomes, and length of stay. Ryan KM , Gagnon M , Hanna T , Mello B , Fofana M , Ciottone G , Molloy M . Noise pollution: do we need a solution? An analysis of noise in a cardiac care unit. Prehosp Disaster Med. 2016;31(4):432-435.
Asunto(s)
Instituciones Cardiológicas/normas , Ruido/prevención & control , Habitaciones de Pacientes/normas , Instituciones Cardiológicas/estadística & datos numéricos , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Humanos , Monitoreo Fisiológico/efectos adversos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Ruido/efectos adversos , Habitaciones de Pacientes/estadística & datos numéricosRESUMEN
OBJECTIVES: The aims of this study were to assess patient-relevant outcomes of delivered cardiovascular care by focusing on disease management as determined by a multidisciplinary Heart Team, to establish and share best practices by comparing outcomes and to embed value-based decision-making to improve quality and efficiency in Dutch heart centres. METHODS: In 2014, 12 Dutch heart centres pooled patient-relevant outcome data, which resulted in transparent publication of the outcomes, including long-term follow-up up to 5 years, of approximately 86 000 heart patients. This study presents the results of both disease- and treatment patient-relevant outcome measures for coronary artery disease and aortic valve disease. The patients included were presented to a Heart Team and underwent invasive or operative treatment. In-hospital and out-of-hospital patient-relevant outcome measures were collected as well as initial conditions. Quality of life was assessed using the Short Form (SF)-36 or SF-12 health survey. RESULTS: In the Netherlands, patient-relevant and risk-adjusted outcomes of cardiovascular care in participating heart centres are published annually. Data were sufficiently reliable to enable comparisons and to subtract best practices. The statistically lower risk-adjusted mortality rate after coronary artery bypass grafting resulted in a voluntary roll-out of a perioperative safety check. The in-depth analysis of outcomes after percutaneous coronary intervention resulted in process improvements in several heart centres, such as pre-hydration for patients with renal insufficiency and the need of target vessel revascularizations within a year. CONCLUSION: Annual data collection on follow-up of patient-relevant outcomes of cardiovascular care, initiated and organized by physicians, appears feasible. Transparent publication of outcomes drives the improvement of quality within heart centres. The system of using a limited set of patient-relevant outcome measures enables reliable comparisons and exposes the quality of decision-making and the operational process. Transparent communication on outcomes is feasible, safe and cost-effective, and stimulates professional decision-making and disease management.
Asunto(s)
Válvula Aórtica , Instituciones Cardiológicas/normas , Enfermedad de la Arteria Coronaria/terapia , Enfermedades de las Válvulas Cardíacas/terapia , Mejoramiento de la Calidad/organización & administración , Benchmarking/métodos , Instituciones Cardiológicas/organización & administración , Enfermedad de la Arteria Coronaria/mortalidad , Manejo de la Enfermedad , Estudios de Seguimiento , Investigación sobre Servicios de Salud/métodos , Enfermedades de las Válvulas Cardíacas/mortalidad , Humanos , Países Bajos/epidemiología , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Readmisión del Paciente/estadística & datos numéricos , Calidad de Vida , Recurrencia , Resultado del TratamientoRESUMEN
Despite standard fall precautions, including nonskid socks, signs, alarms, and patient instructions, our 48-bed cardiac intermediate care unit (CICU) had a 41% increase in the rate of falls (from 2.2 to 3.1 per 1,000 patient days) and a 65% increase in the rate of falls with injury (from 0.75 to 1.24 per 1,000 patient days) between fiscal years (FY) 2012 and 2013. An evaluation of the falls data conducted by a cohort of four clinical nurses found that the majority of falls occurred when patients were unassisted by nurses, most often during toileting. Supported by the leadership team, the clinical nurses developed an accountability care program that required nurses to use reflective practice to evaluate each fall, including sending an e-mail to all staff members with both the nurse's and the patient's perspective on the fall, as well as the nurse's reflection on what could have been done to prevent the fall. Other program components were a postfall huddle and guidelines for assisting and remaining with fall risk patients for the duration of their toileting. Placing the accountability for falls with the nurse resulted in decreases in the unit's rates of falls and falls with injury of 55% (from 3.1 to 1.39 per 1,000 patient days) and 72% (from 1.24 to 0.35 per 1,000 patient days), respectively, between FY2013 and FY2014. Prompt call bell response (less than 60 seconds) also contributed to the goal of fall prevention.
Asunto(s)
Accidentes por Caídas/prevención & control , Atención de Enfermería/normas , Personal de Enfermería en Hospital/educación , Seguridad del Paciente/normas , Garantía de la Calidad de Atención de Salud/normas , Accidentes por Caídas/economía , Accidentes por Caídas/estadística & datos numéricos , Instituciones Cardiológicas/economía , Instituciones Cardiológicas/organización & administración , Instituciones Cardiológicas/normas , Alarmas Clínicas , Correo Electrónico , Humanos , Difusión de la Información/métodos , Capacitación en Servicio/métodos , Atención de Enfermería/métodos , Personal de Enfermería en Hospital/normas , Estudios de Casos Organizacionales , Seguridad del Paciente/economía , Pennsylvania , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/métodos , Tiempo de Reacción , Responsabilidad SocialRESUMEN
INTRODUCTION: Several studies have identified that socioeconomic inequalities in coronary artery disease (CAD) morbidity and mortality lead to a disadvantage in patients with low socioeconomic status (SES). International studies have shown that socioeconomic inequalities also exist in terms of access, utilisation and quality of cardiac care. The aim of this qualitative study is to provide information on the impact of socioeconomic inequalities on the pathway of care for CAD, and to establish which factors lead to socioeconomic inequality of care to form and expand existing scientific theories. METHODS AND ANALYSIS: A longitudinal qualitative study with 48 patients with CAD, aged 60-80â years, is being conducted. Patients have been recruited consecutively at the University Hospital in Halle/Saale, Germany, and will be followed for a period of 6â months. Patients are interviewed two times face-to-face using semistructured interviews. Data are transcribed and analysed based on grounded theory. ETHICS AND DISSEMINATION: Only participants who have been informed and who have signed a declaration of consent have been included in the study. The study complies rigorously with data protection legislation. Approval of the Ethical Review Committee at the Martin-Luther University Halle-Wittenberg, Germany was obtained. The results of the study will be presented at several congresses, and will be published in high-quality peer-reviewed international journals. TRIAL REGISTRATION NUMBER: This study has been registered with the German Clinical Trials Register and assigned DRKS00007839.
Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Disparidades en Atención de Salud , Anciano , Anciano de 80 o más Años , Instituciones Cardiológicas/normas , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Alemania , Humanos , Estudios Longitudinales , Masculino , Investigación Cualitativa , Calidad de la Atención de Salud , Factores SocioeconómicosAsunto(s)
Instituciones Cardiológicas/organización & administración , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/cirugía , Instituciones Cardiológicas/economía , Instituciones Cardiológicas/normas , Procedimientos Quirúrgicos Cardíacos/economía , Procedimientos Quirúrgicos Cardíacos/mortalidad , Niño , Política de Salud , Humanos , Estados Unidos/epidemiologíaRESUMEN
AbstractDuring the last decades, advances in diagnosis and treatment of congenital heart disease have allowed many individuals to reach adulthood. Due mainly to the great diagnostic diversity and to the co-morbidities usually present in this age group, these patients demand assistance in a multidisciplinary facility if an adequate attention is aimed. In this paper we reviewed, based in the international literature and also on the authors’ experience, the structural conditions that should be available for these patients. We highlighted aspects like the facility characteristics, the criteria usually adopted for patient transfer from the paediatric setting, the composition of the medical and para- medical staff taking into account the specific problems, and also the model of outpatient and in-hospital assistance. We also emphasized the importance of patient data storage, the fundamental necessity of institutional support and also the compromise to offer professional training. The crucial relevance of clinical research is also approached, particularly the development of multicenter studies as an appropriate methodology for this heterogeneous patient population.
ResumoDurante as últimas décadas, os avanços verificados no diagnóstico e tratamento das cardiopatias congênitas têm permitido que muitos indivíduos cheguem à idade adulta. Devido principalmente à grande diversidade diagnóstica e também às comorbidades habitualmente presentes nesse grupo etário, esses pacientes necessitam ser atendidos numa unidade multidisciplinar, se o objetivo for proporcionar uma assistência adequada. Neste trabalho revisamos, com base na experiência dos autores e na literatura internacional, as condições estruturais que devem estar disponíveis para esses pacientes. Procuramos ressaltar aspectos como as características da unidade, o critério usualmente adotado para transferência desses pacientes da unidade pediátrica, a composição das equipes médica e paramédica levando em consideração os problemas específicos dos pacientes e também o modelo de assistência ambulatorial e hospitalar. Enfatizamos, ainda, a importância do armazenamento dos dados dos pacientes, a necessidade fundamental de apoio institucional e a importância de oferecer treinamento profissional. A relevância da pesquisa clínica é também abordada, particularmente a importância da confecção de estudos multicêntricos, como uma metodologia apropriada para essa heterogênea população de pacientes.
Asunto(s)
Adulto , Niño , Humanos , Procedimientos Quirúrgicos Cardíacos , Instituciones Cardiológicas/normas , Cardiopatías Congénitas/cirugía , Guías de Práctica Clínica como Asunto , Factores de Edad , Atención Ambulatoria/organización & administración , Atención Ambulatoria/normas , Brasil , Instituciones Cardiológicas/organización & administración , Educación Médica , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/normasRESUMEN
During the last decades, advances in diagnosis and treatment of congenital heart disease have allowed many individuals to reach adulthood. Due mainly to the great diagnostic diversity and to the co-morbidities usually present in this age group, these patients demand assistance in a multidisciplinary facility if an adequate attention is aimed. In this paper we reviewed, based in the international literature and also on the authors' experience, the structural conditions that should be available for these patients. We highlighted aspects like the facility characteristics, the criteria usually adopted for patient transfer from the paediatric setting, the composition of the medical and para- medical staff taking into account the specific problems, and also the model of outpatient and in-hospital assistance. We also emphasized the importance of patient data storage, the fundamental necessity of institutional support and also the compromise to offer professional training. The crucial relevance of clinical research is also approached, particularly the development of multicenter studies as an appropriate methodology for this heterogeneous patient population.
Asunto(s)
Instituciones Cardiológicas/normas , Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Guías de Práctica Clínica como Asunto , Adulto , Factores de Edad , Atención Ambulatoria/organización & administración , Atención Ambulatoria/normas , Brasil , Instituciones Cardiológicas/organización & administración , Niño , Educación Médica , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/normas , HumanosRESUMEN
Using the Six Sigma quality improvement framework of Define, Measure, Analyze, Improve, and Control, nurses in the medical cardiac intensive care unit at a large academic medical center in the Midwest identified a gap in the quality of central line site care, evaluated the current state of site care, implemented an intervention to create an improvement in nursing performance of site care, quantified this improvement, and created a model for sustained quality control. Reasons for nonocclusive dressings were revealed and addressed. An unexpected benefit was found in a unifying sense of pride in improving patient care.
Asunto(s)
Instituciones Cardiológicas/normas , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/enfermería , Infección Hospitalaria/prevención & control , Control de Infecciones/normas , Unidades de Cuidados Intensivos/normas , Mejoramiento de la Calidad , Centros Médicos Académicos , HumanosRESUMEN
A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system.