ABSTRACT
OBJETIVO: Evaluar el impacto de un cambio organizativo en la gestión del proceso musculoesquelético en nuestra Área de Gestión Sanitaria (AGS) estudiando los cambios en la capacidad de resolución de estos procesos mediante la derivación a la especialidad útil. DISEÑO: Estudio descriptivo prospectivo para evaluar las tendencias de las derivaciones de atención primaria (PAP) y atención hospitalaria (PAE) con procesos musculoesqueléticos en el periodo 2012-2018. MATERIAL Y MÉTODO: Se incluye a toda la población de referencia de nuestra AGS derivada a alguna de las 3 especialidades hospitalarias que atienden procesos musculoesqueléticos, sin determinación del tamaño muestral. Variables estudiadas: PAP, PAE, servicio de procedencia y de destino. Para el análisis estadístico se utilizó el programa SPSS; se presenta la evaluación de frecuencias absolutas. RESULTADOS: Las derivaciones totales realizadas desde atención primaria han pasado de 25.575 en 2012 a 24.871 en 2018. Las derivaciones PAE han pasado de 17.207 en 2012 a 9.803 en 2018. De las derivaciones PAP, el de mayor impacto ha sido el Servicio de Rehabilitación, que ha pasado de recibir el 8,2% de PAP en 2012 al 47% en 2018. De las derivaciones PAE por especialidad, la mayor reducción ha sido la del Servicio de Traumatología, que pasó de recibir 10.587 PAE en 2012 a 3.911 en 2018. CONCLUSIONES: El rediseño organizativo de la atención al proceso musculoesquelético ha conseguido mejorar la resolución de los procesos musculoesqueléticos. En este cambio organizativo, el Servicio de Rehabilitación ha asumido el liderazgo desde el punto de vista asistencial y de gestión del proceso musculoesquelético, lo que ha colaborado en la mejora de la resolución de estos procesos
OBJECTIVE: To evaluate the impact of an organisational change in the musculoskeletal referral pathway in our health management area (HMA) by identifying changes in the ability to improve healthcare outcomes by facilitating referral to the most suitable specialty. DESIGN: This prospective descriptive study aimed to evaluate referral trends from primary care services (PCS) and hospital care (PHS) to musculoskeletal services from 2012 to 2018. MATERIALS AND METHODS: We included all patients who were referred to any of the 3 musculoskeletal services from our HMA catchment area, without specifying sample size. The variables studied were PCS, PHS, service of origin and destination. We used the SPSS programme for the statistical analysis and obtained absolute frequency data. RESULTS: The total number of referrals from PCS increased from 25,575 in 2012 to 24,871 in 2018. PHS referrals decreased from 17,207 in 2012 to 9,803 in 2018. With regards to PCS referrals, the service most increasing the number of referrals to the musculoskeletal team was the Rehabilitation Service, from 8.2% in 2012 to 47% in 2018. Regarding PHSs referrals by specialty, the service that most reduced the number of referrals to the musculoskeletal team was the Traumatology Service, from 10,587 in 2012 to 3,911 in 2018. CONCLUSIONS: The redesign of the musculoskeletal referral pathway improved healthcare outcomes by improving the quality of the referral process. In this organisational change, the Rehabilitation Service took the leadership from the point of view of healthcare and management of the musculoskeletal process, collaborating in the improvement of the healthcare outcomes of these processes
Subject(s)
Humans , Musculoskeletal Diseases/rehabilitation , Rehabilitation Centers/organization & administration , Outcome and Process Assessment, Health Care/statistics & numerical data , Models, Organizational , Musculoskeletal Physiological Phenomena , Quality Improvement/trends , Primary Health Care/organization & administrationABSTRACT
OBJECTIVE: To evaluate the impact of an organisational change in the musculoskeletal referral pathway in our health management area (HMA) by identifying changes in the ability to improve healthcare outcomes by facilitating referral to the most suitable specialty. DESIGN: This prospective descriptive study aimed to evaluate referral trends from primary care services (PCS) and hospital care (PHS) to musculoskeletal services from 2012 to 2018. MATERIALS AND METHODS: We included all patients who were referred to any of the 3 musculoskeletal services from our HMA catchment area, without specifying sample size. The variables studied were PCS, PHS, service of origin and destination. We used the SPSS programme for the statistical analysis and obtained absolute frequency data. RESULTS: The total number of referrals from PCS increased from 25,575 in 2012 to 24,871 in 2018. PHS referrals decreased from 17,207 in 2012 to 9,803 in 2018. With regards to PCS referrals, the service most increasing the number of referrals to the musculoskeletal team was the Rehabilitation Service, from 8.2% in 2012 to 47% in 2018. Regarding PHSs referrals by specialty, the service that most reduced the number of referrals to the musculoskeletal team was the Traumatology Service, from 10,587 in 2012 to 3,911 in 2018. CONCLUSIONS: The redesign of the musculoskeletal referral pathway improved healthcare outcomes by improving the quality of the referral process. In this organisational change, the Rehabilitation Service took the leadership from the point of view of healthcare and management of the musculoskeletal process, collaborating in the improvement of the healthcare outcomes of these processes.
Subject(s)
Models, Organizational , Musculoskeletal Diseases/therapy , Referral and Consultation/organization & administration , Catchment Area, Health , Continuity of Patient Care , Diagnosis-Related Groups , Hospitalization , Humans , Medicine , Musculoskeletal Diseases/rehabilitation , Primary Health Care , Prospective Studies , Treatment OutcomeABSTRACT
This article presents a case of intrapelvic migration of a Gamma nail lag screw (Stryker, Mahwah, New Jersey) in an 82-year-old woman 7 months after fixation of an unstable pertrochanteric fracture. Two of the most common complications associated with the use of the Gamma nail and other sliding intramedullary devices, as well as lag screw and side plate devices, relate to the lag screw: cut out and medial migration in the femoral head. As compared to lag screw migration in the femoral head, intrapelvic migration of the Gamma lag screw is a rare complication. To our knowledge, intra-pelvic migration after disengagement of the lag screw from the Gamma nail has been reported in the literature only 3 times. Several risk factors can be associated with Gamma nail failure, most importantly damage to femoral head leading to lag screw migration, plate/lag or nail/lag screw interface dysfunction, technical mistakes, and additional subsequent trauma. This article reviews the literature and the theories for such device failures.
Subject(s)
Bone Nails/adverse effects , Bone Screws/adverse effects , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Hip Fractures/surgery , Soft Tissue Injuries/diagnostic imaging , Soft Tissue Injuries/etiology , Aged , Female , Foreign-Body Migration/surgery , Hip Fractures/complications , Humans , Pelvis/diagnostic imaging , Pelvis/injuries , Pelvis/radiation effects , Pelvis/surgery , Radiography , Soft Tissue Injuries/surgery , Treatment OutcomeABSTRACT
Las habilidades comunicativas son imprescindibles en el tratamiento de los pacientes discapacitados, para satisfacción de ellos, sus familias y los propios profesionales.Material y método. Se gestiona la información encontrada en Internet Medline, centrada prioritariamente en ensayos clínicos y textos clásicos.Se elaboran dos cuestionarios de satisfacción en pacientes y cuidadores a partir de los encontrados en la literatura especializada. Con ellos se mide de manera indirecta la comunicación, a la vez que se utilizan para un análisis de situación en nuestro Servicio, sobre una muestra de 102 usuarios.Resultados. Se proponen los dos cuestionarios elaborados que, utilizados en nuestros pacientes, informan de un buen nivel de satisfacción con respecto al conocimiento de su proceso de readaptación.Discusión y conclusiones. La satisfacción del paciente se relaciona principalmente con las dimensiones que reflejan una alta calidad en la relación comunicativa médico-paciente; por ello resulta de gran interés entrenar a los profesionales en habilidades sociales y comunicativas para satisfacción de todos.Hay que perfilar cuestionarios para medir la satisfacción personal del paciente, cuidador/familiar y profesionales en los servicios de rehabilitación. Los cuestionarios presentados en este trabajo deben ser simplificados y estudiarse sus características métricas (AU)
