ABSTRACT
BACKGROUND AND OBJECTIVE: The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalised patients of all specialties. MATERIAL AND METHODS: Background: Third level public hospital with 876 hospitalisation beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalisation that moves to the hospitalisation bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. RESULTS: 572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the Unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. CONCLUSIONS: A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside Otorhinolaryngology.
Subject(s)
COVID-19 , Otolaryngology , Male , Adult , Child , Humans , Female , Tracheostomy , Pandemics , Patient Care , Hospitals, PublicABSTRACT
BACKGROUND: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infection, the predictive factors leading to long-lasting chemosensory dysfunction are still poorly understood. METHODS: 102 out of 421 (24.2%) mildly symptomatic COVID-19 patients completed a second questionnaire about the evolution of their symptoms one year after the infection using visual analog scales (VAS). A subgroup of 69 patients also underwent psychophysical evaluation of olfactory function through UPSIT. RESULTS: The prevalence of chemosensory dysfunction decreased from 82.4% to 45.1% after 12 months, with 46.1% of patients reporting a complete recovery. Patients older than 40 years (OR = 0.20; 95% CI: [0.07, 0.56]) and with a duration of loss of smell longer than four weeks saw a lower odds ratio for recovery (OR = 0.27; 95% CI: [0.10, 0.76]). In addition, 28 patients (35.9%) reported suffering from parosmia, which was associated with moderate to severe taste dysfunction at the baseline (OR = 7.80; 95% CI: [1.70, 35.8]). Among the 69 subjects who underwent the UPSIT, 57 (82.6%) presented some degree of smell dysfunction, showing a moderate correlation with self-reported VAS (r = -0.36, p = 0.0027). CONCLUSION: A clinically relevant number of subjects reported persistent chemosensory dysfunction and parosmia one year after COVID-19 infection, with a moderate correlation with psychophysical olfactory tests.
ABSTRACT
Resumen Antecedentes y objetivo Los cuidados de los pacientes traqueostomizados son habilidades de alto riesgo y baja incidencia. Las estrategias de mejora de la atención sanitaria en plantas hospitalarias y en especialidades distintas a la Otorrinolaringología (ORL) basadas únicamente en la formación no han sido capaces de ofrecer una solución adecuada. Se presenta un modelo de Unidad de Atención al Paciente Traqueostomizado dirigida por el Servicio de Otorrinolaringología para atender a todos los pacientes traqueostomizados de un hospital en todas las especialidades. Material y métodos Ámbito: hospital universitario público de tercer nivel con 876 camas de hospitalización y 30 camas de UCI para 481.296 habitantes. Modelo de Unidad: unidad transversal para el hospital proporcionando atención a todos los pacientes traqueostomizados, adultos y niños, de todas las especialidades, con dedicación del 50% de una enfermera de ORL de hospitalización que se desplaza hasta la cama de hospitalización de la especialidad de cada paciente y el 50% de otra enfermera de ORL de consultas externas para los pacientes ambulatorios, con la consultoría de un especialista en ORL y coordinación de la supervisora de ORL. Resultados Se atendió en la unidad a 572 pacientes entre 2016 y 2021, el 80% varones, con una media de edad de 63±14 años. Se atendieron 14,7±2 pacientes traqueostomizados diarios y 96±4 consultas por complicaciones anuales, elevándose hasta 19 pacientes traqueostomizados diarios en 2020 y 141±8,4 consultas por complicaciones en los años 2020 y 2021, durante la pandemia por COVID-19. Se redujo la estancia media de las especialidades no ORL en 13 días a lo largo de los 6 años del estudio, aumentando la satisfacción de los profesionales de ORL y de no ORL, y la satisfacción de los usuarios. Conclusiones Una Unidad de Atención al Paciente Traqueostomizado dirigida proactivamente desde el Servicio de Otorrinolaringología para atender transversalmente a todos los pacientes traqueostomizados mejora la calidad de la atención sanitaria al reducir la estancia, complicaciones y urgencias. Este modelo de unidad ha resistido la pandemia COVID-19 manteniendo los estándares alcanzados de calidad y eficiencia. Se mejora la satisfacción de los profesionales no otorrinolaringológicos al reducir la incertidumbre de afrontar cuidados de pacientes sobre los que carecen de conocimientos y experiencia, y la de los especialistas y enfermeras de ORL al reducirse las demandas extemporáneas no planificadas de atención. Mejora la satisfacción de los usuarios al percibir una adecuada continuidad asistencial. Los Servicios de Otorrinolaringología aportan su experiencia en manejo de pacientes laringectomizados y traqueostomizados y en trabajo en equipo con otros especialistas y profesionales sin que el hospital tenga necesidad de crear nuevas estructuras al margen de Otorrinolaringología. Background and objective The care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methods Background: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results 572 patients between 2016 and 2021, 80% men, aged 63±14 years, were attended in the unit. 14.7±2 tracheostomized patients daily and 96±4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141±8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. Conclusions A Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside otorhinolaryngology.