Gestión de traslados potencialmente evitables a los hospitales de agudos desde unidades de rehabilitación geriátrica: aspectos críticos de un protocolo de intervención / Management of avoidable acute transfers from an intermediate care geriatric facility to acute hospitals: critical aspects of an intervention protocol

Objetivo. Los traslados no planificados (TNP) desde centros de atención intermedia, postagudos a agudos se asocian a consecuencias adversas para los pacientes y a un importante coste para el sistema. Presentamos un protocolo práctico y el diseño de un estudio de intervención dirigido a disminuir los TNP evitables desde una unidad de rehabilitación geriátrica a hospitales de agudos. Pacientes y métodos. Estudio cuasiexperimental no aleatorizado. La intervención consiste en dos ejes: 1) protocolo de detección precoz de síntomas con el objetivo de realizar un manejo proactivo de las descompensaciones; 2) protocolo estructurado de directrices avanzadas delante de las descompensaciones agudas, compararemos el grupo de intervención con una cohorte paralela de control y una cohorte histórica. Las muestras se compararán por variables demográficas, funcionales, cognitivas, comorbilidad y sociales. Variable dependiente: número de TNP de la unidad de rehabilitación geriátrica a los hospitales de agudos. Discusión. Este estudio cuasiexperimental, con una importante caracterización práctica, pretende valorar el impacto de un protocolo multidisciplinar y multifactorial para reducir los TNP potencialmente evitables a centros de agudos durante el ingreso en convalecencia y rehabilitación. Además, creemos que los resultados del proyecto podrán resultar útiles para futuros estudios aleatorizados y controlados (AU)

Objective. The unplanned transfers (UT) from post-acute intermediate care facilities, are associated with adverse outcomes for patients, and a significant cost to the system. We present a practical protocol and the design of an intervention study aimed at reducing avoidable UT from a geriatric post-acute rehabilitation setting to acute care hospitals. Patients and Methods. A quasi-experimental non randomized study. The intervention consists in: 1) protocol for early detection of symptoms in order to conduct a pro-active management of decompensation; 2) an advanced care planning structured protocol for the acute decompensations. We will compare the intervention group with a parallel and a historical cohort for demographic, functional, cognitive, comorbidity and social variables. Outcome: number of UT to acute care hospitals. Discussion. This is a quasi-experimental study, focused on everyday care practice that intends to assess the impact of multi-disciplinary and multi-factorial intervention to reduce UT from a post-acute rehabilitation unit. We expect that the project results will be useful for future randomized and controlled studies (AU)

[Management of avoidable acute transfers from an intermediate care geriatric facility to acute hospitals: critical aspects of an intervention protocol]. / Gestión de traslados potencialmente evitables a los hospitales de agudos desde unidades de rehabilitación geriátrica: aspectos críticos de un protocolo de intervención.

OBJECTIVE: The unplanned transfers (UT) from post-acute intermediate care facilities, are associated with adverse outcomes for patients, and a significant cost to the system. We present a practical protocol and the design of an intervention study aimed at reducing avoidable UT from a geriatric post-acute rehabilitation setting to acute care hospitals. PATIENTS AND METHODS: A quasi-experimental non randomized study. The intervention consists in: 1) protocol for early detection of symptoms in order to conduct a pro-active management of decompensation; 2) an advanced care planning structured protocol for the acute decompensations. We will compare the intervention group with a parallel and a historical cohort for demographic, functional, cognitive, comorbidity and social variables. OUTCOME: number of UT to acute care hospitals. DISCUSSION: This is a quasi-experimental study, focused on everyday care practice that intends to assess the impact of multi-disciplinary and multi-factorial intervention to reduce UT from a post-acute rehabilitation unit. We expect that the project results will be useful for future randomized and controlled studies.