Análise da influência da retirada do leito de idosos na UTI e da continuidade da fisioterapia na enfermaria sobre o tempo de permanência, a readmissão e a mortalidade / Analysis of the influence of bed's withdrawal of the elderly in the ICU and the continuity of physical therapy in the ward on length of stay, readmission and mortality

Objetivo: Analisar a influência da retirada do leito de idosos na UTI e da continuidade da fisioterapia na enfermaria sobre tempo de internação, readmissão e mortalidade. Métodos: Trata-se de um estudo de coorte histórico realizado por meio dos registros de idosos egressos de UTI de um hospital público. Verificou-se as caracterí­sticas clí­nicas e o ní­vel de gravidade dos pacientes pelo escore SAPS 3 (Simplified Acute Physiology Score III). Analisou-se a retirada do leito na UTI, o ní­vel de mobilização alcançado e a continuidade da fisioterapia na enfermaria. Observou-se a relação entre essas variáveis e os desfechos ocorridos. Resultados: Os 133 idosos estudados apresentaram média de idade de 70 ±7 anos; 66,1% eram homens; 78,2% foram retirados do leito na UTI e, após a admissão na enfermaria, 51,9% receberam fisioterapia. O tempo médio de internação após a alta da UTI foi de 27,6 dias; 11,2% dos pacientes foram readmitidos em unidades crí­ticas e 18% foram a óbito. Os idosos que não foram retirados do leito na UTI e aqueles que mantiveram o ní­vel de mobilização após a admissão na enfermaria apresentaram maior readmissão e mortalidade. Conclusão: Parece existir menor risco de readmissão e de mortalidade em pacientes submetidos í terapêutica de retirada do leito na UTI. (AU)

Objective: To analyze the influence of bed's withdrawal of elderly in the ICU and the continuity of the physical therapy in the ward over length of stay, readmission and mortality. Methods: This is a historical cohort study carried out through the registries of elderly patients from the ICU of a public hospital. The clinical characteristics and the level of severity of the patients by the SAPS 3 (Simplified Acute Physiology Score III) were verified. The ICU bed removal, the level of mobilization achieved and the continuity of physical therapy in the ward were analyzed. It was observed whether there was a relationship between these variables and the outcomes. Results: The 133 elderly studied had mean age of 70 ± 7 years; 66.1% were men; 78.2% of the patients were removed from the hospital bed and, after ward admission, 51.9% received physical therapy. The mean length of hospital stay after discharge from the ICU was 27.6 days; 11.2% of the patients were readmitted in critical units and 18% died. The elderly who were not removed from the ICU bed and those who maintained the level of mobilization after admission to the ward presented higher readmission and mortality. Conclusion: There seems to be a lower risk of readmission and mortality in patients undergoing ICU bed removal therapy. (AU)

Adherence to Inpatient Venous Thromboembolism Prophylaxis: A Single Institution's Concurrent Review.

Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated. Seventy-six patients consented for participation. Nurse documented adherence was 66% (29/44), 44% (27/61), and 89% (50/56) for mechanical, ambulatory, and chemoprophylactic prophylaxis, respectively. Patient report and nurse documentation showed moderate agreement for mechanical and no agreement for ambulatory adherence (κ = 0.51 and 0.07, respectively). Concurrent review using a cloud-based tool can provide robust, timely, and relevant information on adherence to recommended VTE prophylaxis. Iterative concurrent reviews can guide efforts to improve adherence and reduce rates of hospital-acquired VTE.

Tempo de internaçäo por infarto cerebral: permanência hospitalar näo justificada / Causes of unjustified hospital stay following cerebral infarction

Os autores buscaram determinar a frequência e as causas de prolongamento desnecessário de internaçäo hospitalar por infarto cerebral agudo. Foram estudados 20 pacientes admitidos nas primeiras 48 horas após o inÝcio dos sintomas e randomizados para o International Stroke Trial, estudo multicÛntrico de avaliaçäo de drogas antitrombóticas. Foi utilizado o protocolo de R. S. Goldman e col. (1996) de avaliaçäo de duraçäo de internaçäo, frequência e razöes alegadas para a permanência hospitalar näo justificada (PHÑJ). O tempo médio (mÚdia + desvio padräo) de internaçäo para os 20 pacientes foi 13,1 + 11,5 dias (mediana=10 dias). Doze pacientes (60 por cento) tiveram um ou mais dias de PHÑJ). Nestes 12 pacientes, 83 (62 por cento) dos 134 dias de internaçäo foram considerados desnecessários (6,9 + 4,6). A principal razäo alega para PHÑJ nestes pacientes foi a necessidade de realizaçäo de exames complementares disponíveis no hospital, como ecocardiograma transtorácico e duplex-scan dos vasos cervicais. A idade, o sexo, o local de internaçäo do paciente ou a necessidade de transferência näo se associaram ao tempo de hospitalizaçäo. Em conclusäo, a duraçäo da hospitalizaçäo após o infarto cerebral pode ser drasticamente reduzida pela otimizaçäo do uso de métodos diagnósticos disponíveis no hospital estudado.

[Causes of unjustified hospital stay following cerebral infarction]. / Tempo de internação por infarto cerebral. Permanência hospitalar não justificada.

The frequency and causes of prolonged length of stay (LOS) in patients with acute ischemic stroke were studied in 20 patients admitted to a university hospital participating in the International Stroke Trial (IST). The protocol for prolonged LOS study designed by R. S. Goldman et al. (1996) was reproduced. Mean (+/- SD) LOS was 13.1 +/- 11.5 days (median = 10 days). Prolonged LOS occurred in 12 (60%) patients. In these 12 patients, a total of 83 (62%) of 134 days were found to be unnecessary (6.9 +/- 4.6). Most of these patients remained hospitalized while awaiting for routinely performed tests, such as 2D echocardiogram or carotid Doppler. LOS was not influenced by patient characteristics (age or gender) or specific location in the hospital (emergency room or other). In conclusion, LOS and hospitalization costs can be markedly reduced in this hospital by rational use of already available diagnostic tests.

Metodologia para comparaçäo de indicadores hospitalares / Metodology for comparison between hospital indicators

Este trabalho discute método para padronização, a partir do perfil de nosologias atendidas, do tempo de permanência e da taxa de mortalidade, usados como indicadores de consumo de recursos e de severidade, para comparação entre hospitais.

Abstract - This paper discusses a case mix adjustment metbod applied to lenght-of-stay and mortality rate, used as resources consumption and severity indices to compare hospitais

Health care cost containment: how Pittsburgh is addressing the challenge.

Rapidly escalating health care costs have the public and private sectors searching for methods to provide health care benefits in a more efficient manner. Efforts have also been underway at the community level with the development of health care coalitions created to build consensus toward a fair solution for all parties affected. With the assistance of the Robert Wood Johnson Foundation and many local co-sponsors, the Pittsburgh Program for Affordable Health Care (PPAHC) was organized to address health care cost containment issues in the greater Pittsburgh area. One of the means by which PPAHC chose to achieve this was through the development of a Model Utilization Management Program. This is a document containing community-sanctioned administrative and clinical standards for utilization review which take into consideration the needs and concerns of providers, purchasers, and consumers, and which have a goal of reducing medically unnecessary inpatient hospitalization while concurrently maintaining quality of and access to care. This article describes both the process and the product of PPAHC's efforts toward health care cost containment in Pittsburgh, specifically focusing on its utilization management component.