Perfil clínico, abordaje y pronóstico del paciente con shock cardiogénico sometido a traslado interhospitalario en España / Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in Spain

Introducción y objetivos El objetivo es analizar el perfil clínico, el abordaje y el pronóstico del shock cardiogénico (SC) por infarto agudo de miocardio con elevación del segmento ST (IAMCEST) que requiere traslado interhospitalario, así como el impacto pronóstico de las variables estructurales de los centros en este contexto. Métodos Se incluyó a los pacientes con SC-IAMCEST atendidos en centros con capacidad de revascularización (2016-2020). Se consideró a: a) pacientes atendidos durante todo el ingreso en hospitales con cardiología intervencionista sin cirugía cardiaca; b) pacientes atendidos en hospitales con cardiología intervencionista y cirugía cardiaca, y c) pacientes trasladados a centros con cardiología intervencionista y cirugía cardiaca. Se analizó la asociación del volumen de SC-IAMCEST atendidos y la disponibilidad de cuidados intensivos cardiológicos (UCIC) y trasplante cardiaco con la mortalidad hospitalaria. Resultados Se incluyeron 4.189 episodios, 1.389 (33,2%) del grupo A, 2.627 del grupo B (62,7%) y 173 del grupo C (4,1%). Los pacientes trasladados eran más jóvenes, tenían más riesgo cardiovascular y recibieron más frecuentemente revascularización, asistencia circulatoria y trasplante cardiaco durante el ingreso (p<0,001). Los pacientes trasladados presentaron menor tasa bruta de mortalidad (el 46,2 frente al 60,3% del grupo A y el 54,4% del grupo B; p<0,001). Mayor volumen asistencial (OR=0,75; p =0,009) y disponibilidad de UCIC (OR=0,80; p =0,047) se asociaron con menor mortalidad. Conclusiones El porcentaje de SC-IAMCEST trasladados en nuestro medio es bajo. Los pacientes trasladados son más jóvenes y reciben más procedimientos invasivos. Los traslados a centros con mayor volumen y UCIC presentan menor mortalidad. (AU)

Introduction and objectives The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting. Methods This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality. Results A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047). Conclusions The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU. (AU)

Clinical profile, management and outcomes of patients with cardiogenic shock undergoing transfer between centers in Spain.

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze the clinical profile, management, and prognosis of ST segment elevation myocardial infarction-related cardiogenic shock (STEMI-CS) requiring interhospital transfer, as well as the prognostic impact of structural variables of the treating centers in this setting. METHODS: This study included patients with STEMI-CS treated at revascularization-capable centers from 2016 to 2020. The patients were divided into the following groups: group A: patients attended throughout their admission at hospitals with interventional cardiology without cardiac surgery; group B: patients treated at hospitals with interventional cardiology and cardiac surgery; and group C: patients transferred to centers with interventional cardiology and cardiac surgery. We analyzed the association between the volume of STEMI-CS cases treated, the availability of cardiac intensive care units (CICU), and heart transplant with hospital mortality. RESULTS: A total of 4189 episodes were included: 1389 (33.2%) from group A, 2627 from group B (62.7%), and 173 from group C (4.1%). Transferred patients were younger, had a higher cardiovascular risk, and more commonly underwent revascularization, mechanical circulatory support, and heart transplant during hospitalization (P<.001). The crude mortality rate was lower in transferred patients (46.2% vs 60.3% in group A and 54.4% in group B, (P<.001)). Lower mortality was associated with a higher volume of care and CICU availability (OR, 0.75, P=.009; and 0.80, P=.047). CONCLUSIONS: The proportion of transfers in patients with STEMI-CS in our setting is low. Transferred patients were younger and underwent more invasive procedures. Mortality was lower among patients transferred to centers with a higher volume of STEMI-CS cases and CICU.

Calidad de atención interhospitalaria: Revisión sistemática / Quality of interhospital care: Systematic review / Qualidade do atendimento inter-hospitalar: revisão sistemática

En la actualidad la calidad de atención durante los traslados interhospitalarios de pacientes es una tarea compleja, que desafía la capacidad del personal de salud para mantener un ambiente de cuidado alrededor de estos pacientes. Objetivo. Analizar la calidad de atención interhospitalaria. Metodología. Se realizó una revisión sistemática y se evalúa la calidad de atención interhospitalaria. En la búsqueda de información se utilizaron términos DeCS y operadores boleanos con algoritmos (calidad de atención) AND (Interhospitalaria); (Care quality) AND (Interhospital). Considerando estudios de 2017-2023, en bases de datos como PubMed se obtuvieron 48 artículos, PLoS one 5 artículos, Science Direct 11, Scielo 33 artículos, Sage Journals 6, Elsevier 7, Springer Link 5 artículos. De los 131 artículos en total, se eliminaron 70 en base a resúmenes incompletos y se excluyeron 34 artículos que no tenían información completa; obteniendo 17 artículos para realizar la extracción y el análisis de los datos. Conclusión. Existen estrategias para una adecuada atención interhospitalaria, tales como: oxigenación por membrana extracorpórea como una opción para transportar de forma segura a los pacientes con Síndrome de distrés respiratorio agudo grave, es fundamental garantizar medidas de higiene y el suministro de equipos de protección personal para prevenir propagación de enfermedades; asegurar adecuada comunicación e intercambio de información, a través de medios virtuales, tanto para los familiares y personal; es esencial tener un plan general para prevenir cualquier evento impredecible y agudo, mejoran la eficiencia de la prestación de atención médica, lo que finalmente se traduce en mejores resultados para los pacientes.

Currently, the quality of care during interhospital transfers of patients is a complex task, which challenges the ability of health care personnel to maintain a caring environment around these patients. Objective. To analyze the quality of interhospital care. Methodology. A systematic review was carried out and the quality of interhospital care was evaluated. DeCS terms and Boolean operators with algorithms (Care quality) AND (Interhospital); (Care quality) AND (Interhospital) were used in the information search. Considering studies from 2017-2023, in databases such as PubMed 48 articles were obtained, PLoS one 5 articles, Science Direct 11, Scielo 33 articles, Sage Journals 6, Elsevier 7, Springer Link 5 articles. Of the 131 articles in total, 70 were eliminated based on incomplete abstracts and 34 articles that did not have complete information were excluded; obtaining 17 articles to perform data extraction and analysis. Conclusion. There are strategies for adequate interhospital care, such as: extracorporeal membrane oxygenation as an option to safely transport patients with Severe Acute Respiratory Distress Syndrome, it is essential to ensure hygiene measures and the provision of personal protective equipment to prevent the spread of disease; ensure adequate communication and exchange of information, through virtual means, both for family members and staff; it is essential to have a general plan to prevent any unpredictable and acute event, improve the efficiency of health care delivery, which ultimately translates into better outcomes for patients.

A qualidade do atendimento durante as transferências inter-hospitalares de pacientes é atualmente uma tarefa complexa, que desafia a capacidade da equipe de saúde de manter um ambiente de cuidado em torno desses pacientes. Objetivo. Analisar a qualidade do atendimento interhospitalar. Metodologia. Realizamos uma revisão sistemática e avaliamos a qualidade do atendimento inter-hospitalar. Na busca de informações, foram utilizados termos do DeCS e operadores booleanos com algoritmos (Care quality) AND (Interhospital); (Care quality) AND (Interhospital). Considerando estudos de 2017 a 2023, foram obtidos 48 artigos em bancos de dados como PubMed, 5 artigos em PLoS one, 11 artigos em Science Direct, 33 artigos em Scielo, 6 artigos em Sage Journals, 7 artigos em Elsevier e 5 artigos em Springer Link. Do total de 131 artigos, 70 artigos foram eliminados com base em resumos incompletos e 34 artigos foram excluídos por não terem informações completas, obtendo-se 17 artigos para extração e análise de dados. Conclusões. Existem estratégias para o atendimento inter-hospitalar adequado, tais como oxigenação por membrana extracorpórea como uma opção para o transporte seguro de pacientes com síndrome da angústia respiratória aguda grave; garantia de medidas de higiene e fornecimento de equipamentos de proteção individual para evitar a propagação de doenças; garantia de comunicação e troca de informações adequadas, por meios virtuais, tanto para os familiares quanto para a equipe; ter um plano geral para evitar qualquer evento imprevisível e agudo é essencial para melhorar a eficiência da prestação de serviços de saúde, o que, em última análise, se traduz em melhores resultados para os pacientes.

Teoría de las transiciones y empoderamiento: un marco para las intervenciones enfermeras durante la transición del paciente de la unidad de cuidados intensivos / Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition

Objetivos: 1) Explorar las principales características de la transición de la unidad de cuidados intensivos de acuerdo a la experiencia vivida de los pacientes y 2) identificar la terapéutica enfermera para facilitar la transición de los pacientes desde la unidad de cuidados intensivos a la unidad de hospitalización. Metodología: Análisis secundario de los hallazgos de un estudio cualitativo descriptivo sobre la experiencia de los pacientes ingresados en una UCI durante la transición a la unidad de hospitalización, en base a la teoría de las transiciones de enfermería. Los datos para el estudio primario se generaron de 48 entrevistas semiestructuradas de pacientes que habían sobrevivido a una enfermedad crítica en 3 hospitales universitarios de tercer nivel. Resultados: Se identificaron 3 temas principales durante la transición de los pacientes de la unidad de cuidados intensivos a la unidad de hospitalización: 1) naturaleza de la transición de la UCI, 2) patrones de respuesta y 3) terapéutica enfermera. La terapéutica enfermera incorpora la información, educación y promoción de la autonomía del paciente; además del apoyo psicológico y emocional. Conclusiones: La teoría de las transiciones como marco teórico ayuda a comprender la experiencia de los pacientes durante la transición de la UCI. La terapéutica enfermera de empoderamiento integra las dimensiones dirigidas a satisfacer las necesidades y expectativas de los pacientes durante la misma.(AU)

Objectives: 1) To explore the main characteristics of intensive care unit transition according to patients’ lived experience and 2) to identify nursing therapeutics to facilitate patients’ transition from the intensive care unit to the inpatient unit. Methodology: Secondary analysis of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the nursing transitions theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in three tertiary university hospitals. Results: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. Conclusions: Transitions theory as a theoretical framework helps to understand patients’ experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients’ needs and expectations during ICU discharge.

Transitions and empowerment theory: A framework for nursing interventions during intensive care unit patient transition.

OBJECTIVES: 1) To explore the main characteristics of intensive care unit transition according to patients' lived experience and 2) To identify nursing therapeutics to facilitate patients' transition from the intensive care unit to the inpatient unit. METHODOLOGY: Secondary Analysis (SA) of the findings of a descriptive qualitative study on the experience of patients admitted to an ICU during the transition to the inpatient unit, based on the Nursing Transitions Theory. Data for the primary study were generated from 48 semi-structured interviews of patients who had survived critical illness in 3 tertiary university hospitals. RESULTS: Three main themes were identified during the transition of patients from the intensive care unit to the inpatient unit: 1) nature of ICU transition, 2) response patterns and 3) nursing therapeutics. Nurse therapeutics incorporates information, education and promotion of patient autonomy; in addition to psychological and emotional support. CONCLUSIONS: Transitions Theory as a theoretical framework helps to understand patients' experience during ICU transition. Empowerment nursing therapeutics integrates the dimensions aimed at meeting patients' needs and expectations during ICU discharge.

Escala de Respuestas Emocionales por Estrés al Traslado en Transporte Público / Scale of Emotional Responses due to Commuting Stress in Public Transport

Resumen El traslado cotidiano entre la casa y el trabajo demanda un importante uso de recursos personales y puede llegar a ser estresante. El objetivo fue construir y evaluar una escala de respuestas emocionales por el estrés en el traslado en transporte público para la Zona Metropolitana del Valle de México de manera exploratoria. Método: Se realizó un estudio cualitativo a través de entrevistas semi estructuradas con el propósito de identificar emociones asociadas a la experiencia de estrés por el traslado para desarrollar los reactivos de acuerdo con el contexto. Posteriormente, dos estudios cuantitativos permitieron evaluar las propiedades psicométricas. Participaron 196 y 298 personas respectivamente. La aplicación de la escala se realizó en línea en septiembre de 2020 y abril de 2021. Resultados: la escala incluyó 26 respuestas emocionales asociadas al estrés. En el Análisis Factorial Exploratorio se redujo a nueve emociones negativas (X2=1183, gl=36, p=.001, KMO=.94, 60% de varianza explicada, Alfa ordinal=.93), corroboradas en el Análisis Factorial Confirmatorio (X2=41.87, gl=26, X2/gl=1.61, p=.025; RMR=.036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conclusión: la propuesta exploratoria de la escala para evaluar las respuestas emocionales por el estrés en el traslado presenta valores adecuados para aplicarse en la Zona Metropolitana del Valle de México.

Abstract The stress in urban settings is related to a greater request for personal resources to face situations of daily life, such as the commuting, since in big cities, people spend a lot of time on it, and sometimes is uncomfortable and annoying, which can cause stress. Commuting stress has been assessed, through commuting daily hassles, commuting stressful features and physiological responses, but it is possible assess it through emotional responses. The aim of this study was to develop and assess an exploratory scale of emotional responses for the study of commuting stress by public transport in an urban area of México that is densely populated. Method, a cross sectional design was used, in which a qualitative exploratory study was carried out through 23 individual semi-structured interviews and two focus group, where it was identified the main emotions experienced during the commuting stress to develop the items in the language of the population. Subsequently, those emotions were compared with emotions proposed in previous studies to complement the scale. Thus, 26 emotions were included to assess the commuting stress through emotional responses. Finally, two quantitative studies were carried out to assess the psychometric properties of the scale, in which 196 and 298 people participated, respectively. The scale was applied online in September 2020 and in April 2021. Results, from the 26 emotional stress responses were reduced to nine negative emotions in an Exploratory Factor Analysis (X2=1183, df=36, p=.001, KMO= .94, 60% variance, Alfa ordinal=.93). This solution was corroborated with a Confirmatory Factor Analysis (X2=41.87, d.f.=26, X2/d.f.=1.61, p=.025; RMR= .036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conserve only nine negative emotions is due to statistical analysis but also because some emotions referred to conditions of physical exhaustion or body energy level. On the other hand, positive emotions were related with pleasant commuting situations, not with the commuting stress experience. Conclusion, the exploratory scale to assess the commuting stress through emotional responses presents acceptable values to be applied in this urban area of Mexico.

The effect of patient transfer type to the operating room on surgical site infection: Concerns versus evidence.

BACKGROUND: Concerns about surgical site infection (SSI) give rise to practices and procedures not evidence-based. OBJECTIVES: This study investigates whether the type of patient transfer to operating rooms plays a role in developing surgical site infection. METHODS: Three thousand four hundred and seventy-one patients were divided into two groups: transfer group with stretcher (ST) (n = 1699) and patient bed transfer group (PBT) (n = 1772). The data of the two groups and the SSI rates were comparatively analyzed. RESULTS: The SSI rate was 2.5% (n = 43) in the ST group and 2.8% (n = 49) in the PBT group, and there was no statistically significant difference. Both types of patient transfer had similar effects on the probability of SSI development. The odds ratio was 1.095 for stretcher transfer while 0.913 for patient bed transfer. CONCLUSION: Patients transfer to operating rooms on their beds are comfortable and safe. Furthermore, it has a similar effect to stretcher transfer on the probability of surgical site infection. Therefore, it is safer and cheaper to act based on evidence instead of trusting our concerns.

ANTECEDENTES: las preocupaciones sobre la infección del sitio quirúrgico (ISQ) dan lugar a prácticas y procedimientos que no se basan en pruebas. OBJETIVOS: Este estudio investiga si el tipo de traslado del paciente a los quirófanos influye en el desarrollo de la infección del sitio quirúrgico. MÉTODOS: Se dividieron 3471 pacientes en dos grupos: Grupo de transferencia con camilla (ST) (n = 1699) y Grupo de transferencia de cama de paciente (PBT) (n = 1772). Los datos de los dos grupos y las tasas de ISQ se analizaron comparativamente. RESULTADOS: La tasa de ISQ fue de 2.5% (n = 43) en el grupo ST y 2.8% (n = 49) en el grupo PBT, y no hubo diferencia estadísticamente significativa. Ambos tipos de transferencia de pacientes tuvieron efectos similares sobre la probabilidad de desarrollo de ISQ. La razón de posibilidades fue de 1.095 para el traslado en camilla y de 0,913 para el traslado de la cama del paciente. CONCLUSIÓN: El traslado de los pacientes a los quirófanos en sus camas es cómodo y seguro. Además, tiene un efecto similar al traslado en camilla sobre la probabilidad de infección del sitio quirúrgico. Por lo tanto, es más seguro y económico actuar en base a evidencias en lugar de confiar en nuestras preocupaciones.

Traslado neonatal: evaluación de 4 años en un departamento del interior del país / Neonatal transport services: 4-year assessment in the interior of Uruguay / Transporte neonatal: avaliação de 4 anos em um departamento do interior do Uruguai

Introducción: la creación de sistemas de traslado neonatal marcó una inflexión en cuanto a la reducción de morbimortalidad de los recién nacidos (RN). La Organización Panamericana de la Salud estima que 1% de los RN requerirá ingreso a la unidad de cuidados intensivos. El traslado ideal es intraútero, pero muchas veces esto no es posible, requiriendo un traslado neonatal. La regionalización de los sistemas de traslado, la capacitación de recursos humanos y la adquisición de materiales son elementos que han mejorado su calidad y disminuido su indicación. Objetivos: describir a los RN que requirieron traslado y valorar el impacto sobre ellos al adquirir materiales y recursos humanos capacitados. Metodología: estudio descriptivo, retrospectivo y multicéntrico, incluyendo todos los RN que requirieron traslado en el período 2016-2019. Variables analizadas: número de nacimientos, número de traslados, edad gestacional (EG), edad al momento del traslado, peso al nacer, tiempo de estabilización, oxigenoterapia y métodos, medicación recibida, medio de transporte y recursos humanos. Resultados y discusión: se realizaron 101 traslados neonatales, 1,5% del total de nacimientos. Variación anual: 2% de los RN en el año 2016, 1,6% en el 2017, 1,4% en el 2018, 1.1% en el 2019. Sector público: 63,3%. La media de EG fue de 33 semanas (25-40), modo 31 semanas. Pretérminos extremos 4,17%, pretérminos severos 37,5%, pretérminos moderados 17,7%, pretérminos tardíos 15,6% y de término 25%. La media de peso al nacer fue de 2.102 gramos (710-4.160), modo 1.440 gramos. La media de días al momento del traslado fue de 2,1 (3 horas-26 días). Indicaciones de traslado: prematurez 39,6%, otros SDR 22,9%, patología quirúrgica 13,5%, shock séptico 10,4%, asfixia/convulsiones 8,3% y cardiopatías 3%. Tratamiento durante la estabilización: oxigenoterapia 87,1%. Intubación orotraqueal y asistencia ventilatoria mecánica 71%, CPAP 9,7%, catéter nasal 6,4%. Requirieron surfactante 58,5%, antibióticos 77,4%, inotrópicos 26,6%, prostaglandinas 3,3%, aminofilina 3,3%. La media de tiempo de estabilización fue de 10,5 horas (3-36 horas). Destino: 64,3% Montevideo, 30,6% Tacuarembó, 3% Salto, 1% Canelones y 1% Minas. Medio de transporte: terrestre 95% y aéreo 5%. Fallecidos 1%. Recursos humanos disponibles: en 2016 un neonatólogo y seis pediatras. En 2019 tres neonatólogos, dos posgrados en neonatología, un pediatra intensivista, nueve pediatras (que se capacitaron en la estabilización del RN) y un supervisor docente y referente. Concomitante creación de unidades neonatales de estabilización con capacitación continua del personal de enfermería. Conclusiones: la principal causa de traslado fue la prematurez severa. Con la adquisición de recursos materiales adecuados y humanos capacitados se logró un descenso de casi 50% de los traslados. La regionalización ha ido en aumento pero se debe enfatizar, sobre todo en los RN menores a 1.000 gramos.

Introduction: the creation of neonatal transport systems showed a landmark regarding reduced morbidity and mortality of newborns (NB). The Pan-American Health Organization estimates that 1% of NBs require admission to an Intensive Care Unit. The ideal transport system would be intrauterine; however, many times this is not possible and neonatal transport services are needed. The regionalization of transport services, the training of human resources and the acquisition of materials have improved and therefore the need for transport services has decreased. Objectives: to describe the situation of newborns who required transport services and assess the impact on these services when acquiring materials and skilled human resources. Methodology: descriptive, retrospective and multicenter study, including all newborns who required transport services in 2016-2019. Variables analyzed: number of births, number of transfers, gestational age (GA), age at the time of transfer, birth weight, stabilization time, oxygen therapy and methods, medication received, means of transport and human resources. Results and discussion: 101 neonatal transfers were carried out, 1.5% of all births. Annual variation: 2% of newborns in 2016, 1.6% in 2017, 1.4% in 2018, 1.1% in 2019. Public sector: 63.3%. The mean GA was 33 weeks (25-40), mode 31 weeks. Extreme pre-terms 4.17%, severe pre-terms 37.5%, moderate pre-terms 17.7%, late pre-terms 15.6% and term newborns 25%. The mean birth weight was 2102 grams (710-4160), mode 1440 grams. The mean number of days at the time of transfer was 2.1 (3 hours-26 days). Transport main indications: prematurity 39.6%, other RDS 22.9%, surgical pathology 13.5%, septic shock 10.4%, asphyxia/seizures 8.3%, and heart disease 3%. Treatment during stabilization: Oxygen therapy: 87.1%. Orotracheal intubation and mechanical ventilation assistance 71%, CPAP 9.7%, nasal catheter 6.4%. 58.5% required surfactant, 77.4% antibiotics, 26.6% inotropes, 3.3% prostaglandins, 3.3% aminophylline. The mean stabilization time was 10.5 hours (3-36 hours). Destination: 64.3% Montevideo, 30.6% Tacuarembó, 3% Salto, 1% Canelones and 1% Minas. Means of transport: land 95% and air 5%. Deceased 1%. Available human resources: in 2016, 1 neonatologist and 6 pediatricians. In 2019, 3 neonatologists, 2 post graduated doctors in neonatology, 1 intensivist pediatrician, 9 pediatricians (who were trained in NB stabilization) and an academic supervisor and referent. Simultaneous neonatal stabilization units with continuous training of the nursing staff were created. Conclusions: the main cause of neonatal transport was severe prematurity. With the acquisition of adequate material and trained human resources, a decrease of almost 50% of these transfers was achieved. Regionalization has been rising even though it should be strengthened, especially in newborns weighing less than 1000 grams.

Introdução: a criação dos sistemas de transporte neonatal marcou uma virada na redução da morbimortalidade de recém-nascidos (RN). A Organização Pan-Americana da Saúde estima que 1% dos RNs necessitarão de internação em Unidade de Terapia Intensiva. O transporte ideal é intrauterino, más muitas vezes isso não é possível, sendo necessário o transporte neonatal. A regionalização do transporte neonatal, a formação de recursos humanos e a aquisição de materiais, tem melhorado a qualidade e diminuído a indicação do transporte neonatal. Objetivos: descrever a situação dos recém-nascidos que necessitaram de transporte e avaliar o impacto da aquisição de materiais e recursos humanos capacitados sobre os resultados. Metodologia: estudo descritivo, retrospectivo e multicêntrico, incluindo todos os recém-nascidos que necessitaram de transporte no período 2016-2019. Variáveis analisadas: número de partos, número de transportes, idade gestacional (IG), idade no momento do transporte, peso ao nascer, tempo de estabilização, oxigenoterapia e métodos, medicação recebida, meio de transporte e recursos humanos. Resultados e discussão: foram realizados 101 transportes neonatais, 1,5% de todos os nascimentos. Variação anual: 2% dos recém-nascidos em 2016, 1,6% em 2017, 1,4% em 2018, 1,1% em 2019. Setor público: 63,3%. A média de IG foi de 33 semanas (25-40), moda de 31 semanas. Pré-termos maduros extremos 4,17%, pré-termos graves 37,5%, pré-termos moderados 17,7%, pré-termos tardios 15,6% e recém-nascidos a termo 25%. O peso médio ao nascer foi de 2.102 gramas (710-4.160), moda 1.440 gramas. O número médio de dias no momento do traslado foi de 2,1 (3 horas-26 dias). Indicações de transporte: prematuridade 39,6%, outras SDR 22,9%, patologia cirúrgica 13,5%, choque séptico 10,4%, asfixia/convulsões 8,3% e cardiopatia 3%. Tratamento durante a estabilização: Oxigenoterapia: 87,1%. Intubação orotraqueal e assistência à ventilação mecânica 71%, CPAP 9,7%, cateter nasal 6,4%. 58,5% necessitaram de surfactante, 77,4% de antibióticos, 26,6% de inotrópicos, 3,3% de prostaglandinas, 3,3% de aminofilina. O tempo médio de estabilização foi de 10,5 horas (3-36 horas). Destino: 64,3% Montevidéu, 30,6% Tacuarembo, 3% Salto, 1% Canelones e 1% Minas. Meios de transporte: terrestre 95% e aéreo 5%. Falecidos 1%. Recursos humanos disponíveis: em 2016, 1 neonatologista e 6 pediatras. Em 2019, 3 neonatologistas, 2 pós-graduados em neonatologia,1 pediatra intensivista, 9 pediatras (treinados em estabilização de RN) e uma supervisora e referente académica. Simultaneamente se criaram unidades de estabilização neonatal com treinamento contínuo da equipe de enfermagem. Conclusões: a principal causa de transporte neonatal foi a prematuridade grave. Com a aquisição de material adequado e recursos humanos capacitados, conseguiu-se uma diminuição de quase 50% dos traslados. A regionalização vem aumentando, mas deve ser reforçada, principalmente para os casos de recém-nascidos com menos de 1.000 gramas de peso.

Incidentes relacionados con la seguridad del paciente crítico durante los traslados intrahospitalarios / Incidents related to critical patients afety during in hospital transfer

Objective: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators.DesignA prospective, observational and non-intervention cohort study was carried out.SettingA 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital.PatientsAll IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study.Main measurementsDemographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT.ResultsA total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable.ConclusionsAfter the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents (AU)

Objetivo: Analizar los incidentes relacionados con la seguridad del paciente (IRSP) durante los traslados intrahospitalarios (TIH) del paciente crítico tras la aplicación de un protocolo, así como sus factores de riesgo. Evaluar la seguridad durante los traslados mediante indicadores de calidad.DiseñoEstudio de cohorte, prospectivo, observacional y no intervencionista.ÁmbitoUnidad de Cuidados Intensivos (UCI) polivalente de 10 camas de un hospital universitario de segundo nivel.PacientesSe incluyen todos los TIH de pacientes críticos realizados de UCI a pruebas diagnósticas y a quirófano entre marzo de 2011 y marzo de 2017.Principales variables del estudioVariables demográficas, gravedad de los pacientes, prioridad del traslado, momento del día, motivo y tipo de equipo del traslado. Se recogen comprobaciones pre-traslado e IRSP. Análisis semestral de indicadores de calidad diseñados para el TIH.ResultadosDe los 805 traslados registrados, la mayoría urgentes (53,7%) y para pruebas diagnósticas (77%), 112 traslados (13,9%) presentaron algún tipo de IRSP, 54% relacionado con el equipamiento y 30% con el equipo y la organización. En 19 (2,4%) traslados se produjeron eventos adversos. En el análisis multivariante los factores de riesgo fueron la ventilación mecánica y el equipo que realiza el traslado. La evolución de los indicadores relacionados con los traslados es significativamente favorable.ConclusionesTras la aplicación de un protocolo de TIH, los IRSP son bajos y el principal factor de riesgo es la ventilación mecánica invasiva. La experiencia del equipo que realiza el TIH influye en la detección de un mayor número de incidentes (AU)

Incidents related to critical patient safety during in-hospital transfer.

OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.

Traslado a una nueva residencia: preparando el cambio: Experiencia de un Supervisor de enfermería en el traslado del Área de Discapacidad Intelectual del Complejo Asistencial Benito Menni de Ciempozuelos a la nueva Residencia de Arroyomolinos / Moving to a new residence: Experience of a nursing supervisor in the movement of the intellectual disability area of the Benito Menni Assistance Complex of Ciempozuelos to the new residence of Arroyomolinos

En marzo del 2014, se trasladaron 159 residentes del Área de Personas con Discapacidad Intelectual (APDI), desde el Complejo Asistencial Benito Menni de Ciempozuelos (CABM) a la nueva Residencia de Arroyomolinos. A través de este artículo, compartiré la experiencia que tuve como Supervisorde Enfermería, en la organización de dicho traslado, dando importancia a la planificación realizada y plan de traslado que se elaboró, así como la gestión de la información y comunicación que se llevó a cabo.Todo ello resaltando el papel de la enfermera como un importante Agente dentro de la Gestión del Cambio. (AU)

In March 2014, 159 residents of theArea of Persons with Intellectual Disabilities (APDI) were transferred from the Benito Menni Care Complex of Ciempozuelos (CABM) to the new Residence of Arroyomolinos. Through this article, I will share the experience I had as a Nursing Supervisor, in organizing this transfer, giving importance to the planning and transfer plan that was developed, as well as the management of the information and communication that was carried out cape. All of this highlighting the role of the nurse as an important Agentwithin Change Management (AU)

Registro Nacional de Quemados Chile: presentación de una plataforma online y mirada al pronóstico de pacientes no trasladados a Centro de Quemados / Presentation of an online National Registration Platform for severely burned patients in the Chilean Public Health System and a look into the prognosis of patients not transferred to the National Reference Burn Center

Resumen Introducción: En el año 2017 se incorporó un registro de notificación en línea (Registro Nacional de Quemados) al flujo de derivación de pacientes quemados en Chile. Objetivo: A partir de la información obtenida de esta plataforma, se describe la epidemiología de las quemaduras y las variables que podrían explicar los traslados fallidos a nuestra unidad de quemados. Materiales y Método: Se analizaron los casos subidos a esta plataforma entre julio de 2017 y julio de 2018. Se caracterizó la población global y comparó variables relevantes entre el grupo de pacientes no trasladados a nuestra unidad y los que fueron trasladados con éxito. Resultados: Se analizaron 319 pacientes, 66% hombres, edad promedio 51 años, IMC de 27% y 47% con enfermedades previas. El fuego fue la principal causa de quemaduras. Se observó un 31% de injuria inhaladora. 107 pacientes no se trasladaron a nuestro centro de quemados. Los pacientes trasladados puntuaron más alto en comorbilidad, índice de gravedad, superficie corporal total quemada y aseo quirúrgico en el hospital base. El grupo de pacientes no trasladados puntuó más alto en injuria inhalatoria. La mortalidad global fue 20,4%. La mortalidad fue mayor en pacientes no trasladados (33,6% versus 13,7%; p < 0,001). Conclusiones: Además de facilitar el flujo de pacientes y ahorrar recursos, un uso noble de esta plataforma es ser fuente de información epidemiológica y de implementación de políticas públicas, lo cual puede ser tomado como ejemplo por otros países en vías de desarrollo. Además, se demuestra que ser trasladado constituye un factor protector de muerte por quemaduras.

Introduction: In 2017, an online notification register, the National Burn Registry, was incorporated into the referral flow of burned patients in Chile. Aim: Through the information obtained from this platform, we describe the epidemiology of burns in Chile, and identify variables that could explain failed transfers to our burn unit. Materials and Method: Cases uploaded to this platform between July 2017 - July 2018 were analyzed. We characterize the global population and relevant variables were compared between the group of patients that failed to be transferred to the burn unit and the ones who were successfully transferred. Results: 319 patients were analyzed, 66% men, average age 51 years, BMI of 27 and 47% with previous illnesses. Fire was the main cause of burn injury. Smoke inhalation injury was observed for 31%. 107 patients failed to reach to our burn center. Transferred patients rated higher in comorbidity, severity index, total burned body surface and surgical debridement at base hospital. The group of not transferred patients rated higher in inhalation injury. Overall mortality was 20.4%. Mortality was higher in non-transferred patients (33.6% versus 13.7%; p < 0.001). Conclusions: Aside from facilitating the flow of burned patients and resources saving, a noble use of this platform has been to serve as a source of epidemiological information and implementation of public policies, which can be taken as an example by other developing countries. Also, being transferred is a protective factor for death from burn injuries.

Tiempos de traslado, características y evolución de los pacientes con infarto agudo de miocardio que requirieron derivación a Centros con Hemodinamia a más de 400 km de San Carlos de Bariloche / Transfer Times, Characteristics and Evolution of Patients with Acute Myocardial Infarction Referred to Hemodynamic Centers More Than 400 km From San Carlos de Bariloche

RESUMEN Introducción: Este estudio analiza los tiempos y las complicaciones de los traslados hacia centros con Hemodinamia (C-PCI) de los pacientes del registro prospectivo REGIBAR, que incluyó a todos los pacientes que sufrieron un primer infarto agudo de miocardio (IAM) en San Carlos de Bariloche entre junio de 2014 y junio de 2015. Material y métodos: Se registraron 114 casos de IAM internados. De ellos, 25 pacientes fueron trasladados a C-PCI a más de 400 km. Resultados: La mediana de tiempo de gestión del traslado (TGT) para derivación de emergencia, tanto en ambulancia (unidad de terapia intensiva móvil, UTIM) como en avión, fue de 480 minutos. La mediana de tiempo de traslado (T) con UTIM fue de 407 minutos y con avión sanitario, de 259 minutos. La sumatoria de los tiempos de gestión y de traslado, esto es, el tiempo total (TOT), fue de 915 min con UTIM de emergencia y de 780 min en avión. Este último implicó un ahorro de solo 15% del tiempo total de traslado. Conclusiones: Los tiempos de traslado fueron más prolongados de lo esperado, principalmente a expensas del TGT. Se tendió a trasladar a quienes tuvieron angina pos-IAM, mayor cantidad de derivaciones con supradesnivel del segmento ST, insuficiencia cardíaca, pero también a los más jóvenes. No hubo complicaciones durante los traslados.

ABSTRACT Introduction: This study analyzes transfer times and complications to Hemodynamics centers (PCI-C) of patients from the prospective REGIBAR registry, including all patients suffering a first acute myocardial infarction (AMI) in San Carlos de Bariloche between June 2014 and June 2015. Methods: Among 114 hospitalized AMI cases, 25 patients were transferred to PCI-C more than 400 km from San Carlos de Bariloche. Results: Median transfer management time (TMT) for emergency referral, both by ambulance [mobile intensive care unit (MICU)] and by plane, was 480 minutes. Median travel time (TT) by MICU was 407 minutes and by air ambulance, 259 minutes. The sum of management and transfer times, that is, the total time (TOT), was 915 min by emergency MICU and 780 min by plane. The latter saved only 15% of the total travel time. Conclusions: Transfer times were longer than expected, mainly at the expense of TMT. There was a tendency to transfer those who had post-AMI angina, a higher number of ST-segment elevation leads, heart failure, but also younger patients. There were no complications during transfers.

Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade. / Resultados de un programa específico y estructurado en la transición de pacientes jóvenes con diabetes tipo 1 desde pediatría a un hospital de adultos. La experiencia de una década.

OBJECTIVE: Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGY: This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTS: A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.

Incidents related to critical patient safety during in-hospital transfer. / Incidentes relacionados con la seguridad del paciente crítico durante los traslados intrahospitalarios.

OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.

Barreiras e estratégias no handover de enfermagem do doente crítico: revisão integrativa / Barriers and strategies in the nursing handover of critically ill patients: integrative review / Barreras y estrategias en el handover de enfermería de pacientes críticos: una revisión integradora

OBJETIVO: Verificar as principais barreiras e estratégias inerentes ao handover de Enfermagem ao paciente crítico na literatura científica. MÉTODOS: Trata-se de uma revisão integrativa da literatura, abordagem quantitativa, realizada entre 19 de outubro a 02 de novembro de 2018. Com seleção dos artigos publicados entre 2002 a 2018. RESULTADOS: 26 (100%) artigos identificados, todos publicados no âmbito internacional, desses 16 (62%) publicados nos últimos cinco anos. Dentre os artigos, 38% abordaram a barreiras e 27% as estratégias de handover, sendo 35% relacionados à segurança do paciente. DISCUSSÃO: a comunicação constitui-se instrumento básico para o cuidado em Enfermagem, no handover está torna-se indispensável, possibilitando a continuidade dos cuidados e minimizando os eventos adversos. CONCLUSÃO: Com os resultados desta revisão, é latente a necessidade emergente de desenvolver ferramentas e estratégias que auxiliem o Handover de Enfermagem no paciente crítico.

OBJECTIVE: To verify the main barriers and strategies inherent to the nursing handover of critically ill patients in the scientific literature. METHOD: This is an integrative review of the literature which used a quantitative approach and was conducted between October 19 to November 2, 2018. With the selection of article published between 2002 and 2018. RESULTS: 26 (100%) identified articles, all published internationally, among these 16 (62%) were published in the last five years. Among the articles, 38% addressed barriers and 27% handover strategies, 35% of which were related to patient safety. DISCUSSION: communication is a basic instrument for nursing care, and it is becoming indispensable in handover, enabling continuity of care and minimizing adverse events. CONCLUSION: The results of this review show the emerging need to develop tools and strategies to assist the Nursing Handover in critically ill patients.

OBJETIVO: Verificar las principales barreras y estrategias inherentes al Handover de enfermería a pacientes críticos en la literatura científica.. MÉTODO: Esta es una revisión bibliográfica integradora, un enfoque cuantitativo, realizada entre el 19 de octubre y el 2 de noviembre de 2018. Con una selección de artículos publicados entre 2002 y 2018. RESULTADOS: 26 (100%) artículos identificados, todos publicados internacionalmente, de estos 16 (62%) publicados en los últimos cinco años. Entre los artículos, el 38% abordó las barreras y el 27% las estrategias de transferencia, el 35% relacionados con la seguridad del paciente. DISCUSSÃO: La comunicación es un instrumento básico para la atención de enfermería, el Handover se está volviendo indispensable, permitiendo la continuidad de la atención y minimizando los eventos adversos. CONCLUSIÓN: con los resultados de esta revisión, existe una necesidad latente de desarrollar herramientas y estrategias para ayudar a la handover de enfermería en pacientes críticos.

Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center. / Hipoglucemia desapercibida en jóvenes con diabetes tipo 1 trasladados a un centro de adultos.

OBJECTIVE: To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS: Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively. RESULTS: Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04). CONCLUSIONS: The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.

As implicações do transporte intra-hospitalar na segurança do paciente: revisão integrativa / The implications of in-hospital transport on patient safety: integrative review / Las implicaciones del transporte intra-hospital en la seguridad del paciente: revisión integrativa

Introdução:O transporte intra-hospitalar é necessário para a realização de testes diagnósticos (tomografia computadorizada, ressonância nuclear magnética, angiografias, dentre outros para intervenções terapêuticas (como para o centro cirúrgico) ou para a internação em centro de terapia intensiva (CTI). Objetivo:Elucidar as implicações do transporte intra-hospitalar na segurança do paciente.Metodologia:Estudo bibliográfico, descritivo, do tipo revisão integrativa no período de 2008 a 2017,realizado durante outubro a novembro nas bases de dados IBECS, LILACS e BDENF.Construídoa partir de seis etapas.Analisaram-se os estudos a partir da leitura dos títulos, resumos e dos artigos completos que respondessem o objetivo proposto,seguindo dasíntese dosresultados dos 4artigos selecionadose apresentadosde forma descritiva em tabelas. Consideraram-se as categorias temáticas que emergiram da Técnica de Análise de Conteúdo após a análise dos artigos. Resultados:Observou-se nos estudos selecionados queas implicações no transporte do paciente envolvem eventos adversos como ainstabilidade hemodinâmicae respiratória e falta de recursos humanos capacitados e materiais com bom funcionamento, sendo necessário implementar protocolosde segurança do paciente por meio de um planejamentoe comunicação eficiente e utilização de checklist.Conclusões:Recomenda-se a padronização das ações dos profissionais envolvidos no transporte e a previsão e provisão dos equipamentos necessários para monitorização clínica do paciente, minimizando os eventos adversos e obtendo-se a excelência do atendimento e segurança do paciente. Destaca-se a necessidade de novos estudos que implementem novos protocolos assistenciais para a segurança do paciente no transporte intra-hospitalar (AU).

Introduction:In-hospital transport is required for diagnostic tests (computed tomography, nuclear magnetic resonance, angiography, among others for therapeutic interventions (such as for the operating room) or for intensive care unit (ICU) hospitalization.Objective:To clarify the implications of intrahospitaltransport on patient safety.Methodology:Bibliographic descriptive study of the integrative review type from 2008 to 2017, conducted during October to November in the IBECS, LILACS and BDENF databases. Built from six steps. The studies were analyzed by reading the titles, abstracts and complete articles that met the proposed objective, following the synthesis of the results of the 4 selected articles and presented descriptively in tables. The thematic categories that emerged from the Content Analysis Technique after the analysis of the articles were considered.Results:It was observed in the selected studies that the implications for patient transport involve adverse events such as hemodynamic and respiratory instability and lack of trained human resources and well-functioning materials. It is necessary to implement patient safety protocols through efficient planning and communication. and use of checklist. Conclusions:It is recommendedto standardize the actions of professionals involved in transportation and to provide and provide the necessary equipment for clinical monitoring of the patient, minimizing adverse events and achieving excellence in patient care and safety. There is a need for further studies that implement new care protocols for patient safety in intra-hospital transport (AU).

Introducción:El transporte intrahospitalario es necesario para realizar pruebas diagnósticas (tomografía computarizada, resonancia magnética nuclear, angiografías, entre otras intervenciones terapéuticas (como para el centro quirúrgico) o para Centro de Cuidados Intensivos (UCI). Objetivo:Esclarecer las implicaciones del transporte intrahospitalario en la seguridad del paciente. Metodología:Revisión bibliográfica, descriptiva e integradora en el período 2008-2017, realizada entre octubre y noviembre en las bases de datos IBECS, LILACS y BDENF. Construido a partir de seis escalones. Los estudios fueron analizados a partir de la lectura de los títulos, resúmenes y los artículos completos que respondieron al objetivo propuesto, siguiendo la síntesis de los resultados de los 4 artículosseleccionados y presentados descriptivamente en tablas. Consideramos las categorías temáticas que surgieron de la técnica de análisis de contenido después del análisis de los artículos. Resultados:Se observó en los estudios seleccionados que las implicaciones en el transporte del paciente implican eventos adversos como inestabilidad hemodinámica y respiratoria y falta de recursos humanos calificados y materiales con buen funcionamiento, protocolos de seguridad del paciente a través de una planificación y comunicación eficientes y el uso de la lista de verificación. Conclusiones:Recomendamos la estandarización de las acciones de los profesionales implicados en el transporte y la predicción y provisión del equipo necesario para el seguimiento clínico del paciente, minimizando los eventos adversos y obteniendo la excelencia de la atención y la seguridad del paciente. Cabe destacar la necesidad de nuevos estudios que implementen nuevos protocolos de atención para la seguridad del paciente en el transporte intrahospitalario (AU).

Interhospital transfer of severely injured trauma patients does not influence outcome. / El traslado secundario de pacientes con traumatismo grave no influye en el pronóstico.

OBJECTIVES: To examine outcomes and mortality in multiple-injury patients initially admitted or transferred to a level-I trauma center in Germany and to analyze the reasons for transfers from other level hospitals. MATERIAL AND METHODS: . Retrospective analysis of data recorded from January 2005 through December 2014. We compared 2 main groups: patients admitted directly to the level-I center and patients transferred from another center. We also analyzed transferred patients according to whether they came from local, regional or supraregional trauma centers. Demographic information and trauma characteristics were collected. We also recorded variables related to management in the intensive care unit (eg, duration of ventilation, transfusion requirement), complications [eg, presence of Acute Respiratory Distress Syndrome or Multiple Organ Dysfunction Syndrome], Glasgow Outcome Scale, and mortality. The reasons for transfer were extracted from the case histories and transfer protocols. RESULTS: . A total of 999 cases were identified: 863 patients were admitted directly and 136 were transferred (from local centers, 43.3%; regional centers, 39.7%; supraregional centers, 16.9%). We identified no negative effects on short-term outcomes that could be attributed to interhospital transfers. Transferred patients had higher Acute Physiology and Chronic Health Evaluation II scores on admission, but their injuries were not more severe than transferred patients'. Interhospital transfer was not independently associated with mortality, and the mean hospital stay and outcomes were similar in the 2 groups. Reasons for transfer differed according to the timing of transfer and to type of trauma center (regional or local vs supraregional center). CONCLUSION: Patients transferred to a level-I trauma center are generally more severely ill at the time of admission, but mortality and mean hospital stay are similar in directly admitted and transferred patients.

OBJETIVO: Examinar los resultados y la mortalidad de pacientes politraumáticos admitidos de forma primaria y secundaria en un hospital de traumatología de nivel 1 en Alemania, así como analizar el motivo de traslado desde los otros hospitales. METODO: Análisis retrospectivo de una base de datos que abarca de enero de 2005 a diciembre de 2014. Se construyeron dos grupos principales [de admisión primaria (AP) y de admisión secundaria (AS)] y se investigó el carácter de los hospitales de transferencia (locales vs regionales vs suprarregionales). Se incluyeron datos demográficos, características del traumatismo, aspectos relacionados con la unidad de cuidados intensivos (UCI) [como por ejemplo tiempo de ventilación, requisitos de transfusión, complicaciones postraumáticas como el síndrome de distrés respiratorio del adulto (SDRA) y el síndrome de disfunción orgánica múltiple (SDOM)] y la escala de Glasgow y mortalidad. Los motivos de transferencia analizados fueron obtenidos a través de la historia clínica y los protocolos de transferencia. RESULTADOS: Se identificaron 999 pacientes: 863 AP y 136 AS procedentes de centros traumatológicos locales (43,3%), regionales (39,7%) y suprarregionales (16,9%). No hay efectos negativos en los resultados a corto plazo debido al transporte interhospitalario de pacientes politraumatizados. Los pacientes con AS mostraron un puntaje APACHE II aumentado en el momento de admisión, pero no presentaron heridas de mayor gravedad que los pacientes con AP. La transferencia secundaria no es un factor de riesgo independiente de mortalidad: la estancia media hospitalaria para ambos grupos es semejante y el resultado es equivalente. Los motivos y el momento de transferencia difieren según el nivel del centro traumatológico (suprarregional vs regional/local). CONCLUSIONES: Los pacientes transferidos a un hospital de traumatología nivel 1 por lo general se encuentran más enfermos (en el momento de admisión), pero presentan resultados semejantes de mortalidad y estancia en comparación con los pacientes admitidos de forma primaria.

Impacto clínico-funcional del traslado directo desde domicilio a un centro con servicio de hemodinamia en el infarto agudo de miocardio con elevación de ST / Clinical-functional impact of direct transfer from home to a center with hemodynamic service in acute myocardial infarction with ST elevation

Antecedentes: la demora en la reperfusión del infarto agudo de miocardio con elevación del ST (IAMCST) es un determinante mayor de su evolución clínica y funcional. Objetivo: analizar el impacto del traslado directo desde domicilio a un centro con hemodinamia sobre los tiempos de reperfusión y la evolución clínico-ecocardiográfica del IAMCST. Material y método: se diseñó un estudio prospectivo, observacional, que incluyó los pacientes con IAMCST recibidos en el servicio de hemodinamia del Instituto de Cardiología Intervencionista de Casa de Galicia (INCI) para angioplastia transluminal coronaria (ATC) primaria del 1º de febrero de 2016 al 30 de setiembre de 2016. Los pacientes se clasificaron en dos grupos: 1) traslado directo desde domicilio a servicio de hemodinamia y 2) traslado desde otro centro asistencial. Se evaluaron los tiempos dolor-primer contacto médico (PCM) y PCM-balón. Se comparó la evolución clínica, la fracción de eyección del ventrículo izquierdo (FEVI) y el score de contractilidad sectorial del VI a corto plazo (a las 48 horas tras el ingreso y al mes) entre ambos grupos. Resultados: se incluyeron 124 pacientes, 38 mujeres (31%), edad media 63,2±13,5 años. El tiempo PCM-balón representó el 54,7% del tiempo isquémico. Provenían de domicilio 51 pacientes (41%). El tiempo de reperfusión en el grupo 1 fue 284±241 min vs 498±309 min en el grupo 2 (p<0,001), mientras que el tiempo PCM-balón del grupo 1 fue 111±76,3 min vs 263±175,1 min del grupo 2, (p<0,001). No existieron diferencias significativas entre los grupos 1 y 2 en referencia a la FEVI medida al ingreso (49,5±9,33% vs 46,5±9,78%) y al mes (53,0±-8,5) vs (50,2±10,5). El score de contractilidad inicial fue menor en el grupo 1 (1,37±0,39) que en el grupo 2 (1,46±0,31) (p=0,029), mientras que no mostró diferencias significativas en el control al mes (1,23±0,26) vs 1,34±0,32. La mortalidad total fue de 12 pacientes (9,7%) y antes de las 48 horas, 8 pacientes (6,5%). La tasa de eventos cardíacos adversos mayores (ECAM: reinfarto, revascularización urgente, muerte y accidente cerebrovascular [ACV]) no difirió entre ambos grupos. Los pacientes que sufrieron ECAM presentaron mayor score de contractilidad inicial y menor FEVI inicial y al mes. Conclusión: la estrategia de traslado directo desde domicilio a un centro de hemodinamia se asocia con un menor tiempo isquémico total a expensas de un menor tiempo PCM-balón, menor tiempo PCM-puerta y con un mejor score de contractilidad segmentaria inicial.

Background: delayed reperfusion of acute myocardial infarction with ST elevation (STEMI) is a major determinant of its clinical and functional course. Objective: to analyze the impact of the direct transfer from home to a center with hemodynamic service on the reperfusion times and in the clinical and echocardiographic evolution of the STEMI. Method: a prospective, observational study was designed that included patients with STEMI received at the INCI hemodynamic service for primary coronary transluminal angioplasty (TCA) from 1st.February 2016 to 30th September 2016. Patients were classified in two groups: 1) direct transfer from home to hemodynamic service and 2) transfer from another care center. Pain-first medical contact (FMC) and FMC-device times were evaluated. The short-term clinical evolution, the left ventricular ejection fraction (LVEF) and left ventricular sector contractility score (at 48 hours post admission and at one month) were compared between both groups. Results: we included 124 patients, 38 (31%) women, mean age 63.2±13.5 years. FMC-device time accounted for 54.7% of ischemic time. 51 patients (41%) were direct transfer from domicile. The reperfusion time in group 1 was 284 ± 241 min vs. 498 ± 309 min in group 2 (p <0.001), while the FMC-device time of group 1 was 111 ± 76.3 min vs 263 ± 175.1 min of group 2, (p <0.001). There were no significant differences between groups 1 and 2 in relation to LVEF measured at admission (49.5 ± 9.33% vs. 46.5 ± 9.78%) and at one month (53.0 ± -8.5) vs. (50.2 ± 10.5). The initial contractility score was lower in group 1 (1.37 ± 0.39) than in group 2 (1.46 ± 0.31) (p = 0.029), whereas it did not show significant differences in control and at one month (1.23 ± 0.26). 1.34 ± 0.32. The total mortality was 12 patients (9.7%) and 8 patients (6.5%) before 48 hours. The rate of major adverse cardiac events (MACE) did not differ between the two groups. Conclusion: the strategy of direct transfer from home to a hemodynamic center is associated with a shorter total ischemic time at the expense of a shorter FMC-device time and a shorter FMC-door time and with a better segmental contractility score.