Cenário epidemiológico da Covid-19 no estado do Rio de Janeiro Período de Análise: março/2020 a abril/2021 / Epidemiological scenario from Covid-19 in the state of Rio de Janeiro Analysis Period: March/2020 to April/2021

O Estado do Rio de Janeiro vem monitorando a evolução das variantes da Covid-19 por meio de três processos de seleção de amostras. O primeiro é o monitoramento realizado pelos municípios que notifica e solicita o sequenciamento, seguindo os critérios e fluxos descritos na Nota técnica da SES-RJ Nº 09/2021. O segundo faz parte da Vigilância Genômica organizada pelo Ministério da Saúde, onde três amostras aleatórias são enviadas pelo Lacen/RJ para FUNED/MG, de acordo com os critérios estabelecidos pela SVS/ FUNED. O terceiro é através de um estudo com financiamento da Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) que iniciou em março de 2021 e irá realizar a genotipagem de um total de 4.800 amostras nos próximos seis meses, sendo 400 a cada 15 dias. Por fim, a Secretaria de Estado de Saúde tem envidado esforços em ações de redução de risco, como a vacinação, ampliação de testagem, monitoramento genômico e promoção de saúde em todo o estado do Rio de Janeiro. E é recomendado manter as medidas de proteção à vida: como evitar aglomeração, usar de máscara, lavar as mãos e fazer higienização das mãos com álcool 70°.

Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease.

Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.

Medicina de alto valor: análisis de su práctica / High Value Care: Analysis of this Medical Practice

Analizar la relación entre los planteamientos diagnósticos de ingreso y egreso, así como la utilidad de los exámenes paraclínicos solicitados para su eficacia diagnóstica. También se determinaron los tiempos de estancia en los servicios de emergencia y hospitalización como parte del sistema de control de calidad. Métodos: Estudio de casos, prospectivo y longitudinal. La muestra estuvo constituida por pacientes que consultaron al Servicio de Emergencia del Hospital General del Oeste y fueron hospitalizados en el servicio de Medicina Interna. Se trató de un muestreo no probabilístico, de selección intencional, de pacientes de cualquier género mayores de 18 años, que ingresaron en el período de Enero a Julio de 2018 con un total de 135. Los datos recolectados de los exámenes complementarios se clasificaron en útiles o no, según cada diagnóstico. Otra importante variable medida fue la identificación de estancia intrahospitalaria prolongada y su causa. Tratamiento estadístico: Se aplicó estadística descriptica a través de medidas de tendencia central y proporción según la naturaleza de las variables, con el fin de priorizar las principales fallas de calidad seguida de la estimación de los costos. Resultados: En el 45% de los casos la causante de estancia prolongada en la Emergencia fue la limitación en la infraestructura. En cuanto a la estancia hospitalaria y su costo, las seis principales fallas correspondieron a un total estimado de US$ 289.695 e incluyó al personal y al Sistema de Salud. Los exámenes diagnósticos de laboratorio e imágenes más solicitados representaron un porcentaje de no utilidad con un costo total estimado de US$ 7.224. Conclusión: En este primer trabajo venezolano sobre Atención Médica de Alto Valor se observaron múltiples causas por las cuales su práctica no fue completa(AU)

To analyze the relationship between the diagnostic approaches at admission and discharge of our hospital, as well as the utility of the tests requested in terms of their diagnostic efficacy and the determination of the length of stay in the emergency services and hospitalization as part of the evaluation of the health system´s quality. Methods: Case study, prospective and longitudinal. The sample were patients who consulted to the Emergency Service of the Hospital General del Oeste, Caracas, Venezuela, and were hospitalized in the Internal Medicine wards. It was a non-probabilistic sampling, of intentional selection, of patients of any gender over 18 years old, from January to July 2018, with a total sample of 135 subjects. The data collected of the tests and images ordered, were clasified as useful or not according to their iagnostic power; another important variable was to evaluate the prolonged hospital stay length and the causes for it. Statistics: Measures of central tendency and proportion, according to the nature of the variables, in order to prioritize the main quality faults, followed by the estimation of costs. Results: In 45% the cause of prolonged stay in the Emergency was the limitation of the infrastructure. In the context of the hospital stay and the six main failures corresponded to an estimated total cost of US$ 289.695 and ncluded health personnel and the Health System. The most frequently ordered laboratory tests and images showed a percentage of non-utility with an estimated total cost of US$ 7.224. Conclusion: In this first Venezuelan study on High-Value Medical Care, multiple causes were observed and explain why its practice is not complete(AU)

Measuring Patient and Staff Satisfaction Before and After Implementation of a Paperless Registration System.

EXECUTIVE SUMMARY: While many aspects of patient care have transitioned to digital technology, the patient registration process often is still paper based. Several studies have examined the effects of changes in clinic workflows and appointment scheduling on patient satisfaction, but few have investigated changes from a paper-based to a paperless registration process. The authors measured patient and staff satisfaction before and after implementation of a new, tablet-based registration process at NYU Langone Health's Center for Women's Health in New York City. Mean preimplementation patient satisfaction scores on the six questions related to the registration process (1-5 scale, with 5 being the highest score) ranged from 4.0 to 4.5. Postimplementation satisfaction scores on the nine questions (six premeasure questions and three additional questions related to the tablet-based process) ranged from 4.4 to 4.6, with four of the six premeasures showing statistically significant improvement in patient satisfaction. Staff satisfaction was generally lower (2.8-3.6 preimplementation and 2.8-4 postimplementation), with no statistically significant difference between time frames. Patient satisfaction was relatively high under the paper registration process, and it improved significantly in some respects under the paperless process, while staff satisfaction did not change. The convenience and ease of use of a paperless registration system can help maintain or increase patient and staff satisfaction while introducing new workflows and improving the efficiency of the outpatient registration process. In adopting technology that can lead to changing workflows, organizations should train staff members and support them during the process.

Differences among admitting departments in alerts and alert overrides for drug-drug interaction.

OBJECTIVE: To determine differences in the incidence and risk factors of alerts for drug-drug interaction (DDI) and the rate of alert overrides by an admitting department. METHODS: A retrospective cohort study was performed using electronic health records of a Korean tertiary teaching hospital including all hospitalized adult patients for 18 months. The main outcome measures included incidence rates of alerts for DDI and their override, hazard ratios (HRs) for DDI alerts, and odds ratios (ORs) for alert overrides by admitting department (emergency department [ED], general ward [GW], and intensive care unit [ICU]) after adjusting for other known risk factors. RESULTS: Among 102 379 incident admissions, 6060 had alerts for DDI (5.4/person-year). After adjusting for covariates, patients admitted to the ED (HR, 4.02; confidence interval [CI], 3.69-4.38) or ICU (HR, 1.62; CI, 1.29-2.04) showed higher risks for DDI compared with those admitted to the GW. The alert-override rate was significantly higher in the ED (OR 1.68) than in the GW; however, there was no significant difference between GW and ICU. The prevalence of DDI alerts and their override rate were also demonstrated. DISCUSSION: The incidence of DDI and the alert-override rate differed by admitting department. The ED and ICU were associated with higher risks for alerts on DDI than did the GW after adjusting for other known risk factors. CONCLUSIONS: Admitting department was an independent risk factor for alerts and alert overrides. Strategies to reduce alerts and alert overrides should consider the admitting department.

Lack of genitourinary physical examination before urologic consultation--a quality of care issue.

OBJECTIVE: To quantify the frequency of genitourinary (GU) physical examinations obtained by the emergency department or primary hospital team before obtaining a urologic consultation and evaluate the role of the different demographic and clinical factors. MATERIALS AND METHODS: For 6 weeks, from July to August 2010, 420 consecutive patients evaluated by the urology consultation service had their medical charts reviewed retrospectively, with the frequency of GU physical examination performed by the emergency department or primary hospital team recorded. RESULTS: Of 357 patients requiring a urologic consultation, 88 of 324 (27%) had a GU physical examination performed by the emergency department and 98 of 319 (31%) had a GU physical examination performed by the primary hospital team before the urologic consultation. The emergency department was 6 times more likely to perform a GU physical examination on a male patient than a female patient, and the primary team was twice as likely to perform a GU physical examination on a male patient than a female patient. The likelihood of examination by either team decreased as patients became older. Race was not significantly associated with the likelihood of examination. CONCLUSION: The results of our study indicate that examinations are performed less than one-third of the time before obtaining a urologic consultation, with the frequency related to age and sex. The low rate of preconsultation examination creates concern for quality of care, the correctness of billing, and unnecessary urologic consultations.

Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

Influence of language barriers on outcomes of hospital care for general medicine inpatients.

BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: : To examine whether patients' primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276-282. (c) 2010 Society of Hospital Medicine.

Taking the offensive against claims denials.

Hospitals can fight costly claims denials by paying more attention to contracts with insurers and teaching staff to head off problems at the front end.

SuperWorker: admitting staff with the right stuff.

Patients with high-deductible health plans are often unprepared to pay a bigger chunk of their bill. Smart hospitals are hiring a new kind of admitting staff who let patients know up front how much they'll owe and can even work out a payment plan.

The key to improving prognosis for aneurysmal subarachnoid hemorrhage remains in the pre-hospitalization period.

BACKGROUND: Despite advances in neurosurgical management, aneurismal subarachnoid hemorrhage (aSAH) still has high mortality and morbidity. This study aimed to clarify how delaying hospital admission after aSAH contributes to worse prognosis even today and to find the possibility for an improvement of its prognosis by early admission. METHODS: Four hundred twenty-one consecutive patients are the basis for this study. Cause of delay was classified into 5 categories: patient delay (PD), doctor delay (DD), transportation delay (TD), no delay (ND) (within 2 hours of onset), and others. Condition of each patient was assessed at time of onset and admission using H&K. The relationships between cause of delay and worsening of Hunt and Kosnik grading (H&K) were examined. RESULTS: The median delay time was 1.7 days. Only 41% of patients visited our institution without delay. Admission delay, especially PD and DD, exhibited a significant correlation to worsening of H&K. In addition to nondirect admission, misdiagnosis or delayed diagnosis contributed significantly to worsening of H&K. Incidence of DD has declined in recent years, whereas that of PD has increased. Consequently, no change in total number of delays was found. CONCLUSIONS: There remains much room for an improvement of prognosis for aSAH by early admission. We need to fully realize this reality and to directly face this problem.

Evaluation of the informed consent procedures prior to patient bookings at Western District Health Service.

The aim of this study was to determine the compliance rate of medical officers in relation to obtaining informed consent from the consumer prior to a booking for elective surgery in the Western District Health Service, a regional hospital service in Western Victoria, Australia. Data on elective bookings was gathered from 1 February 2005 to 31 May 2005. Elective Request for Admission forms that did not incorporate the appropriate documentation were flagged and recorded on an Excel spreadsheet. In addition, elective theatre statistics were obtained from 1 February 2005 to 31 May 2005 from the Patient Administration System, to serve as the denominator for calculating the results. The results revealed that 19 Visiting Medical Officers (VMOs) performed a total of 1194 elective operations during the study timeframe, while throughout the bookings process, 66 patients presented with insufficient consent documentation. T he percentage of patients admitted with documented informed consent prior to their booking was above 90 per cent within each month of the study and it was observed that the majority of VMOs who utilised the operating suite at Western District Health Service (WDHS)provided adequate information to their patients prior to their booking.

[Hospital admissions forms versus medical records to assess risk of in-hospital death from acute myocardial infarction in Rio de Janeiro, Brazil]. / AIH versus prontuário médico no estudo do risco de óbito hospitalar no infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil.

The objective of this study was to analyze the usefulness of the Brazilian Hospital Information System (SIH) in comparison to medical records to study factors associated with in-hospital mortality due to acute myocardial infarction (AMI). We evaluated a stratified random sample of 391 medical records (out of 1,936 hospital admissions forms) with AMI as the primary diagnosis in the city of Rio de Janeiro. Factors associated with in-hospital death were studied through logistic modeling. Models were developed directly from the SIH and from medical records. ROC curves were constructed to allow comparison of the different models. We found an AMI diagnostic confirmation = 91.7% and hospital mortality = 20.6%. The logistic model derived from medical records produced the best fit (concordance = 90.1%). Although the SIH model had a worse fit (concordance = 70.6%), the correction of keying-in and information errors using data from medical records did not significantly modify its performance. Under-recording of secondary diagnosis was high in the SIH forms and was the main limiting factor.

Post-endoscopy checklist reduces length of stay for non-variceal upper gastrointestinal bleeding.

OBJECTIVE: To examine the effect of improved gastroenterologist-to-admitting service communication on hospital stay for upper gastrointestinal bleeding. HYPOTHESIS: a detailed checklist addressing factors relevant to discharge planning would shorten hospital stay, when added to the procedure report. DESIGN: Pre-post intervention design, recording balance measures (potential confounders). SETTING: A Canadian university hospital. STUDY PARTICIPANTS: Intermittent 5- to 7-day batches of consecutive emergency patients presenting with non-variceal upper gastrointestinal bleeding as their primary problem. The durations of the background and intervention periods were 3 months (beginning 9 June 2003) and 4 weeks (beginning 8 September 2003), respectively. INTERVENTION: The gastrointestinal bleeding Quality Improvement and Health Information multidisciplinary team (quality improvement personnel; emergency physicians, hospitalists, gastroenterologists, in-patient and endoscopy nurses) developed a one-page checklist, outlining detailed recommendations (3-Ds-diet, drugs, discharge plan) to append to the procedure report. MAIN OUTCOME MEASURES: Difference in median length of hospital stay was the primary endpoint. As balance measures, demographics, bleeding severity, comorbidities, readmission rates, and various benchmark times were recorded prospectively. RESULTS: Thirty-nine patients met the criteria in the background period (4 months, intermittently sampled), and 22 in the intervention period (4 weeks, continuously sampled). There were no significant baseline differences. Median in-patient stay was 7.0 (95% interquartile range 2-24) versus 3.5 (95% interquartile range 1-12) days for the background and intervention periods, respectively (P = 0.003). This remained significant when outliers (stay > 10 days) were removed (P = 0.02). CONCLUSION: A checklist, with very specific recommendations to the admitting service, significantly reduced hospital stay for non-variceal gastrointestinal bleeding.

Using patient waiting-time data to improve the hospital bed-assignment process.

An improvement activity involving use of real-time waiting-time data resulted in reductions in bed-assignment times and overall diversion hours.

[Subrenal abdominal aortic aneurysms--critical analysis of deteriorating medico-social problem]. / Podrenalni aortni anevrizmi--kritichen analiz na vloshavasht se mediko-sotsialen problem.

An analysis of patients that have been accepted at the Dept. of vascular surgery, Higher Medical Institute of Plovdiv, Bulgaria, is presented. The number of patients with subrenal abdominal aortic aneurysm for a period of ten years is 201. Most of the patients are with the symptoms of AAA-163, there are 33 with rupture of the aneurysm and 5 with aneurysm for which there were no symptoms. Eighty of the patients have been operated--resection of abdominal aorta with replacement. 72.5% of the patients left the hospital with normal preoperative condition and without any complications. Post-operative mortality is as follows: when there were no symptoms it was 0%, when there were symptoms it was 5.66%; when there was rupture it was 39.2%. Patients that have lived longer than 5 years are 68%. The data from our own research is compared to the data found in the literature. No matter the good outcomes some critical conclusions may be made. The number of patients accepted at the hospital is not real and is far under the real number, what is more--the patients are accepted with an advanced disease. Smarter decisions should be taken by the authorities.

How evidence based are therapeutic decisions taken on a medical admissions unit?

OBJECTIVES: To audit the proportion of drug treatments started on a medical admissions unit that is justified by published evidence, and the proportion for which no justification could be found. METHODS: Retrospective review of randomly selected case notes to identify drug treatments started and the problem(s) for which they were prescribed, followed by literature searches. RESULTS: A total of 132 treatment-problem pairs were found, comprising 85 unique treatment-problem pairs. An evidence base was found in support of 78 of the treatments started (59.1%). A further 41 treatment-problem pairs could be argued to be reasonable practice (sometimes included in guidelines), even though no published trial data support them. Ninety per cent of drug treatments started on the medical admissions unit have either an evidence base or are accepted practice. CONCLUSIONS: Regular audit of this nature could be carried out on units admitting acute medical patients. Similar audits in internal medicine have delivered consistent results (50%-60%); there is a baseline level against which units can compare themselves. Clinical audit is an integral feature of clinical governance; all wards admitting acute medial patients could conduct similar audits on a random sample of patients.

Six sigma in action. Case studies in quality put theory into practice.

Case studies of four hospitals show how Six Sigma can be used for everything from reducing ED hold time to cutting down on medical errors. Our examples pinpoint the costs of implementation and the savings and other benefits derived.

Reasons for crowded EDs vary among hospitals, communities, GAO says.

While no single issue explains the main reason for overcrowding in hospital emergency departments (EDs), the inability to transfer emergency patients to inpatient beds quickly once a decision to admit them has been made appears to be an important contributing factor at many hospitals, according to a new report on ED overcrowding from the U.S. General Accounting Office.