Asunto(s)
Neuritis del Plexo Braquial/etiología , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/complicaciones , Melfalán/efectos adversos , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Anciano , Neuritis del Plexo Braquial/terapia , Femenino , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/terapia , Melfalán/administración & dosificación , Persona de Mediana Edad , Trasplante de Células Madre de Sangre Periférica/métodos , Modalidades de Fisioterapia , Trasplante Autólogo/efectos adversosAsunto(s)
Fibrilación Atrial/etiología , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/complicaciones , Melfalán/uso terapéutico , Trasplante de Células Madre/métodos , Adulto , Anciano , Fibrilación Atrial/patología , Femenino , Humanos , Incidencia , Masculino , Melfalán/farmacología , Persona de Mediana EdadAsunto(s)
Amiloidosis/tratamiento farmacológico , Antineoplásicos Alquilantes/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/métodos , Hospitalización/tendencias , Melfalán/uso terapéutico , Acondicionamiento Pretrasplante/métodos , Antineoplásicos Alquilantes/administración & dosificación , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Melfalán/administración & dosificación , Estudios RetrospectivosRESUMEN
UNLABELLED: We examined whether a combined critical care outreach and acute pain service comprising both medical and nursing staff from the Department of Anaesthesia would decrease the incidence of postoperative serious adverse events in a hospital with an established Medical Emergency Team. We called this combined service IMPACT: Inpatient Management of acute Pain and Advice on Clinical Treatment. We conducted a prospective, before-and-after trial with a baseline phase (319 patients) of standard acute pain management followed by the IMPACT phase (271 patients), during which the IMPACT team systematically reviewed high-risk postoperative patients for the first three days after their return to the general wards. The incidence of serious adverse events decreased from 23 events per 100 patients to 16 events per 100 patients. The 30-day mortality decreased from 9% to 3%, p = 0.004. An acute pain service providing critical care outreach may improve postoperative outcome but the workload is considerable.
Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Cuidados Críticos/organización & administración , Clínicas de Dolor/organización & administración , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Anciano , Femenino , Investigación sobre Servicios de Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Grupo de Atención al Paciente/organización & administración , Estudios Prospectivos , VictoriaRESUMEN
We proposed that critical care outreach would decrease the incidence of postoperative serious adverse events and so conducted a sequential cohort study with a surveillance-only phase (baseline) followed by an intervention phase. We studied high-risk patients in a large Australian hospital. A critical care qualified nurse reviewed patients for the first three days after return to the general wards. During the intervention phase the nurse intervened in patient care where appropriate. We examined the incidence of 11 categories of serious adverse events per 100 patients during the first three days on the general wards during the surveillance and intervention phases. The surveillance phase had 319 patients and the intervention phase 345 patients. In a subgroup analysis, there were four myocardial infarctions per 100 patients in the surveillance phase and seven per 100 patients during the intervention phase (95% confidence interval: 1-7 infarctions per 100 patients increase). For the other 10 serious adverse events there were 19 per 100 patients in the surveillance phase and 11 per 100 patients in the intervention phase (95% confidence interval: 4-11 serious adverse events per 100 patients decrease). Outreach may have led to greater detection of myocardial infarctions while reducing the incidence of other serious adverse events.