Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional / Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit

OBJETIVO: Evaluar la influencia del cambio en la gestión de ingresos en una unidad geriátrica de recuperación funcional (UGRF) sobre su actividad y resultados asistenciales. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Se recogieron datos registrados desde el año 2000 de la UGRF del Hospital Central Cruz Roja, agrupados en periodos de 4 años, salvo los ingresos centralizados (septiembre de 2016-diciembre de 2018). Los datos recogidos al ingreso fueron Escala Funcional y Mental de Cruz Roja, índice de Barthel, diagnóstico principal motivo del deterioro funcional (que se agrupó en ictus, patología ortopédica y cuadros de inmovilidad multifactorial) y comorbilidad evaluada por el índice de Charlson. Como variables de resultado se estudiaron la ganancia funcional al alta, tanto global como relativa, la estancia hospitalaria, la eficiencia funcional, las altas a residencia y los retraslados a unidad de agudos. Analizamos la relación entre los ingresos realizados de manera centralizada desde una unidad externa y el periodo previo (ingresos gestionados directamente desde la UGRF) en las variables resultados utilizando un análisis multivariante (regresión lineal para variables resultado continuas y regresión logística para las dicotómicas) ajustado por variables al ingreso. RESULTADOS: En el análisis multivariante los pacientes ingresados desde la unidad central presentaron una mayor ganancia funcional global y relativa (diferencia de medias de 3,49 puntos con IC 95%=1,65-5,33 y 12,41% con IC 95%=0,74-24,08, respectivamente), mayor estancia (12,92 días; IC 95%=11,54-14,30) y menor eficiencia (−0,36; IC 95%=−0,16 a −0,57), mayor riesgo de institucionalización (OR 1,61; IC 95%=1,19-2,16) y riesgo de retraslado a unidad de agudos (OR 3,16; IC 95%=2,24-4,47). CONCLUSIONES: El sistema centralizado de ingreso influyó en la mejora de parámetros funcionales, pero a costa de una mayor estancia y una menor eficiencia asistencial, objetivándose un incremento de la institucionalización al alta y de los retraslados a unidades de agudos

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (−0.36, 95% CI; −0.16 to −0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed

[Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. / Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional.

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.

Absceso piógeno en psoas como causa de deterioro funcional subagudo en el paciente anciano. A propósito de un caso / Pyogenic psoas abscess as a cause of subacute functional impairment in the elderly patient

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Violencia de género: cuando el agresor es un paciente con demencia. A propósito de un caso / Gender violence: when the aggressor is a patient with dementia. About clinical case

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Influencia de la duración de la estancia hospitalaria sobre la mortalidad tras el alta en pacientes mayores con patología médica aguda / Influence of length of hospital stay on mortality after discharge in older patients with acute medical diseases

Objetivo: Analizar la influencia de la estancia hospitalaria sobre la mortalidad a los 6 meses del alta en ancianos. Métodos: Estudio longitudinal observacional en pacientes supervivientes al alta tras un ingreso hospitalario. Se realizó un análisis de regresión logística binaria para estudiar factores relacionados con la estancia prolongada (>12 días). Se estudió la relación entre la mortalidad a los 6 meses y los cuartiles de estancia mediante un análisis de regresión de Cox. Resultados: Se estudiaron 1180 pacientes, con una edad media de 86,6 años (desviación estándar: 6,9). La mediana de estancia fue de 8 días (rango intercuartílico: 5-12). La mortalidad a los 6 meses fue del 26,1%. Tras ajustar por edad, sexo, diagnóstico principal, comorbilidad, albúmina al ingreso, deterioro funcional al ingreso y situación funcional y mental al alta, la estancia por encima de la mediana se relacionó con la mortalidad a los 6 meses: para 9-12 días, hazard ratio (HR) de 1,79 e intervalo de confianza del 95% (IC95%) de 1,01-3,14; para más de 12 días, HR de 2,04 e IC95% de 1,19-3,53. Conclusiones: La estancia hospitalaria prolongada es un factor de riesgo independiente de mortalidad a los 6 meses tras la hospitalización (AU)

Objective: To analyse whether hospital length of stay is associated with mortality at six months after discharge in the elderly. Methods: An observational longitudinal study of patients surviving at hospital discharge. A binary logistic regression analysis was performed to study factors related to extended stay (> 12 days). The relationship between mortality at 6 months and length-of-stay quartiles was studied using a Cox regression analysis. Results: 1180 patients were studied with a mean age of 86.6 years (standard deviation: 6.9). The median length of stay was 8 days (interquartile range: 5-12). Six-month mortality was 26.1%. After adjusting for age, gender, main diagnosis, comorbidity, albumin at admission, functional deterioration at admission and functional and mental status at discharge, hospital stay above the median was associated with mortality at 6 months: 9-12 days, HR=1.79, 95% CI: 1.01-3.14; and > 12 days, HR=2.04, 95% CI: 1.19-3.53. Conclusions Prolonged hospital stay is an independent risk factor for mortality at 6 months after discharge (AU)

Síndrome neuroléptico maligno asociado a quetiapina tras retirada de olanzapina y donepezilo, con EEG con diagnóstico diferencial para enfermedad de Creutzfeldt-Jakob / Neuroleptic malignant syndrome associated with quetiapine after withdrawal of olanzapine and donepezil, with EEG differential diagnosis of Creutzfeldt-Jakob disease

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[Influence of length of hospital stay on mortality after discharge in older patients with acute medical diseases]. / Influencia de la duración de la estancia hospitalaria sobre la mortalidad tras el alta en pacientes mayores con patología médica aguda.

OBJECTIVE: To analyse whether hospital length of stay is associated with mortality at six months after discharge in the elderly. METHODS: An observational longitudinal study of patients surviving at hospital discharge. A binary logistic regression analysis was performed to study factors related to extended stay (> 12 days). The relationship between mortality at 6 months and length-of-stay quartiles was studied using a Cox regression analysis. RESULTS: 1180 patients were studied with a mean age of 86.6 years (standard deviation: 6.9). The median length of stay was 8 days (interquartile range: 5-12). Six-month mortality was 26.1%. After adjusting for age, gender, main diagnosis, comorbidity, albumin at admission, functional deterioration at admission and functional and mental status at discharge, hospital stay above the median was associated with mortality at 6 months: 9-12 days, HR=1.79, 95% CI: 1.01-3.14; and > 12 days, HR=2.04, 95% CI: 1.19-3.53. CONCLUSIONS: Prolonged hospital stay is an independent risk factor for mortality at 6 months after discharge.

Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año / Prognostic value of the primary diagnosis in elderly patients admitted to an acute geriatric unit at discharge and one year later

Objetivo. Analizar la asociación entre el diagnóstico principal que motiva el ingreso hospitalario en una unidad geriátrica de agudos (UGA) y el riesgo de mortalidad intrahospitalaria y al año del alta. Material y métodos. Estudio longitudinal de los pacientes que ingresaron en la UGA del Hospital Central de la Cruz Roja de Madrid durante 2009. El diagnóstico de ingreso se agrupó por grupos relacionados por el diagnóstico (GRD). La fecha de fallecimiento fue recogida del informe médico y del Índice Nacional de Defunciones del Ministerio de Sanidad. Como variable resultado se analizó la asociación entre diagnósticos al ingreso y deterioro funcional al alta (medido como una pérdida de 10 o más puntos entre el Índice de Barthel al alta respecto al previo al ingreso), mortalidad durante el ingreso, a los 3 meses y al año del alta. El análisis se ajustó por edad, sexo, comorbilidad, situación funcional y cognitiva, y niveles de albúmina sérica. Resultados. Se estudiaron 1.147 pacientes, con una edad media de 86,7 años (DE: ± 6,7), 66% eran mujeres. Fallecieron durante el ingreso un 10,1% y presentaron deterioro funcional al alta el 36,6%. La mortalidad postalta fue del 25,5% a los 3 meses y el 42,2% al año. La frecuencia de los principales diagnósticos al ingreso (entre paréntesis su mortalidad intrahospitalaria y al año) fueron insuficiencia cardiaca 21,4% (8,1 y 37,4%), neumonía no aspirativa 13,3% (12,3 y 46,4%) y neumonía aspirativa 4,7% (27,5 y 71%), bronconeumopatías 13,3% (6,6 y 38,2%), infección urinaria 10,2% (5,1 y 42,7%) e ictus (excluyendo AIT) 9,9% (13,3 y 46,9%). En el análisis multivariante solo el ingreso por neumonía aspirativa se asociaba de forma independiente con mayor riesgo de mortalidad intrahospitalaria (odds ratio-2,23; IC95% = 1,13-44,42) y el ingreso por ictus a la presencia de deterioro funcional al alta (odds ratio-6,01; IC95% = 3,42-10,57). Ningún diagnóstico se asoció de manera independiente con aumento del riesgo de muerte a los 3 meses y al año. Conclusiones. El ingreso por neumonía aspirativa conlleva un mayor riesgo de muerte en ancianos hospitalizados por patología médica aguda. Tras el alta, el riesgo aumentado de muerte debe ser atribuido a otros factores diferentes al diagnóstico (AU)

Objective. To analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after discharge. Material and methods. A longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin. Results. The study included1147 patients, with a mean age of 86.7 years (SD ± 6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI = 1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI = 3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at year. Conclusions. Admission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis (AU)

[Prognostic value of the primary diagnosis in elderly patients admitted to an acute geriatric unit at discharge and one year later]. / Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año.

OBJECTIVE: To analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after discharge MATERIAL AND METHODS: A longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin. RESULTS: The study included1147 patients, with a mean age of 86.7 years (SD±6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI=1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI=3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at year CONCLUSIONS: Admission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis.

Anemia y mortalidad tras el ingreso en una unidad geriátrica de agudos / Anaemia and mortality after admission to an acute geriatric unit

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Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness.

OBJECTIVES: To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of all patients aged 90 years or older admitted in a geriatric unit during 2009 due to medical acute illness. Baseline variables were collected at admission (sex, cause of admission, Charlson index, serum albumin, functional, and mental status), functional loss at admission (as the difference between Barthel index(BI) 2 weeks before admission and BI at admission), and functional loss at discharge(as the difference between BI 2 weeks before admission and BI at discharge). The association of these variables with mortality at 1 month and 1 year after admission was analyzed by multivariate Cox regression analysis. RESULTS: Out of all patients admitted, 434 (33%) were 90 years old or older and 76.3% were female. Mortality at 1 month and 1 year after admission was 19% and 57%, respectively. In the month mortality multivariate analysis, being older (HR, 1.11; 95% CI=1.02 to 1.20), a previous Barthel index less than 40 points (HR, 5.87; 95% CI=1.16 to 29.67), and functional loss at admission (HR; 1.13; 95% CI=1.03 to 1.25) were independent risk factors. When patients that died 1 month after admission were excluded, the presence of hypoalbuminemia <3g/dl (HR, 2.70; 95% CI=1.69 to 4.32) and functional loss at discharge (HR-1.08, 95% CI=1.03 to 1.14) were the factors associated with 1 year mortality. CONCLUSIONS: In nonagenarians, functional impairment is the most important risk factor associated with short and long-term mortality after hospitalization due to acute medical illness.