RESUMO
Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.
Assuntos
Cuidados Críticos/organização & administração , Atenção à Saúde/organização & administração , Nefrologia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Terapia de Substituição Renal/métodos , Adulto , Idoso , Canadá/epidemiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Modelos Organizacionais , Estudos de Casos Organizacionais , Admissão e Escalonamento de Pessoal/organização & administração , Alocação de Recursos/organização & administração , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
The ideal system for management of trauma remains controversial, especially in respect of prehospital care and regionalisation of trauma-care delivery. To explore these issues, we compare two differing trauma systems--in the USA the focus is on the trauma centre, with a lesser emphasis on prehospital care, whereas in France there is more emphasis on prehospital care coordinated by the Service d'Aide Médicale Urgente. We describe the historical developments, current structure, and major controversies with regard to trauma-care delivery in the two countries. Comparative evidence on the effectiveness of the two systems was obtained through a structured review of databases, but very little evidence permits direct comparison of outcomes across the two systems. Crude injury mortality rates and fatality rates from motor-vehicle accidents (crashes in US usage) are higher in France than in the USA, although adjustment for potential confounders is difficult. Adjusted mortality rates suggest equivalent outcomes among patients who survive to hospital, although these data are confounded by the lack of a contemporaneous comparator population. There are differences in the American and French trauma systems that might translate into measurable differences in trauma-related mortality. However, the lack of data to allow comparison of outcomes between countries significantly impedes the identification and implementation of components of a trauma system that are effective and the discarding of those that offer little benefit.