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1.
PLoS One ; 16(3): e0247865, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33657142

RESUMEN

COVID-19 is a global threat with an increasing number of infections. Research on IgG seroprevalence among health care workers (HCWs) is needed to re-evaluate health policies. This study was performed in three pandemic hospitals in Istanbul and Kocaeli. Different clusters of HCWs were screened for SARS-CoV-2 infection. Seropositivity rate among participants was evaluated by chemiluminescent microparticle immunoassay. We recruited 813 non-infected and 119 PCR-confirmed infected HCWs. Of the previously undiagnosed HCWs, 22 (2.7%) were seropositive. Seropositivity rates were highest for cleaning staff (6%), physicians (4%), nurses (2.2%) and radiology technicians (1%). Non-pandemic clinic (6.4%) and ICU (4.3%) had the highest prevalence. HCWs in "high risk" group had similar seropositivity rate with "no risk" group (2.9 vs 3.5 p = 0.7). These findings might lead to the re-evaluation of infection control and transmission dynamics in hospitals.


Asunto(s)
/epidemiología , Personal de Salud/tendencias , /inmunología , /inmunología , Hospitales/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/tendencias , Pandemias , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Turquia/epidemiología
2.
PLoS One ; 16(3): e0247463, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33657621

RESUMEN

The risk of overwhelming hospitals from multiple waves of COVID-19 is yet to be quantified. Here, we investigate the impact of different scenarios of releasing strong measures implemented around the U.S. on COVID-19 hospitalized cases and the risk of overwhelming the hospitals while considering resources at the county level. We show that multiple waves might cause an unprecedented impact on the hospitals if an increasing number of the population becomes susceptible and/or if the various protective measures are discontinued. Furthermore, we explore the ability of different mitigation strategies in providing considerable relief to hospitals. The results can help planners, policymakers, and state officials decide on additional resources required and when to return to normalcy.


Asunto(s)
/epidemiología , Política de Salud/tendencias , Hospitalización/tendencias , Prestación de Atención de Salud/tendencias , Instituciones de Salud/tendencias , Hospitalización/estadística & datos numéricos , Hospitales/tendencias , Humanos , Modelos Estadísticos , Pandemias/estadística & datos numéricos , Estados Unidos/epidemiología
4.
J Patient Saf ; 17(2): 141-148, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33395019

RESUMEN

OBJECTIVE: This study aimed to determine if the implementation of large-scale patient safety initiatives have been successful in reducing overall and preventable adverse event rates in hospital inpatients. DESIGN: The design used in this study was systematic review and meta-analysis. DATA RESOURCES: We followed our published protocol (PROSPERO [CRD42019140058]) and searched the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library, and Embase from inception to February 2020. The reference lists of eligible studies were also searched. ELIGIBILITY: All longitudinal retrospective record review studies that examined adverse event rates before and after the introduction of patient safety initiatives in hospital inpatients were included. DATA EXTRACTION: Data extraction, quality, and risk of bias assessment were carried out by 2 independent reviewers. Information on study design, setting, demographics, interventions, and safety outcome measures was extracted. RESULTS: A total of 3894 articles were screened, and 7 articles met the eligibility criteria for our systematic review with 5 of these providing sufficient information for inclusion in the meta-analysis. The degree of heterogeneity was high among studies. The meta-analysis demonstrated a minimal risk reduction in overall adverse event rates of 0.017 (95% confidence interval, 0.002-0.032) when the lower-quality studies were excluded, with one adverse event being prevented for every 59 hospital admissions. CONCLUSIONS: These findings are significant when the large numbers of admissions to a hospital every year are considered. Given the low numbers of large-scale implementation studies, there is a need for more research on the effectiveness of patient safety initiatives to further assess the impact of such initiatives on adverse events.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Hospitales/tendencias , Humanos , Estudios Longitudinales , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos
6.
Rev Esp Salud Publica ; 942020 Dec 16.
Artículo en Español | MEDLINE | ID: mdl-33372916

RESUMEN

OBJECTIVE: Under the declaration of the state of alarm (SA) in efforts to control COVID-19, normal development of health programs was threatened. The aim of the study was the evaluation of COVID 19 emergency and SA approval impact on neonatal Endocrine and Metabolic Disorders Program (EMDP) and Neonatal Hearing Program (HP) in Madrid. METHODS: Qualitative and quantitative descriptive study was conducted. Semistructured interview was designed and developed to picture newborn screening activities taking place from January 1st to 31st of April 2020. To describe the undergo rates of newborn screening, neonatal screening information system (RECRINE) and martenity and prenatal care units were studied. Differences were analyzed using Chi2 test (p value = 0.05). RESULTS: More than 70% interviews were reported. Early hospital discharges, between 24 and 48h, were made in more than 80% hospitals. Screening programs were adapted in more than 75% health care centers. EMDP 19 diseases, RECRINE and Clinical Reference Units (RCU) referral were conducted. No significant incidences were observed in diagnostic confirmation and treatment in the RCU. RCU were adapted because of the reorganization of health care. 88.5% of the hospitals showed higher than 95% coverage rates on Hearing screening and SEM. No differences were observed compared to the pre-epidemic period. CONCLUSIONS: Our study demonstrates PCN professionals resilience. The importance of designing periodic evaluations to understand and alleviate the COVID-19 impact is remarkable. We need to assure 2020 newborns attention health care quality.


Asunto(s)
/epidemiología , Trastornos de la Audición/diagnóstico , Pruebas Auditivas/estadística & datos numéricos , Enfermedades Metabólicas/diagnóstico , Tamizaje Neonatal/organización & administración , Femenino , Hospitales/tendencias , Humanos , Incidencia , Recién Nacido , Masculino , Tamizaje Neonatal/tendencias , Alta del Paciente , Evaluación de Programas y Proyectos de Salud , España
7.
Rev. clín. esp. (Ed. impr.) ; 220(7): 444-449, oct. 2020. ilus, graf
Artículo en Español | IBECS | ID: ibc-199647

RESUMEN

La Sociedad Española de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas


Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals


Asunto(s)
Humanos , Arquitectura y Construcción de Hospitales/tendencias , Hospitales/tendencias , Unidades Hospitalarias/organización & administración , Tecnología Biomédica/tendencias , Medicina Interna/organización & administración , Infraestructura Sanitaria/tendencias , Calidad de la Atención de Salud/organización & administración , Participación del Paciente/tendencias
8.
Environ Health Prev Med ; 25(1): 55, 2020 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-32958006

RESUMEN

The ongoing pandemic coronavirus disease 19 (COVID-19) remains a significant issue for global health, economics, and society. In order to balance epidemic control and economic recovery, many countries have successively announced the gradual relaxation of some lockdown restrictions. Hospitals and medical staff constitute the backbone in this war against COVID-19. In response to this serious situation, many hospitals went into emergency and impaired healthcare access to patients with conditions other than COVID-19. Therefore, gradually promoting hospital operations and functions back to the new normal is important, especially when this outbreak has been effectively controlled. In this study, we introduce existing and potential problems that could seriously affect people's health. Additionally, we propose that an especial transition phase between the emergency and regular modes of hospitals can be well adapted to the current situation.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Política de Salud/tendencias , Hospitales/tendencias , Pandemias , Neumonía Viral/epidemiología , Hospitales/normas , Humanos
9.
J Gen Intern Med ; 35(9): 2732-2737, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32661930

RESUMEN

Hospitalists are well poised to serve in key leadership roles and in frontline care in particular when facing a pandemic such as the SARS-CoV-2 (COVID-19) infection. Much of the disaster planning in hospitals around the country addresses overcrowded emergency departments and decompressing these locations; however, in the case of COVID-19, intensive care units, emergency departments, and medical wards ran the risk of being overwhelmed by a large influx of patients needing high-level medical care. In a matter of days, our Division of Hospital Medicine, in partnership with our hospital, health system, and academic institution, was able to modify and deploy existing disaster plans to quickly care for an influx of medically complex patients. We describe a scaled approach to managing hospitalist clinical operations during the COVID-19 pandemic.


Asunto(s)
Betacoronavirus , Creación de Capacidad/métodos , Infecciones por Coronavirus/prevención & control , Planificación en Desastres/métodos , Médicos Hospitalarios , Hospitales , Pandemias/prevención & control , Neumonía Viral/prevención & control , Creación de Capacidad/tendencias , Contención de Riesgos Biológicos/métodos , Contención de Riesgos Biológicos/tendencias , Infecciones por Coronavirus/epidemiología , Planificación en Desastres/tendencias , Médicos Hospitalarios/tendencias , Hospitales/tendencias , Humanos , Colaboración Intersectorial , Neumonía Viral/epidemiología
11.
Health Syst Reform ; 6(1): e1745580, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32521206

RESUMEN

Heterogeneity of effects produced by performance-based incentives (PBIs) at different levels of care provision is not well understood. This study analyzes effect heterogeneities between different facility types resulting from a PBI program in Malawi. Identical PBIs were applied to both district hospitals and health centers to improve the performance of essential health services provision. We conducted two complementary quasi-experiments comparing all 17 interventions with 17 matched independent control facilities (each 12 health centers, five hospitals). A pre- and post-test design with difference-in-differences analysis was used to estimate effects on 14 binary quality indicators; interrupted time series analysis of monthly routine data was used to estimate effects on 11 continuous quantity indicators. Effects were estimated separately for health centers and hospitals. Most quality indicators performed high at baseline, producing ceiling effects on further measurable improvements. Significant positive effects were observed for stocks of iron supplements (hospitals) and partographs (health centers). Four quantity indicators showed similar positive trend improvements across facility types (first-trimester antenatal visits, voluntary HIV-testing of couples, iron supplementation in pregnancy, vitamin A supplementation of children); two showed no change for either type of facility (skilled birth attendance, fully immunized one-year-olds); five indicators revealed different effect patterns for health centers and hospitals. In both health centers and hospitals, the largely positive PBI effects on antenatal care included resilience against interrupted supply chains and improvements in attendance rates. Observed heterogeneity might have been influenced by the availability of specific resources or the redistribution of service use.


Asunto(s)
Centros Comunitarios de Salud/economía , Hospitales/tendencias , Indicadores de Calidad de la Atención de Salud/normas , Reembolso de Incentivo , Centros Comunitarios de Salud/tendencias , Países en Desarrollo/estadística & datos numéricos , Humanos , Malaui , Motivación , Indicadores de Calidad de la Atención de Salud/tendencias
13.
Rev Bras Enferm ; 73(3): e20170809, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32267407

RESUMEN

OBJECTIVES: To describe the nursing care provided to people deprived of liberty (PDL) in the hospital environment. METHODS: An exploratory-descriptive study with a qualitative approach, conducted with 38 nursing professionals in three regional hospitals located in the Northeast of Brazil, between March and July of 2016. Content analysis was performed on the data. RESULTS: Two categories emerged from the analysis: nursing care provided to people deprived of liberty in the hospital setting and self-evaluation of nursing care provided to PDL. FINAL CONSIDERATIONS: The nursing care delivered to people deprived of liberty in the hospital environment is limited to technical procedures, revealing a fragmented work process that falls short of the standards of public policies. We found that structural deficiency, particularly regarding safety in the hospital environment, associated with lack of professional training to deal with this clientele, make nursing care difficult in this context.


Asunto(s)
Hospitales/tendencias , Atención de Enfermería/métodos , Prisioneros , Brasil , Humanos , Atención de Enfermería/tendencias , Investigación Cualitativa , Encuestas y Cuestionarios
14.
Am J Respir Crit Care Med ; 201(6): 681-687, 2020 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-31948262

RESUMEN

Rationale: Whether critical care improvements over the last 10 years extend to all hospitals has not been described.Objectives: To examine the temporal trends of critical care outcomes in minority and non-minority-serving hospitals using an inception cohort of critically ill patients.Measurements and Main Results: Using the Philips Health Care electronic ICU Research Institute Database, we identified minority-serving hospitals as those with an African American or Hispanic ICU census more than twice its regional mean. We examined almost 1.1 million critical illness admissions among 208 ICUs from across the United States admitted between 2006 and 2016. Adjusted hospital mortality (primary) and length of hospitalization (secondary) were the main outcomes. Large pluralities of African American (25%, n = 27,242) and Hispanic individuals (48%, n = 26,743) were cared for in minority-serving hospitals, compared with only 5.2% (n = 42,941) of white individuals. Over the last 10 years, although the risk of critical illness mortality steadily decreased by 2% per year (95% confidence interval [CI], 0.97-0.98) in non-minority-serving hospitals, outcomes within minority-serving hospitals did not improve comparably. This disparity in temporal trends was particularly noticeable among African American individuals, where each additional calendar year was associated with a 3% (95% CI, 0.96-0.97) lower adjusted critical illness mortality within a non-minority-serving hospital, but no change within minority-serving hospitals (hazard ratio, 0.99; 95% CI, 0.97-1.01). Similarly, although ICU and hospital lengths of stay decreased by 0.08 (95% CI, -0.08 to -0.07) and 0.16 (95% CI, -0.16 to -0.15) days per additional calendar year, respectively, in non-minority-serving hospitals, there was little temporal change for African American individuals in minority-serving hospitals.Conclusions: Critically ill African American individuals are disproportionately cared for in minority-serving hospitals, which have shown significantly less improvement than non-minority-serving hospitals over the last 10 years.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Cuidados Críticos/estadística & datos numéricos , Cuidados Críticos/tendencias , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Resultados de Cuidados Críticos , Femenino , Hospitales/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
16.
Pediatrics ; 145(1)2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31882440

RESUMEN

BACKGROUND: Provision of high-quality care to acutely ill and injured children is a challenge to US hospitals because many have low pediatric volume. Delineating national trends in definitive pediatric acute care would inform improvements in care. METHODS: We analyzed emergency department (ED) visits by children between 2008 and 2016 in the Nationwide Emergency Department Sample, a weighted sample of 20% of EDs nationally. For each hospital annually, we determined the Hospital Capability Index (HCI) to determine the frequency of definitive acute care, defined as hospitalization instead of ED transfer. Hospitals were classified annually according to 2008 HCI quartiles to understand shifts in pediatric capability. RESULTS: The national median HCI was 0.06 (interquartile range: 0.01-0.17) in 2008 and 0.02 (interquartile range: 0.00-0.09) in 2016 (P < .001). Definitive care became less common regardless of annual pediatric volume, urban or rural designation, or condition frequency. In 2016, 2171 EDs (49.0%) had HCIs <0.013, which represented the lowest 25% of ED HCIs in 2008. Pediatric visits to EDs categorized in the bottom 2008 capability quartile more than doubled from 2.5 million in 2008 to 5.3 million in 2016. Despite decreasing capability, centers with higher annual pediatric volume and urban centers provided more definitive inpatient care and had fewer inter-ED transfers than lower-volume and rural centers. CONCLUSIONS: Across the United States from 2008 to 2016, hospital provision of definitive acute pediatric care decreased, and ED visits to the hospitals least likely to provide definitive care increased. Systems improvements are needed to support hospital-based acute care of children.


Asunto(s)
Servicios Médicos de Urgencia/provisión & distribución , Servicio de Urgencia en Hospital/tendencias , Hospitales/tendencias , Transferencia de Pacientes/tendencias , Enfermedad Aguda/terapia , Adolescente , Niño , Preescolar , Servicios Médicos de Urgencia/tendencias , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Pediatría/estadística & datos numéricos , Estados Unidos , Heridas y Traumatismos/terapia
17.
J Mycol Med ; 30(1): 100906, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31708424

RESUMEN

BACKGROUND: Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy. METHODS: Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016-2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed. RESULTS: A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins<2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC. CONCLUSIONS: No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.


Asunto(s)
Fungemia/epidemiología , Fungemia/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Cultivo de Sangre/estadística & datos numéricos , Cultivo de Sangre/tendencias , Candida/clasificación , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Niño , Preescolar , Farmacorresistencia Fúngica , Femenino , Historia del Siglo XXI , Hospitales/estadística & datos numéricos , Hospitales/tendencias , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Adulto Joven
18.
Spine (Phila Pa 1976) ; 45(8): E448-E456, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-31609883

RESUMEN

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess nonresponder biases for the HCAHPS survey following spine surgery. SUMMARY OF BACKGROUND DATA: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported patient satisfaction survey. In addition to having the potential of impacting a hospital's reputation, it is directly linked to government reimbursement. However, it is known that a minority of patients return this survey, and it is expected that there are nonresponder biases. METHODS: All adult inpatient spine surgery patients at a single institution between January 2013 and August 2017 at a single institution were selected for retrospective analysis. Patient demographics and perioperative outcomes were assessed as potential predictors of not returning HCAHPS surveys. Univariate and multivariate analyses were performed. RESULTS: Of 5517 spine surgeries analyzed, 1505 (27.3%) patients returned the HCAHPS survey. Response rate was variable based on patient characteristics (with statistically significant differences based on age, functional status, race, and American Society of Anesthesiologists score) but not variable based on anatomic region of the spine surgery. Multivariate analysis revealed that patients who did not return the HCAHPS survey were more likely to be black/African American (OR = 2.8, P < 0.001), have a higher American Society of Anesthesiologists score (OR 1.76, P < 0.001), and have had a major adverse event (OR = 1.66; P = 0.001), minor adverse event (OR = 2.50; P < 0.001), discharged to a destination other than home (OR = 2.16, P < 0.001), hospital readmission (OR = 2.58; P < 0.001), and a long hospital length of stay (OR = 1.28, P = 0.001). CONCLUSION: For spine surgery patients, patient characteristics and perioperative outcomes were found to be significantly associated with the nonresponder bias for HCAHPS surveys. Although the potential resultant bias in HCAHPS scores cannot be directly determined, this must be considered in interpreting the results of such satisfaction surveys given that less than one-third of patients actually completed this survey in the study population. LEVEL OF EVIDENCE: 3.


Asunto(s)
Personal de Salud/tendencias , Hospitales/tendencias , Satisfacción del Paciente , Enfermedades de la Columna Vertebral/psicología , Enfermedades de la Columna Vertebral/cirugía , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Comportamiento del Consumidor , Femenino , Personal de Salud/normas , Hospitales/normas , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/normas , Alta del Paciente/tendencias , Distribución Aleatoria , Estudios Retrospectivos , Adulto Joven
19.
Worldviews Evid Based Nurs ; 17(1): 60-70, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31621192

RESUMEN

BACKGROUND: When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought. AIMS: The aim of this study was to examine the evidence regarding clinical nurses' perception of what they need to practice nursing effectively in the acute care hospital environment. METHODS: The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies. RESULTS: The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing. LINKING EVIDENCE TO ACTION: This integrative review, which explored nurses' perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.


Asunto(s)
Hospitales/tendencias , Liderazgo , Enfermeras y Enfermeros/psicología , Lugar de Trabajo/normas , Humanos , Satisfacción en el Trabajo , Enfermeras y Enfermeros/estadística & datos numéricos , Carga de Trabajo/psicología , Carga de Trabajo/normas , Lugar de Trabajo/psicología
20.
J Stroke Cerebrovasc Dis ; 29(1): 104464, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31699576

RESUMEN

INTRODUCTION: Emergency departments play a key role in the diagnosis and treatment of transient ischemic attacks, but limited data are available about the early management of such patients in emergency wards. Therefore, we aimed to evaluate emergency physicians' management of transient ischemic attack and analyze variations factors. METHODS: A multicenter survey among emergency physicians of the Grand Est region network (Est-RESCUE) was conducted from January 28th to March 28th, 2019. Medical and administrative data were collected by the same network and the national directory of medical resources. RESULTS: Among 542 emergency physicians recipients, 78 answered (14%) and 71 were finally included, practicing in 25 public hospitals homogeneously distributed across the territory, including 3 university hospitals. A cerebral magnetic resonance imaging was obtained for 75%-100% of patients by 4.3% of responders, 36.4% of which were performed within more than 24 hours. A cardiac monitoring was prescribed in 75%-100% of cases by 32.4% of responders. A neurologic consultation was routinely requested by 84.6% of responders practicing in a university hospital and 36.8% of responders practicing in a community hospital (P = .02). Patients were hospitalized in a neurovascular unit in 75%-100% of cases by 17.4% of responders, which happened more likely in university hospitals (P < .001). CONCLUSIONS: Transient ischemic attack suffers from management disparities across territories, due to limited access to technical facilities and neurologic consultations. Therefore, international recommendations are too often not followed. Implementation of territorial neurovascular tracks may help to standardize the management of these patients.


Asunto(s)
Servicio de Urgencia en Hospital/tendencias , Disparidades en Atención de Salud/tendencias , Hospitales/tendencias , Ataque Isquémico Transitorio/terapia , Pautas de la Práctica en Medicina/tendencias , Tiempo de Tratamiento/tendencias , Adulto , Femenino , Francia , Encuestas de Atención de la Salud , Hospitalización/tendencias , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Derivación y Consulta/tendencias , Factores de Tiempo , Resultado del Tratamiento
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