[Surgical patients hospital home care program: two years evaluation]. / Programa de hospitalización domiciliara de pacientes quirúrgicos: evaluación de los dos años de funcionamiento.

OBJECTIVE: To evaluate the results after two years of the implementation of surgical patients' hospital home care program in Consort. Hospitalari de Vic. METHOD: Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. RESULTS. 691 patients were assessed, and 80.75% were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05% of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82% of patients were assigned to the care plan "surgical patient", and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 +/- 1.37 out of 10. CONCLUSIONS: The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role.

[Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool]. / Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica.

BACKGROUND AND AIM: Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. MATERIAL AND METHODS: The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. RESULTS: Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. CONCLUSIONS: In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients.

[Continuity of care from the acute care hospital: Results]. / La continuidad de cuidados desde el hospital de agudos: resultados.

OBJECTIVE: To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. METHOD: A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. RESULTS: A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). CONCLUSIONS: Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions.

Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica / Improving shared decision-making for hospital patients: description and evaluation of a treatment intensity assessment tool

Fundamento y objetivo. La toma de decisiones compartida entre pacientes y profesionales es un elemento clave de la atención centrada en la persona y tiene como objetivo facilitar la adecuada armonización entre los valores y preferencias de los pacientes, los objetivos asistenciales propuestos y la intensidad de las intervenciones realizadas. Pero tan importante como velar por la calidad de este proceso colaborativo es poder disponer de sistemas que permitan registrarlo de forma fiable y sencilla, con el objetivo de preservar la coherencia en las decisiones durante el proceso asistencial. El presente estudio describe un sistema de registro de nivel de intensidad terapéutica (NIT) diseñada para tal fin y evalúa los resultados de su implementación. Material y método. Se comparan los resultados pre-implementación y post-implementación en 2 cohortes de pacientes registrados durante un período de un mes, respectivamente. Resultados. El 6,1% de los pacientes del grupo pre-implementación (n = 673) tienen algún registro de nivel asistencial, frente al 31,6% del grupo post-implementación (n = 832) (p < 0,01), existiendo diferencias entre servicios. La mortalidad intrahospitalaria de ambas cohortes es del 1,9%; el 93,75% de los pacientes del grupo post-implementación que fallecieron tenían registro de NIT. Conclusiones. La disponibilidad de una herramienta hospitalaria específica parece incentivar el proceso de toma de decisiones compartidas entre pacientes y profesionales —multiplicando por más de 5 veces el registro de NIT—, facilita la continuidad asistencial entre equipos y permite monitorizar la personalización de las intervenciones. Serán necesarios más estudios para seguir avanzando en la toma de decisiones compartida con los pacientes hospitalizados (AU)

Background and aim. Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. Material and methods. The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. Results. Some record of care was registered in 6.1% of patients in the pre-implementation group (n = 673) compared to 31.6% of patients in the post-implementation group (n = 832) (P < .01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. Conclusions. In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals —multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients (AU)

[The concept of "patient type": utility for the care of surgical patients]. / Concepto <>: utilidad para el cuidado de los pacientes quirúrgicos.

OBJECTIVE: To describe a model of surgical "patient type" by identifying the needs and characteristics of surgical patients. METHOD: We performed a cross-sectional study of surgical patients with one or more diseases and similar needs and/or characteristics admitted to the surgical wards of a general hospital over a 10-month period. The variables analyzed were sociodemographic and clinical data, degree of autonomy, and Virginia Henderson's needs, which were identified through an interview performed in the postoperative period. Univariate analysis, stratified descriptive statistics and multiple correspondence analysis were performed. RESULTS: A total of 270 medium- or low-complexity patients from different surgical specialties took part in the analysis. During the surgical process (pre- and post-operative), almost a half of the patients suffered from hypotension, heart rate showed no significant changes and the risk of developing a pressure ulcer was unmodified according to Norton's scale. The first statistical analysis classified the surgical patients into five groups and showed the relationship between the degree of autonomy (measured through Barthel's index) and the number of personal problems (assessed according to the Henderson model). A subsequent statistical analysis classified the patients into four groups or types, explaining 70% of the total variance. CONCLUSIONS: Through the use of Virginia Henderson's model, a surgical patient type composed of four different groups was identified. The results of this study may be useful in the care of low- and medium-complexity patients in distinct surgical specialties.

La continuidad de cuidados desde el hospital de agudos: resultados / Continuity of care from the acute care hospital: results

OBJETIVO: Describir los casos atendidos por la gestora de continuidad de cuidados en un hospital de agudos durante los primeros 6 meses de su actividad, así como el perfil de los pacientes atendidos y la asignación de recursos. MÉTODO: Estudio descriptivo transversal prospectivo de pacientes con necesidades de atención compleja que requirieron de enlace de continuidad asistencial y fueron atendidos por la gestora de continuidad de cuidados, en un centro de agudos, durante los meses de octubre de 2013 a marzo de 2014. Se estudiaron las características de los pacientes, su entorno social y la asignación de los recursos asistenciales. RESULTADOS: Se analizaron 1.034 casos de demanda que correspondieron a 907 pacientes (mujeres 55,0%; edad: 80,57 ± 10,1, crónicos 47,8%) de los cuales reingresaron el 12,2%. En el modelo multivariante se observó que las variables asociadas al reingreso eran la polifarmacia (OR: 1,86; IC: 1,2-2,9) y el historial de caídas previo al ingreso (OR: 0,586; IC: 0,36-2,88). CONCLUSIONES: Los pacientes atendidos por la GCC son mayores de 80 años, con comorbilidades, síndromes geriátricos, necesidades de atención complejas y de final de vida, a los que se les asigna un recurso alternativo a la hospitalización que evita reingresos

OBJECTIVE: To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource alLOCATION: Method: A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. RESULTS: A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57 ± 10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). CONCLUSIONS: Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions

Programa de hospitalización domiciliaria de pacientes quirúrgicos. Evaluación de los dos años de funcionamiento / Surgical patients hospital home care program: two years evaluation

Objetivo. Evaluar los resultados obtenidos con la implantación del programa de Hospitalización Domiciliaria Quirúrgica (HDQ) en el Consorci Hospitalari de Vic durante un periodo de dos años. Método. Estudio longitudinal realizado entre enero de 2011 y diciembre de 2012, sobre los pacientes incluidos en el programa de HDQ. Se estudiaron variables sociodemográficas, clínicas, económicas, de gestión y de percepción del usuario. Los datos se obtuvieron de los registros del programa HDQ, de la Unidad de Planificación y de los sistemas de información, y mediante encuestas telefónicas. Se realizó un análisis descriptivo univariado con el paquete estadístico IBM SPSS Statistics 19. Resultados. Se valoraron 691 pacientes. El 80.75 % se incluyó en el programa HDQ, su estancia media global fue de 5.01 días y la tasa de reingreso del 3.05 %. Destacó un mayor número de pacientes tratados de sexo masculino; las especialidades que aportaron más pacientes al programa fueron cirugía general, traumatología y urología. Se asignó el plan de cuidados del «paciente quirúrgico intervenido» al 82 % de los pacientes, y las complicaciones potenciales enfermeras más registradas fueron el dolor (539) y la infección (436). La puntuación media de satisfacción global sobre la atención recibida y el funcionamiento de HDQ fue de 8.67 ± 1.37 sobre 10. Conclusiones. Los resultados objetivan el impacto de la HDQ en nuestro ámbito y ponen de manifiesto la relevancia del rol de la atención enfermera especializada en el domicilio (AU)

Objective. To evaluate the results after two years of the implementation of surgical patients’ hospital home care program in Consorci Hospitalari de Vic. Method. Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. Results. 691 patients were assessed, and 80.75 % were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05 % of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82 % of patients were assigned to the care plan «surgical patient», and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 ± 1.37 out of 10. Conclusions. The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role (AU)

Concepto «paciente tipo»: utilidad para el cuidado de los pacientes quirúrgicos / The concept of “patient type”: utility for the care of surgical patients

Objetivo. Identificar y describir las necesidades y las características de los pacientes intervenidos de patología quirúrgica y describir un modelo de «paciente tipo» quirúrgico. Método. Se realizó un estudio transversal para describir un paciente tipo quirúrgico, formado por una o más tipologías con características y/o necesidades similares. La población de estudio fueron los pacientes ingresados en las plantas de hospitalización quirúrgicas de un hospital general, en un período de 10 meses. Se recogieron variables sociodemográficas, clínicas, grado de autonomía y necesidades según V. Henderson mediante una entrevista llevada a cabo durante el postoperatorio. Se realizaron análisis univariante, descriptivo estratificado y de correspondencias múltiples. Resultados. Participaron 270 pacientes de mediana o de baja complejidad, de diferentes especialidades quirúrgicas. Durante el proceso quirúrgico (preoperatorio y postoperatorio) casi la mitad de los pacientes se hipotensaban, la frecuencia cardíaca no sufría cambios significativos y no variaba el riesgo de sufrir úlceras por presión según la escala de Norton. Un primer análisis estadístico clasificó a los pacientes quirúrgicos en 5 grupos y mostró la relación existente entre el grado de autonomía mediante el índice de Barthel, y el número de problemas personales de los pacientes según el modelo de Henderson. Posteriormente, el análisis de conglomerados clasificó a los pacientes quirúrgicos en 4 clases o tipos que explicaban el 70% de la varianza total. Conclusiones. Se ha identificado mediante el modelo de Henderson un «paciente tipo» formado por 4 clases. Se plantea su uso para facilitar el cuidado de los pacientes de mediana o de baja complejidad quirúrgica de diferentes especialidades(AU)

Objective. To describe a model of surgical “patient type” by identifying the needs and characteristics of surgical patients. Method. We performed a cross-sectional study of surgical patients with one or more diseases and similar needs and/or characteristics admitted to the surgical wards of a general hospital over a 10-month period. The variables analyzed were sociodemographic and clinical data, degree of autonomy, and Virginia Henderson′s needs, which were identified through an interview performed in the postoperative period. Univariate analysis, stratified descriptive statistics and multiple correspondence analysis were performed. Results. A total of 270 medium- or low-complexity patients from different surgical specialities took part in the analysis. During the surgical process (pre- and post-operative), almost a half of the patients suffered from hypotension, heart rate showed no significant changes and the risk of developing a pressure ulcer was unmodified according to Norton's scale. The first statistical analysis classified the surgical patients into five groups and showed the relationship between the degree of autonomy (measured through Barthel's index) and the number of personal problems (assessed according to the Henderson model). A subsequent statistical analysis classified the patients into four groups or types, explaining 70% of the total variance. Conclusions. Through the use of Virginia Henderson's model, a surgical patient type composed of four different groups was identified. The results of this study may be useful in the care of low- and medium-complexity patients in distinct surgical specialities(AU)