Triaje, predicción de ingreso y constantes vitales / Triage, predicting hospital admission, and vital constants

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Construção e validação de um objeto de aprendizagem para enfermeiros / Construction and validation of a learning object for nurses

In today's societies, health care is increasingly culturally diverse due to the increasing migratory processes of the population and nurses. Therefore, it is necessary to train nurses to provide culturally competent care. Learning objects are didactic, multimedia, interactive and challenging materials that constitute relevant resources for the teaching-learning processes that go beyond the classroom. In many countries, in nursing education, they are still an innovative way of learning. The study was developed as part of the international project Developing Multimedia Learning for Cross-Cultural Collaboration and Competence in Nursing - TransCoCon, (ERASMUS + Program, contract: 2017-1-UK01-KA203-36612) and aimed to build and validate a learning object that supports the learning of transcultural competences, necessary in nursing care. The learning object developed is subordinated to the theme of admission of a client in a hospital. For its development, the following steps were followed: choice of content; analyze; conceptual map; navigational architecture; storyboard; Implementation; documentation of use; use, evaluation and maintenance. As a result of the work developed, we obtained the learning object "Admission to hospital" and its Portuguese version "Acolhimento do Cliente num Hospital". Both versions include a set of written supportive material for cross-cultural nursing care in hospital and illustrative videos of cross-cultural communication skills. The adopted methodology proved to be effective for the construction of an attractive, interactive and meaningful learning object for nursing students, nurses and nursing teachers

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Derivaciones de profesionales de la salud al Equipo de Psicopedagogía del Hospital General Carlos G. Durand / Referrals from health professionals to the psychopedagogy team of the General Hospital Carlos G. Durand

Proyecto de investigación de residentes de tercer año de Psicopedagogia en el Hospital General de Agudos Carlos Durand, de la Ciudad de Buenos Aires, centrado en el espacio de admisión, y en las expectativas de sus profesionales, al indicar admisión al Servicio de Psicopedagogía, en el período 2017-2019.

Protótipo de um Ambiente Virtual de Aprendizagem para utilização da metodologia Lean Healthcare em unidades de internação hospitalar / Prototype of a Virtual Learning Environment for use of the Lean Healthcare methodology in hospital admission units

A gestão dos hospitais tem sido cada vez mais difícil. Os problemas são causados, principalmente, em função da escassez de recursos financeiros, aumento da demanda, que resulta em longas filas de espera para iniciar tratamentos, falta de vagas em leitos de internação, aumento dos custos operacionais e limitações do espaço físico. No cenário hospitalar, o custo com internação é um dos maiores, sendo apontado como um dos principais responsáveis pelo aumento dos gastos médico-hospitalares que crescem acima da inflação geral. Partindo dessa dificuldade, faz-se necessário adotar um novo método capaz de eliminar os desperdícios e gerar valor para o paciente. O lean healthcare demonstrou ser um método capaz de solucionar os principais problemas nas instituições hospitalares, tratando-se de metodologia com foco na geração de valor para o cliente e, com isso, reduzindo os desperdícios nas atividades das instituições. Contudo, os gestores encontram dificuldades para implementá-la, haja vista que se trata de uma metodologia muito complexa, que demanda profissionais que contemplem o completo domínio da temática, a fim de obter êxito nos resultados. Nesse contexto, as tecnologias de informação e comunicação se apresentam como um recurso estratégico no processo de ensino-aprendizagem, sendo o ambiente virtual de aprendizagem (AVA) uma das mais importantes. Este estudo tem como objetivo desenvolver um protótipo de um AVA que contemple os passos para a implementação de melhores ferramentas e práticas da metodologia lean healthcare para setor de internação em instituições hospitalares. Para o desenvolvimento do AVA, este trabalho baseou-se no Modelo do Design Institucional. Como primeira etapa, foi realizada a revisão integrativa da literatura visando identificar na literatura problemas nos processos de trabalho do setor de internação de instituições hospitalares, bem como as ferramentas utilizadas nas implementações da metodologia lean healthcare. Dentre os problemas identificados, destaca-se o tempo de permanência do paciente, levando a uma sobrecarga dos leitos de internação, o atraso nas altas hospitalares, e os erros durante a prestação do cuidado. A partir desse resultado, o protótipo do AVA foi desenvolvido e está disponível no endereço eletrônico: < https://diangelessilva.wixsite.com/website>. Como proposta futura, o ambiente virtual será avaliado por especialistas na metodologia lean, por especialistas em informática e novas demandas para setor de internação relacionadas ao lean healthcare serão identificadas e acrescentadas

The management of hospitals has been increasingly difficult. The problems are caused, mainly, by the role of financial resources, resulting in long lines to start treatments, lack of places in hospital beds, some increase in operating costs and restriction in physical space. In the hospital set, the cost of hospitalization is one of the largest, being appointed as one of the main responsible for the increment in medical and hospital that grow above the general inflation. Beginning form this difficulty, it is necessary to adopt a new method capable to eliminate waste and to generate value for the patient. The lean healthcare proved to be a capable method of solving problems in hospital institutions, being a methodology focused on generating of value for the client and, therefore, reducing the waste in the activities of the institutions. However, the managers find difficulties to implement it, because it is a very complex methodology that demands professionals who can complete the mastery of the subject in order to achieve the results. In this context, the technologies of information and communication are presented as a strategic resource in the teaching-learning process, being the virtual learning environment (VLE) one of the most important. This study has as aim to develop a prototype of a VLE that look on the steps for the implementation of the better tools and practices of the methodology of lean healthcare for the hospitalization sector in hospital institute. For the development of VLE, this research was based on the Institutional Design Model. As the first step, an integrative review of literature was fulfilled objecting to identify in the literature problems in the processes of the work of the hospitalization sector of hospital institutions, as well the tools used in the implementations of the lean healthcare methodology. Among the problems identified, stands out the length of stay of the patient, leading to an overload of hospital beds, delays in hospital discharge, and the errors during the care installment. From this result, the VLE prototype was developed and it is available at the electronic address: < https://diangelessilva.wixsite.com/website>. As a future proposal, experts in lean methodology, by computer experts, will evaluate the virtual environment and new demands for hospitalization related to lean healthcare will be identified and added

Guías de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España / Admission, discharge and triage guidelines for paediatric intensive care units in Spain

La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous intensive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition

Intermediate care including reablement

This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.

Conciliación de medicación al ingreso mediante un programa de prescripción electrónica asistida / Medicines reconciliation at hospital admission into an electronic prescribing program

Objetivo: Describir y analizar los resultados obtenidos durante un año con un nuevo procedimiento de conciliación de la medicación al ingreso hospitalario basado en un programa de prescripción electrónica asistida. Método: Estudio observacional, prospectivo, no aleatorizado y no controlado de 12 meses de duración, en el que se incluyeron todos los pacientes que ingresaron, durante ese año, en un hospital general concertado de 450 camas. Para la conciliación de la medicación se utilizó el programa de prescripción electró- nica como medio para el abordaje multidisciplinar (enfermería, médicos y farmacéuticos). La conciliación se realizó al ingreso hospitalario y se midieron los errores de conciliación. Resultados: Se incluyeron 23.701 pacientes, conciliándose 53.920 medicamentos, de los cuales no tenían discrepancias 48.744 (90,4%) y 5.176 (9,6%) presentaban discrepancias: 4.731 (8,8 % de los fármacos) justificadas y 445 (0,8% de los fármacos) no justificadas. La mayor parte de las discrepancias no justificadas, (n = 310; 69,7%) se debieron a errores en el registro de la medicación domiciliaria al ingreso: medicación no registrada o errores de medicamentos, dosis, frecuencia o vía de administración, omisiones de prescripción, 23,6% (n = 105) y duplicidades, 6,7% (n = 30). En ningún caso el error de conciliación llegó al paciente. Conclusiones: Mediante las ayudas informáticas incluidas en el programa de prescripción electrónica asistida y el abordaje multidisciplinar del proceso de conciliación se consigue realizar la conciliación de la medicación al ingreso en el 98% de los pacientes en el momento del ingreso, evidenciando errores de conciliación solo en el 1,3% de los pacientes (AU)

Objective: To describe and to analyse a new method of integrated medicines reconciliation in an electronic prescribing program results. Method: 12-month, prospective, observational, non-randomized and uncontrolled study, in which all patients who were admitted, during that year, to a general hospital of 450 beds. The electronic prescribing program was used for medication reconciliation as a means to multidisciplinary approach (nurses, doctors, pharmacists). This reconciliation was done at the time of hospital admission and reconciliation errors were measured. Results: A total of 23 701 patients were included, with 53 920 medications being reconciled, of which 48 744 (90.4%) had no discrepancies and 5 176 (9.6%) had discrepancies: 4 731 (8.7%) justified and 445 (0.8%) not justified. The majority of unjustified discrepancies were due to the drugs in use at home not recorded well on the hospital admission record in 310 (69.7%), prescription omissions in 105 (23.6%) and duplications in 30 (6.7%). In any case the reconciliation errors reached patients. Conclusions: Using an electronic prescribing program and an interdisciplinary approach in the reconciliation of chronic medication, medication reconciliation at the time of hospital admission is achieved in 98% of patients, showing medication errors only in 1.3% of patients (AU)

Analysis of the medication reconciliation process conducted at hospital admission / Análisis de la actividad de conciliación de la medicación establecida al ingreso hospitalario

Objective: To analyze the outcomes of a medication reconciliation process at admission in the hospital setting. To assess the role of the Pharmacist in detecting reconciliation errors and preventing any adverse events entailed. Method: A retrospective study was conducted to analyze the medication reconciliation activity during the previous six months. The study included those patients for whom an apparently not justified discrepancy was detected at admission, after comparing the hospital medication prescribed with the home treatment stated in their clinical hospital records. Those patients for whom the physician ordered the introduction of home medication without any specification were also considered. In order to conduct the reconciliation process, the Pharmacist prepared the best pharmacotherapeutical history possible, reviewing all available information about the medication the patient could be taking before admission, and completing the process with a clinical interview. The discrepancies requiring clarification were reported to the physician. It was considered that the reconciliation proposal had been accepted if the relevant modification was made in the next visit of the physician, or within 24-48 hours maximum; this case was then labeled as a reconciliation error. For the descriptive analysis, the Statistics® SPSS program, version 17.0, was used. Outcomes: 494 medications were reconciled in 220 patients, with a mean of 2.25 medications per patient. More than half of patients (59.5%) had some discrepancy that required clarification; the most frequent was the omission of a medication that the patient was taking before admission (86.2%), followed by an unjustified modification in dosing or way of administration (5.9%). In total, 312 discrepancies required clarification; out of these, 93 (29.8%) were accepted and considered as reconciliation errors, 126 (40%) were not accepted, and in 93 cases (29,8%) acceptance was not relevant due to a change in the situation of the patient. The highest opportunities for improvement were identified in the Gastroenterology, Internal Medicine and Surgery Units, and in the following therapeutic groups: blood and hematopoietic organs, cardiovascular system, and nervous system. Conclusions: In our hospital, only a third of interventions were accepted and acknowledged as reconciliation errors. However, the medication reconciliation process conducted at admission by a Pharmacist has proven to be useful in order to identify and prevent medication errors. A better understanding of the cases in which interventions were not accepted could lead to an improvement in outcomes in the future (AU)

Objetivo: Analizar el resultado de un proceso de conciliación de la medicación al ingreso en el ámbito hospitalario. Valorar la intervención del farmacéutico en la detección de errores de conciliación y en la prevención de acontecimientos adversos que pueden derivarse de ellos. Método: Estudio retrospectivo en el que se analizó la actividad de conciliación en los seis meses previos. Se incluyeron los pacientes en los que se detectaron discrepancias al ingreso, en apariencia no justificadas, tras comparar la medicación hospitalaria prescrita con el tratamiento domiciliario que constaba en su historia digital. Se consideraron también los pacientes en los que el médico ordenaba introducir la medicación domiciliaria sin especificar de cuál se trataba. Para llevar a cabo la conciliación el farmacéutico elaboró la mejor historia farmacoterapéutica posible revisando la información disponible sobre la medicación que podía estar recibiendo el paciente de forma previa al ingreso y completando el proceso mediante una entrevista clínica. Las discrepancias que requerían aclaración fueron comunicadas al médico. La propuesta de conciliación se consideró aceptada si en la siguiente visita médica o en un plazo no superior a 24-48 horas se realizaba la modificación pertinente, en cuyo caso se denominó error de conciliación. Para el análisis descriptivo se empleó el programa SPSS Statistics® versión 17.0. Resultados: Se conciliaron 494 medicamentos en 220 pacientes, con una media de 2,25 fármacos. Más de la mitad de los pacientes (59,5%) presentó alguna discrepancia que requería aclaración, siendo la más frecuente la omisión de un medicamento que recibía previamente al ingreso (86,2%), seguida de la modificación de la posología o vía de administración sin justificar (5,9%). En total 312 discrepancias requirieron aclaración, de las cuales 93 (29,8%) fueron aceptadas y se consideraron errores de conciliación, 126 casos (40%) no lo fueron y en 93 (29,8%) la aceptación no procedía por un cambio en la situación del paciente. Las mayores oportunidades de mejora se identificaron en los servicios de Digestivo, Medicina Interna y Cirugía General y en los grupos terapéuticos: sangre y órganos hematopoyéticos, sistema cardiovascular y sistema nervioso. Conclusiones: En nuestro hospital solo una tercera parte de las intervenciones fueron aceptadas y reconocidas como errores de conciliación. No obstante, la conciliación de la medicación al ingreso realizada por un farmacéutico mostró ser útil en la identificación y prevención de errores de medicación. Un mejor entendimiento de los casos en los que las intervenciones no fueron aceptadas podría mejorar el resultado en el futuro (AU)

Adecuación de los ingresos hospitalarios en función del personal sanitario facultativo responsable bajo un modelo de supervisión no piramidal de médicos residentes en urgencias / Adequacy of hospital admissions according to the type of physician who performs the indication for admission to an emergency room with a model of non-pyramidal supervision

Introducción: La adecuación de ingresos hospitalarios garantiza la sostenibilidad del sistema sanitario y contribuye a incrementar la seguridad de los pacientes. Los hospitales universitarios deben tener como prioridad que el ejercicio de la docencia no repercuta en detrimento de la adecuación de los ingresos hospitalarios. Objetivo: Determinar si nuestro modelo de supervisión de residentes, conocido como no piramidal, garantiza una homogénea proporción de ingresos hospitalarios adecuados desde el servicio de urgencias con independencia de la situación de supervisión que tenga el médico responsable del ingreso. Sujetos y métodos: Se aplicó el protocolo de adecuación de ingresos hospitalarios a un registro aleatorizado obtenido para un estudio previamente realizado sobre prevalencia de adecuación de los ingresos hospitalarios. La proporción de ingresos hospitalarios adecuados se comparó en función de quién había realizado la indicación del ingreso: un facultativo especialista, un residente de primer año bajo supervisión facultativa o un residente de segundo o tercer año. Resultados: Los ingresos hospitalarios indicados por un facultativo especialista, por un residente de primer año bajo supervisión de un facultativo especialista y por un residente de segundo o tercer año fueron 125, 93 y 78, respectivamente. En estos tres grupos, los ingresos hospitalarios considerados inadecuados fueron 4 (3,2%), 5 (5,4%), y 4 (5,1%), respectivamente, sin identificarse diferencias estadísticamente significativas. Conclusiones: En todos los grupos, la proporción de ingresos inadecuados fue inferior a la comunicada en estudios nacionales previos. Creemos que nuestro modelo de supervisión no piramidal garantiza una sostenibilidad del sistema sanitario al ahorrar costes de ingresos inadecuados y contribuye a aumentar la seguridad de los pacientes

Introduction: A hospital admission adequacy warrants sustainability of a healthcare system and contributes increasing patients’ safety. Teaching hospitals must assure that pedagogic exercise with residents do not affect the adequacy of hospital admissions. Aim: To determine if our resident supervision model, known as non-pyramidal, warrants and homogeneous proportion of hospital admissions from the emergency department with independence of the different kind of physician who performs the instruction of hospital admission. Subjects and methods: A validated international protocol of hospital admission adequacy was applied to a randomized group of registries of hospital admissions which was used in a study of prevalence of adequate hospital admissions performed previously. The proportion of adequate hospital admission was compared according to who was who ordered the admission: a urgency physician staff, a first year resident under staff supervision and a second or third year resident. Results. The hospital admissions from the emergency department ordered by a staff physician, a first year resident and a second or third year resident were 125, 93 and 78 respectively. In those three groups, hospital admissions considered inadequate were 4 (3.2%), 5 (5.4%) and 4 (5.1%), respectively. There was no statistically significant difference among those proportions. Conclusions: In all groups, proportion of inadequate hospital admissions was less than those found in national reports. We believe that our non-pyramidal supervision model assures sustainability of the healthcare system saving costs of inadequate hospital admissions and contributes to warrant patients' safety

La saturación en los servicios de urgencias hospitalarios / On hospital emergency department crowding

En los últimos años hemos asistido al despliegue de diferentes medidas de desarrollo de los SUH, pero a pesar de ello los episodios de saturación siguen sucediéndose y el debate en cuanto a sus causas y posibles soluciones sigue abierto. Se trata de un problema universal y en el momento actual las circunstancias socioeconómicas comportan un replanteamiento del sistema sanitario, en el que los SUH tendrán un papel crucial. Recientemente se han consensuado los criterios concretos que definen una situación de saturación en los SUH. Las causas de la saturación son diversas e implican aspectos tanto externos a los SUH como intrínsecos a la propia unidad. Pero los más determinantes son propios de la dinámica hospitalaria, fundamentalmente la dificultad en adjudicación de cama para ingreso y en su disponibilidad real. Esta saturación se asocia a un descenso de la mayoría de indicadores de calidad. Así mismo, se incrementan el número de pacientes que esperan ser atendidos, el tiempo de espera para el inicio de la asistencia y el tiempo de actuación médico-enfermería. Además conlleva un alto riesgo de peores resultados clínicos. Esta situación conduce a la insatisfacción de pacientes, familiares y personal sanitario y a deterioro de aspectos como la dignidad, la comodidad o la confidencialidad. Las propuestas de mejora pasan por asegurar unos mínimos recursos estructurales y de personal, y agilizar algunas exploraciones complementarias, así como implementar áreas de observación y unidades de corta estancia. La respuesta de los centros a los SUH debería incluir alternativas a la hospitalización convencional con dispositivos de diagnóstico rápido, hospitales de día y hospitalización domiciliaria, así como acciones de res- puesta bien definidas a las necesidades de ingreso hospitalario, con agilización de la disponibilidad real de camas. El sistema sanitario por su parte debería mejorar el control de los pacientes crónicos para reducir las necesidades de ingreso, y adecuar la oferta a las necesidades reales de atención sociosanitaria (AU)

Recent years have seen a range of measures deployed to curb crowding in hospital emergency departments, but as episodes of overcrowding continue to occur the discussion of causes and possible solutions remains open. The problem is universal, and efforts to revamp health care systems as a result of current socioeconomic circumstances have put emergency services in the spotlight. Consensus was recently achieved on criteria that define emergency department overcrowding. The causes are diverse and include both external factors and internal ones, in the form of attributes specific to a department. The factors that have the most impact, however, involve hospital organization, mainly the availability of beds and the difficulty of assigning them to emergency patients requiring admission. Crowding is associated with decreases in most health care quality indicators, as departments see increases in the number of patients waiting, the time until initial processing, and the time until a physician or nurse intervenes. Crowding is also associated with risk for more unsatisfactory clinical outcomes. This situation leads to dissatisfaction all around—of patients, families, and staff—as aspects such as dignity, comfort, and privacy deteriorate. Proposals to remedy the problem include assuring that the staff and structural resources of a facility meet minimum standards and are all working properly, facilitating access to complementary tests, and providing observation areas and short-stay units. The response of hospitals to the situation in emergency departments should include alternatives to conventional admission, through means for rapid diagnosis, day hospitals, and home hospitalization as well as by offering a clear response in cases where admission is needed, granting easier access to beds that are in fact available. For its part, the health system overall, should improve the care of patients with chronic diseases, so that fewer admissions are required. It is also essential to search for ways to bring the supply of necessary social and health care services more in step with demand (AU)

Implantación de un procedimiento de conciliación terapéutica al ingreso hospitalario por el servicio de urgencias / Implementation of a therapeutic reconciliation procedure at admission by the emergency department

Objetivo: Evaluar los resultados de la implantación de un procedimiento de conciliación terapéutica (PCT) al ingreso hospitalario por el Servicio de Urgencias (SU).Método: Estudio prospectivo observacional realizado en el Servicio de Urgencias de un Hospital De Referencia de Área. Se recogieron los resultados de la aplicación del PCT de Septiembre a Diciembre de 2012. Un farmacéutico asistió diariamente al relevo de urgencias y revisó las historias clínicas, para seleccionar aquellos pacientes con mayor riesgo de error de conciliación (EC) según el PCT. Posteriormente, elaboró la historia farmacoterapéutica mediante la realizada en Urgencias, los registros de Primaria y entrevista con el paciente o su cuidador. La conciliación terapéutica se llevó a cabo con el urgenciólogo, considerándose EC cualquier discrepancia no justificada por el médico. La gravedad potencial de los EC fue valorada por urgenciólogos ajenos al estudio utilizando la categorización NCCMERP’S. Resultados: Se incluyeron 125 pacientes de los que 96 fueron conciliados. El farmacéutico recogió de media 1,3±2,2 medicamentos domiciliarios más que el médico encontrando 564 discrepancias con la anamnesis realizada en Urgencias en el 95,8% de los pacientes 167 se tradujeron en EC afectando al 71,9% de los pacientes. La mayoría de los errores fueron por omisión de medicamentos. La aceptación por el urgenciólogos de las intervenciones de conciliación fue del 73,9%. El 58% de los EC se consideraron clínicamente relevantes. Se realizaron también otras intervenciones con una aceptación del 97%. Un mayor cumplimiento de criterios de riesgo, polimedicación y pluripatología estuvieron asociados a presentar EC y la prescripción de Medicamentos Alto Riesgo a la necesidad de intervención. Conclusiones: La aplicación del PCT evitó potenciales errores de medicación clínicamente relevantes en la mayoría de los pacientes incluidos, que se beneficiaron además de otras intervenciones optimizando su farmacoterapia (AU)

Target: To evaluate the results of the implementation of a therapeutic reconciliation procedure (TRP) at admission by the emergency department (ED). Methods: Prospective observational study conducted in the ED of a Referral Hospital Area. We collected the results of the implementation of a TRP from September to December 2012. A pharmacist attended daily to emergency department meeting and reviewed medical history to select those patients with high risk of reconciliation error (RE) according TRP. Afterwards, home medication history was elaborated with emergency department and primary care records and interview with the patient or caregiver. Therapeutic reconciliation took place with the emergency physician, considering RE any discrepancies not justified by the doctor. The potential severity of RE was assessed by emergency physicians outside the study using NCCMERP' Scategorization. Results: The pharmacist collected an average of 1,3±2,2 home medication more than the emergency physician finding 564 discrepancies with the emergency record in 95,8% of the patients 167 were RE affecting 69 patients (71,9%). Most of the errors were due to omissions of the drugs. Acceptance by emergency physicians of the reconciliation interventions was 73,9%. 58% of the RE were considered clinically relevants. Other interventions were also performed with an acceptance of 97%. Greater compliance with risk criteria, polypharmacy and pluripathology were associated with present RE and prescription of high-risk medications with the need for intervention Conclusions: The application of TRP avoided any error in most of the patients. TRP should extend to all patients at risk who admitted by the ED (AU)

Evolución de la morbilidad hospitalaria por accidente de tráfico en la Comunidad de Madrid en el periodo 2004-2008 / Evolution of motor vehicle-related injuries hospital admissions in the Community of Madrid (Spain) between 2004 and 2008

Objetivos: Analizar la frecuencia y la distribución en la serie temporal de los ingresos hospitalarios por lesiones causadas en accidente de tráfico. Facilitar la planificación sanitaria mediante la predicción, para los próximos años, de la evolución de los ingresos. Ajustar la asignación de recursos a las previsiones, buscando la máxima eficiencia y equidad. Material y Métodos: Se incluyen los 748 ingresos registrados en el Hospital 12 de Octubre entre enero del 2004 y diciembre del 2008 con lesiones traumáticas graves (ISS > 9), causadas por accidente de tráfico o atropello por vehículo a motor. Se ha desarrollado un modelo matemático mediante técnicas de previsión y predicción con estacionalidad para facilitar un pronóstico de casos futuros. Resultados: No se ha alcanzado un ajuste aceptable con ninguno de los modelos matemáticos aplicados. Las dos actuaciones analizadas: nueva Ley de Seguridad Vial; y apertura simultánea de 8 nuevos hospitales en la Comunidad de Madrid, no parecen haber influido de forma estadísticamente significativa en el número de ingresos. Conclusiones: A partir de los resultados estadísticos obtenidos no parece posible realizar una predicción fiable sobre la evolución futura de la demanda (AU)

Objectives: Objectives: To analyze the frequency and distribution in the time series of hospital admissions for injuries in traffic accidents. Facilitate health planning by predicting, for the coming years, changes in admissions. Adjust the allocation of resources to the forecasts, seeking maximum efficiency and equity. Material and Methods: From January 2004 to December 2008, 748 admissions with severe traumatic injuries (ISS> 9) caused by traffic accident, or being hit by motor vehicle, were recorded in the Hospital 12 de Octubre. We have developed a mathematical model using techniques of forecasting and seasonal forecasting to provide a forecast of future cases. Results: We have not achieved an acceptable fit with any of the mathematical models applied. The two performances analyzed: new Road Safety Law, and simultaneous opening of 8 new hospitals in the Madrid region, seem not to have a statistically significant influence on the number of admissions. Conclusions: From the statistical results obtained, it didn´t seem possible to make a reliable prediction on the future evolution of demand (AU)

Termination of professional responsibility: exploring the process of discharging patients with heart failure from hospitals.

Despite the emphasized importance of the discharge process for patients with heart failure, this process is not taken as seriously as it should be. The objective of this qualitative study is to explore the concept of discharge and its associated factors in 42 experienced patients, family members, nurses and cardiologists at two educational hospitals in Tehran, Iran. The content analysis of the data indicates that the participants consider hospital discharge as the termination of professional responsibility on the part of physicians and nurses as far as health-care support is involved. Three themes were identified as factors related to the treating team, health-care system and patients and their families. Adverse outcomes of inappropriate discharge planning which manifested as incompliance with 'diet and medical regimen' and lack of lifestyle modification were also noted. It seems proper to try and change the attitude of physicians and nurses towards the concept of discharge, and raise their sensitivity to organizing and executing discharge plans. It is also recommended that postdischarge care should be established.

Impact of an express admit unit on emergency department length of stay.

BACKGROUND: Express admit units (EAUs) have been proposed as a way to expedite patient flow through the Emergency Department (ED). OBJECTIVES: We sought to determine the effect of opening a five-bed EAU unit for temporary placement of admitted patients on our ED length of stay (LOS) and waiting room times (WT). METHOD: This was a before-and-after interventional study of the 3-month period immediately before (pre-EAU) and after opening (post-EAU) of the EAU. We compared ED LOS and WT for patients admitted and discharged from the ED for both time periods, controlling for daily census and patient acuity. RESULTS: During the post-EAU period, 386 patients (26.2% of total admits) were admitted through the EAU. Overall LOS decreased from 8:21 (interquartile range [IQR] 6:02-11:20) to 7:41 (IQR 5:22-10:16) for all admitted patients (p < 0.001), and from 3:41 (IQR 2:05-5:58) to 3:35 (IQR 2:00-5:55) for the discharged patients (p = 0.025). After controlling for census and acuity, the LOS decreased an average of 10% (95% confidence interval [CI] 6%-14%; p < 0.001) for admitted patients and 4% (95% CI 2%-7%; p = 0.001) for discharged patients. These changes represented a decreased LOS of about 50 and 9 min, respectively. There were no significant differences in WT (0:44; IQR 0:09-2:07 vs. 0:50; IQR 0:11-2:20 for admitted patients and 0:41; IQR 0:09-1:50 vs. 0:41; IQR 0:10-1:47 for discharged patients). However, after controlling for census and acuity, WT decreased 9% (95% CI 1%-16%; p = 0.022) for discharged patients, which represented a decrease of about 4 min. CONCLUSIONS: With an EAU, there was a modest improvement in ED LOS despite an overall increase in daily ED volume.