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1.
N Engl J Med ; 382(2): 152-162, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31914242

RESUMO

BACKGROUND: There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services. METHODS: We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge. RESULTS: The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group. CONCLUSIONS: In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, NCT02090426; American Economic Association registry number, AEARCTR-0000329.).


Assuntos
Doença Crônica/terapia , Hospitalização/estatística & dados numéricos , Administração dos Cuidados ao Paciente/métodos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Custos de Cuidados de Saúde , Visita Domiciliar , Humanos , Modelos Lineares , Pessoa de Meia-Idade , New Jersey , Administração dos Cuidados ao Paciente/organização & administração , Sumários de Alta do Paciente Hospitalar , Estudos Prospectivos , Fatores Socioeconômicos , Estados Unidos
2.
Enferm. clín. (Ed. impr.) ; 29(5): 302-307, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184155

RESUMO

Introducción: Los informes de alta de hospitalización presentan gran cantidad de abreviaturas y su significado puede ser desconocido por médicos y enfermeras, pudiendo comprometer la seguridad del paciente. Objetivo: Evaluar el conocimiento de médicos y enfermeras de las abreviaturas clínicas presentes en el informe de alta. Métodos: Estudio observacional-transversal mediante un cuestionario elaborado ad hoc dirigido a médicos y enfermeras del Hospital Universitario de Fuenlabrada. Para la validación del cuestionario se realizó la evaluación del contenido y de la validez lógica. La cumplimentación fue anónima y voluntaria y se difundió online a través de los correos corporativos de los profesionales. El cuestionario incluía variables sociodemográficas y 14 abreviaturas presentes en los informes de alta. Los datos se obtuvieron de la historia clínica electrónica. Resultados: De 756 profesionales, el cuestionario fue respondido por 68 médicos y 86 enfermeras (n = 154). La edad media de los profesionales fue de 40,58 años (DE ±7,54), y la media de años de experiencia profesional fue de 17,10 años (DE ±7,37). Los profesionales presentan un porcentaje medio de aciertos del 35,84% de todas las abreviaturas evaluadas. El personal médico presentó un 55,94% de contestaciones correctas, y el personal de enfermería un 23,17%. Las abreviaturas en las que se produjeron más errores fueron: SNG, NPIM, EEA y RCP, con un porcentaje de aciertos del 5,19, 6,49, 6,49 y 7,79%, respectivamente. Conclusiones: La identificación de las abreviaturas en los informes de alta por parte de los médicos es superior a la del personal de enfermería. A nivel global, el conocimiento de las abreviaturas en ambos profesionales es bajo


Introduction: Medical Records have a large number of abbreviations and doctors and nurses may not be aware of their meaning, which could compromise patient safety. Objective: To evaluate the knowledge of doctors and nurses of the clinical abbreviations in medical discharge reports. Methods: Observational-cross sectional study through a questionnaire developed ad hoc for doctors and nurses from Hospital Universitario de Fuenlabrada. The content and logical validity of the questionnaire was assessed. The questionnaire was completed anonymously and voluntarily. The questionnaire was also distributed online to the professionals' corporate emails. The questionnaire included sociodemographic variables and 14 abbreviations present in medical discharge reports. The data were obtained from the Electronic Clinical Record. Results: Out of a total of 756 professionals, the questionnaire was answered by 68 doctors and 86 nurses (n = 154).The mean age of the professionals was 40.58 years (SD ±7.54), and the mean number of years of professional experience was 17.10s (SD ±7.37). The professionals gave an average percentage of correct answers of 35.84%. Doctors gave 55.94% of the correct answers, and nurses 23.17%. The abbreviations for which the most errors occurred were SNG, NPIM, EEA, RCP, with a success rate of 5.19%, 6.49%, 6.49% and 7.79%, respectively. Conclusions: The identification of the abbreviations in medical discharge reports by doctors is superior to that of nursing staff. Overall the knowledge of abbreviations in both professionals is low


Assuntos
Humanos , Conhecimento , Competência Clínica , Abreviaturas como Assunto , Sumários de Alta do Paciente Hospitalar , Registros Médicos/normas , Epidemiologia Descritiva , Alta do Paciente/normas , Inquéritos e Questionários , Estudos Transversais
3.
Managua; s.n; out. 2019. 78 p. ilus, tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1048318

RESUMO

Estudio descriptivo de corte transversal, el cual estuvo conformado por un universo y una muestra de 147 pacientes escogidos a conveniencia de acuerdo a los criterios de inclusión. Se realizaron 147 encuesta de los cuales la edad que más acudieron a la unidad fueron los de 31 a 40 años, 73.42% fueron mujeres, la población rural fue la que más acudió a la unidad con 57.82%, el 42.18% con un nivel académico de educación primaria, los servicios que más demanda la población es la consulta médica 88.44%, 76.19% esperó más de una hora para ser atendido el 65.99% está muy satisfecho con ese tiempo de espera, 39.46% dijo que la consulta duró más de 10 minutos, 82.31% dijo sentirse muy satisfecho, en su mayoría los usuarios dijeron que si recibió información, 68.71% le dieron seguimiento, 82.31% le entregaron completo el medicamento. La percepción con la limpieza es positiva, 59.99% de los usuarios no hizo uso de los servicios higiénicos, 82.99% dijo que el trato del médico es excelente, al igual que de la enfermera el 71.43% opinó lo mismo, 83.27% se siente muy satisfecho en general con la atención recibida.La población se siente muy satisfecha con los servicios que se brindan en consulta externa, una mínima cantidad menciona que no está satisfecho con el tiempo de espera para la consulta


Assuntos
Humanos , Feminino , Satisfação do Paciente , Atenção à Saúde , Sumários de Alta do Paciente Hospitalar , Saúde Pública , Epidemiologia Descritiva , Estudos Transversais
4.
Managua; s.n; ago. 2019. 61 p. ilus, tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1048324

RESUMO

Estudio descriptivo de corte transversal. La muestra estuvo constituida por 220 usuarios, las variables objetivos características sociodemográficas y las 5 dimensiones de la encuesta SERVQUAL. Fuente de información primaria. La información se recolectó por 2 asistentes informáticos. El procesamiento de la información se realizó en Open Data Kit (ODK). Se realizaron 220 encuestas, de las cuales, se observó que hubo un equilibrio en las cuatro categorías de edades una población activa laboralmente y llegando a la adultez, el 51 % fueron varones, el 48.5% son universitarias, y el 86% procedentes del área urbana. Las brechas por dimensión fueron las siguientes: Bienes Tangibles: -0.14, Confiabilidad:-0.01, Responsabilidad: 0.04. Seguridad: 0.08, Empatía: 0.09. El índice de calidad del servicio fue de 0.01. Al clasificar la calidad del servicio, la dimensión con la brecha más alejada de cero fue la confiabilidad y las más cercana de cero fueron los bienes tangibles; el resultado del índice de calidad del servicio (ICS) se interpreta que, según las percepciones y expectativas el área de Rayos x, cumplesatisfactoriamente con el estándar de calidad


Assuntos
Humanos , Raios X , Serviços Hospitalares , Satisfação do Paciente , Sumários de Alta do Paciente Hospitalar , Assistência ao Paciente , Epidemiologia Descritiva , Estudos Transversais , Administração em Saúde
5.
N Z Med J ; 132(1495): 30-41, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31095542

RESUMO

AIMS: Perform an audit which identifies the breadth and commonality of presenting complaints and diagnoses presenting to Middlemore Hospital over a one-week period in August 2016. METHODS: Two thousand and eleven patients attended Middlemore Hospital over one week in winter 2016, with 53 patients excluded. Information from the remaining 1,958 patient discharge summaries were obtained and made confidential for coding purposes. RESULTS: Of 1,958 patients, there were 78 different presenting complaints, with 444 individual final diagnoses. The five most common complaints were cough (n=158, 8.1%), chest pain (n=133, 6.8%), shortness of breath (n=92, 4.7%), finger pain (n=69, 3.5%) and collapse (n=59, 3.0%). Viral illness (n=84, 4.3%), pneumonia (n=83, 4.3%) and laceration/incised wound (n=75, 3.8%) were the three most common diagnoses. With hindsight, only 2 of the 25 most common diagnoses could be classified as severe conditions-often associated with high morbidity or mortality. CONCLUSIONS: Numerous patients are diagnosed with mild conditions after work-up in the emergency department, however a broad diagnostic approach is required by junior clinicians given the possibility of more worrying diagnoses. An analysis of specific markers used by junior clinicians to aid differential diagnosis shows that not all signs and symptoms are required to make common diagnoses. For example, the absence of a documented fever, raised CRP or both, does not rule out significant infection in the case of pneumonia, urinary tract infection and cellulitis. This audit contributes to understanding the case-mix within the emergency department at Middlemore Hospital and allows for tailoring of service delivery and education of junior clinicians.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dor no Peito/epidemiologia , Criança , Pré-Escolar , Tosse/epidemiologia , Dispneia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Sumários de Alta do Paciente Hospitalar , Estudos Retrospectivos , Adulto Jovem
6.
Int J Clin Pharm ; 41(3): 820-824, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31028594

RESUMO

Background The poor quality of discharge summaries following admission to hospital, especially in relation to information on medication changes, is well documented. Hospital pharmacists can record changes to medications in the electronic discharge note to improve the quality of this information for primary care. Objective To audit the pharmacist-completed notes describing changes to admission medication, and to identify improvement opportunities. Setting 750-bed teaching district general hospital in England. Methods An evaluation of pharmacist written notes was conducted at a 750-bed teaching district general hospital in England. A sample of notes was analysed in three consecutive years, 2016-2018. Analyses were performed using descriptive statistics. Main outcome measure The number of discrepancies in the note compared to the discharge summary medication list. Results Notes were analysed for 125, 120 and 120 patients in 2016-2018 respectively. We saw an overall improvement in the accuracy of our notes from 12% of patients having an inaccurate note in 2016 to 4.2% in 2017 and 5.8% in 2018. The percentage of discharge medicines affected by these discrepancies reduced from 1.7% (2016) to 0.6% (2017) and 0.9% (2018). Conclusion Discrepancies were due to changes in the patient's medicines journey not being fully captured and documented. The overall reduction of discrepancies over the three consecutive audits was felt to be largely due to formalisation of the discharge medicines reconciliation process and reminding staff on how to complete a note. We are planning to utilise informatics surveillance tools along with system developments to sustain this elimination of out of date notes being transmitted to primary care.


Assuntos
Registros Eletrônicos de Saúde/normas , Reconciliação de Medicamentos/normas , Sumários de Alta do Paciente Hospitalar/normas , Farmacêuticos/normas , Atenção Primária à Saúde/normas , Cuidado Transicional/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Alta do Paciente/normas , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Atenção Primária à Saúde/métodos , Estudos Retrospectivos , Adulto Jovem
7.
Rev. enferm. UFPE on line ; 13(4): 1142-1150, abr. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1021269

RESUMO

Objetivo: avaliar a participação do enfermeiro no planejamento de alta hospitalar. Método: trata-se de estudo quantitativo, descritivo e exploratório com 21 enfermeiros em um hospital oncológico. Fez-se a avaliação por meio de dois formulários, na análise dos dados, as estatísticas descritivas. Resultados: identificou-se que todos os enfermeiros (21=100%) concordaram que, se o paciente não for incluído no planejamento de alta, poderá desenvolver complicações em seu tratamento. Verificou-se uma proporção de cinco (23,8%) sujeitos que concordaram e dois (9,5%) assinalaram indiferente e que possuem dificuldades na participação no planejamento de alta. Observou-se, entre as justificativas dessa não participação, que predominaram a falha de comunicação entre as equipes multidisciplinares e o inadequado dimensionamento de enfermeiros pela demanda de pacientes a serem orientados. Conclusão: evidenciou-se, nos resultados obtidos, a ciência dos participantes sobre a importância na participação no planejamento de alta hospitalar, na redução dos riscos de reinternações e nas dificuldades encontradas pelos profissionais em sua execução, o que pode impactar a qualidade da assistência prestada pelo enfermeiro nesse processo.(AU)


Objective: to evaluate nurses' participation in hospital discharge planning. Method: it is a quantitative, descriptive and exploratory study with 21 nurses in a cancer hospital. Two forms were used in the analysis of the data, descriptive statistics. Results: It was identified that all nurses (21 = 100%) agreed that if the patient is not included in discharge planning, he or she may develop complications in their treatment. There was a proportion of five (23.8%) subjects who agreed and two (9.5%) indicated that they were indifferent and had difficulty participating in planning discharge. It was observed, among the justifications for this nonparticipation, that the lack of communication between the multidisciplinary teams and the inadequate dimensioning of nurses by the demand of patients to be oriented predominated. Conclusion: the results obtained showed the participants' knowledge about the importance of participating in hospital discharge planning, reducing the risks of rehospitalization and the difficulties encountered by the professionals in their execution, which may impact the quality of care provided by the nurse in this process.(AU)


Objetivo: evaluar la participación del enfermero en la planificación de alta hospitalaria. Método: se trata de un estudio cuantitativo, descriptivo y exploratorio con 21 enfermeros en un hospital oncológico. Se hizo la evaluación por medio de dos formularios, en el análisis de los datos, las estadísticas descriptivas. Resultados: se identificó que todos los enfermeros (21 = 100%) concordaron que, si el paciente no se incluye en la planificación de alta, podrá desarrollar complicaciones en su tratamiento. Se verificó una proporción de cinco (23,8%) sujetos que concordaron y dos (9,5%) señalaron indiferente y que tienen dificultades en la participación en la planificación de alta. Se observó, entre las justificaciones de esa no participación, que predominaron la falla de comunicación entre los equipos multidisciplinares y el inadecuado dimensionamiento de enfermeros por la demanda de pacientes a ser orientados. Conclusión: se evidenció, en los resultados obtenidos, la ciencia de los participantes sobre la importancia en la participación en la planificación de alta hospitalaria, en la reducción de los riesgos de reinternaciones y en las dificultades encontradas por los profesionales en su ejecución, lo que puede impactar la calidad de la asistencia prestada por el enfermero en este proceso.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Enfermagem Oncológica , Alta do Paciente , Sumários de Alta do Paciente Hospitalar , Planejamento em Saúde , Enfermeiras e Enfermeiros , Relações Profissional-Família , Qualidade da Assistência à Saúde , Institutos de Câncer , Epidemiologia Descritiva
8.
Ocotal, Nueva Segovia; s.n; mar. 2019. 53 p. ilus, tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1015428

RESUMO

OBJETIVO: Caracterizar epidemiológicamente la tuberculosis en pacientes ingresados en el Hospital Escuela Universitario, Tegucigalpa Honduras 2017. METODOLOGÍA: Estudio descriptivo de corte transversal desarrollado en el Hospital Escuela Universitario, con una muestra de 158 pacientes con tuberculosis. Se revisaron los expedientes clínicos y los indicadores reportados por el Hospital. RESULTADOS: El 51% procedían de Francisco Morazán, el 9% de Choluteca y 6% de Comayagua y El Paraíso y 24% de otros departamentos. El 61% eran hombres y 39% mujeres. 28% de los pacientes se encontraban en una edad de 65 años y más. Con una edad promedio de 48 años. el de menor edad de 2 años y el de mayor edad 92 años.; el 77% de los pacientes eran nuevos y siguientes, con una reactivación y recaída del 1%. El 56% de los pacientes se clasificaron con tuberculosis pulmonar y 41% tuberculosis extra. Al 46% de los pacientes se le realizó serología por VIH; El 40 % de los pacientes con tuberculosis presentaron comorbilidad, siendo la más frecuente el VIH 62%. Un 24% de pacientes fallecieron. En el año 2017 y 2018 se observó un aumento en la prevalencia de tuberculosis de 1.84y 2.07, en comparación con años anteriores. CONCLUSIONES: La mayoría de los pacientes eran hombres, con predominio de edad de mayores de 65 años y en su mayoría procedían del distrito central. Se observó que la mayoría eran pacientes nuevos, más de la mitad de los casos se clasificaron como tuberculosis pulmonar, con predominio de comorbilidad VIH. En el último año aumentó la prevalencia y letalidad por TB en el Hospital


Assuntos
Humanos , Tuberculose , Sumários de Alta do Paciente Hospitalar , Epidemiologia , Epidemiologia Descritiva , Estudos Transversais
9.
Pharm. pract. (Granada, Internet) ; 17(1): 0-0, ene.-mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184610

RESUMO

Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50-74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Coronariana Aguda/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Iraque/epidemiologia , Síndrome Coronariana Aguda/epidemiologia , Prevenção Secundária/métodos , Indicadores de Morbimortalidade , Estudos Retrospectivos , Continuidade da Assistência ao Paciente/estatística & dados numéricos
10.
Rev. clín. esp. (Ed. impr.) ; 219(1): 18-25, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185585

RESUMO

Antecedentes y objetivos: la información sobre el manejo de los pacientes diabéticos en el momento del alta hospitalaria es reducida. El objetivo del estudio fue evaluar el impacto de la implementación de las recomendaciones del Consenso español para el manejo del alta hospitalaria en pacientes con diabetes tipo 2 (DM2) o hiperglucemia durante la hospitalización. Métodos: estudio observacional con un grupo de recogida prospectiva y otra retrospectiva de pacientes con DM2/hiperglucemia (> 140mg/dl) durante la hospitalización de 19 hospitales españoles. Se recopilaron indicadores de calidad en el informe de alta, terapia hipoglucémica, HbA1c y eventos adversos al ingreso, en el momento del alta y a los 3 meses del alta. Resultados: se incluyó a 199 pacientes en el grupo prospectivo y 75 en el retrospectivo. Los indicadores de calidad del informe de alta hospitalaria fueron mayores en el grupo prospectivo (p<0,001). La proporción de pacientes con tratamiento de insulina, fármacos antidiabéticos orales (ADO) e insulina+ADO sufrió modificaciones en el momento del alta hospitalaria de los pacientes del grupo prospectivo con HbA1c<7,5% (p<0,005) y ≥ 7,5% (p<0,001), y en los pacientes del grupo retrospectivo con HbA1c ≥ 7,5% (p<0,001). En el mes 3 tras el alta, los niveles de HbA1c descendieron de 8,2± 1,9% a 7,3±1,2% (p<0,001) en el grupo prospectivo y desde 8,2±1,9% a 7,3±1,2% (p<0,001) en el retrospectivo. Los episodios de hipoglucemia e hiperglucemia así como los de reingreso fueron semejantes en ambos grupos. Conclusiones: la aplicación del documento español de consenso de las recomendaciones para el manejo del alta hospitalaria en pacientes con DM2 o hiperglucemia mejora de forma considerable el registro de indicadores de calidad en el informe de alta. La conciliación de la medicación antidiabética en el momento del alta hospitalaria mejora el control glucémico después del alta


Background and aims: information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization. Methods: observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge. Results: 199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups. Conclusions: implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge


Assuntos
Humanos , Hiperglicemia/prevenção & controle , Hospitalização/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Hipoglicemiantes/uso terapêutico , Hiperglicemia/epidemiologia , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Consenso , Reconciliação de Medicamentos/métodos , Índice Glicêmico , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos
11.
Int J Clin Pract ; 73(1): e13261, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30239072

RESUMO

AIMS: Prescribing drug treatment for the management of hyperemesis gravidarum (HG), the most severe form of nausea and vomiting in pregnancy, remains controversial. Since most manufacturers do not recommend prescribing antiemetics during pregnancy, little is known regarding which treatments are most prevalent among pregnant patients. Here, we report for the first time, evidence of actual treatments prescribed in English hospitals. METHODS: A retrospective pregnancy cohort was constructed using anonymised electronic records in the Nottingham University Hospitals Trust system for all women who delivered between January 2010 and February 2015. For women admitted to hospital for HG, medications prescribed on discharge were described and variation by maternal characteristics was assessed. Compliance with local and national HG treatment guidelines was evaluated. RESULTS: Of 33 567 pregnancies (among 30 439 women), the prevalence of HG was 1.7%. Among 530 HG admissions with records of discharge drugs, cyclizine was the most frequently prescribed (almost 73% of admissions). Prochlorperazine and metoclopramide were prescribed mainly in combination with other drugs; however, ondansetron was more common than metoclopramide at discharge from first and subsequent admissions. Steroids were only prescribed following readmissions. Thiamine was most frequently prescribed following readmission while high dose of folic acid was prescribed equally after first or subsequent admissions. Prescribing showed little variation by maternal age, ethnicity, weight, socioeconomic deprivation, or comorbidities. CONCLUSION: Evidence that management of HG in terms of discharge medications mainly followed local and national recommendations provides reassurance within the health professional community. Wider documentation of drugs prescribed to women with HG is required to enable full assessment of whether optimal drug management is being achieved.


Assuntos
Antieméticos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Hiperêmese Gravídica/tratamento farmacológico , Adulto , Quimioterapia Combinada , Inglaterra , Feminino , Ácido Fólico/uso terapêutico , Fidelidade a Diretrizes , Hospitalização , Humanos , Sumários de Alta do Paciente Hospitalar , Guias de Prática Clínica como Assunto , Gravidez , Estudos Retrospectivos , Esteroides/uso terapêutico , Tiamina/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Adulto Jovem
12.
Int J Stroke ; 14(2): 159-166, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29553306

RESUMO

BACKGROUND: Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. AIMS: To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. METHODS: Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010-2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. RESULTS: Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53-4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708-$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81-0.89) for those with atrial fibrillation compared to those without. CONCLUSIONS: The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.


Assuntos
Fibrilação Atrial/economia , Custos e Análise de Custo , Isquemia/economia , Tempo de Internação/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Adulto , Fibrilação Atrial/epidemiologia , Bases de Dados Factuais , Humanos , Pacientes Internados , Isquemia/epidemiologia , Modelos Econômicos , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
13.
J Eval Clin Pract ; 25(1): 36-43, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30105889

RESUMO

RATIONALE: One of the key functions of the discharge summary is to convey accurate diagnostic description of patients. Inaccurate or missing diagnoses may result in a false clinical picture, inappropriate management, poor quality of care, and a higher risk of re-admission. While several studies have investigated the presence or absence of diagnoses within discharge summaries, there are very few published studies assessing the accuracy of these diagnoses. The aim of this study was to measure the accuracy of diagnoses recorded in sample summaries, and to determine if it was correlated with the type of diagnoses (eg, "respiratory" diagnoses), the number of diagnoses, or the length of patient stay. METHODS: A prospective cohort study was conducted in three respiratory wards in a large UK NHS Teaching Hospital. We determined the reference list of diagnoses (the closest to the true state of the patient based on consultant knowledge, patient records, and laboratory investigations) for comparison with the diagnoses recorded in a discharge summary. To enable objective comparison, all patient diagnoses were encoded using a standardized terminology (ICD-10). Inaccuracy of the primary diagnosis alone and all diagnoses in discharge summaries was measured and then correlated with type of diseases, number of diagnoses, and length of patient stay. RESULTS: A total of 107 of 110 consecutive discharge summaries were analysed. The mean inaccuracy rate per discharge summary was 55% [95% CI 52 to 58%]. Primary diagnoses were wrong, inaccurate, missing, or mis-recorded as a secondary diagnosis in half the summaries. The inaccuracy rate was correlated with the type of disease but not with number of diagnoses nor length of patient stay. CONCLUSION: Our study showed that diagnoses were not accurately recorded in discharge summaries, highlighting the need to measure and improve discharge summary quality.


Assuntos
Diagnóstico , Sumários de Alta do Paciente Hospitalar/normas , Alta do Paciente/estatística & dados numéricos , Unidades de Cuidados Respiratórios , Idoso , Estudos de Coortes , Confiabilidade dos Dados , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Registros Médicos Orientados a Problemas/normas , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Estudos Prospectivos , Qualidade da Assistência à Saúde , Unidades de Cuidados Respiratórios/métodos , Unidades de Cuidados Respiratórios/normas , Reino Unido
14.
Nutr Clin Pract ; 34(2): 313-318, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29701888

RESUMO

BACKGROUND: As described in detail in the literature, patients identified with malnutrition are at increased risk for poor clinical outcomes. Despite this knowledge, malnourished patients do not always receive optimal nutrition management while admitted into a hospital because of what we describe as gaps in care throughout their admission. We hypothesized that the 3 main gaps in care were poor dietitian-doctor communication, excessive time spent nil per os (NPO) for procedures and testing, and/or inaccurate or incomplete dietary discharge instructions. The objectives of this study were to determine and to characterize gaps in nutrition care after a malnutrition diagnosis. METHODS: This retrospective study involved postdischarge chart reviews of malnourished adult medicine patients admitted to an acute care facility from September 1, 2014, to November 30, 2014 (n = 242). RESULTS: Of the malnourished patients, 76% had at least 1 gap in care. The most prevalent gap (68%) involved discharge diet instructions, most often because of the omission of the dietitian recommendation for oral supplementation. Thirty-five percent of malnourished patients had a gap in care because of procedures or testing extending the period held NPO, and 13% had a gap in care because of poor communication, thus delaying orders and/or interventions. CONCLUSIONS: This is the first study to evaluate gaps in care of patients diagnosed with malnutrition. Identification of these gaps allows us the opportunity to develop strategies for this vulnerable population to improve areas such as discharge documentation and time spent NPO to provide the best and safest nutrition care.


Assuntos
Continuidade da Assistência ao Paciente , Desnutrição , Terapia Nutricional , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/terapia , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Alta do Paciente , Sumários de Alta do Paciente Hospitalar , Quartos de Pacientes , Estudos Retrospectivos , Resultado do Tratamento
15.
Rev. esp. med. prev. salud pública ; 24(1): 18-26, 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184240

RESUMO

La Enfermedad Neumocócica Invasora (ENI) es de declaración obligatoria (EDO) en la Comunidad Au-tónoma de Madrid desde febrero del año 2007. El servicio de Medicina Preventiva detectó una infranotificación de los casos de ENI en el Hospital Universitario Severo Ochoa de Leganés (HUSO) entre los años 2007 y 2012. Por ello se estableció como objetivo evaluar el conocimiento de esta enfermedad por parte de los facultativos responsables de la atención al paciente en el periodo de estudio


Invasive Pneumococcal Disease (IPD) has been notifiable in the Autonomous Community of Madrid since February 2007. The Preventive Medicine Service identified under-reporting of the cases of IPD in Hospital Universitario Severo Ochoa in Leganés (Madrid) between 2007 and 2012. Therefore, assesing the reporting of cases to the Preventive Medicine Service by the doctors responsible for providing medical care was set as an objective


Assuntos
Humanos , Infecções Pneumocócicas , Notificação de Doenças , Sumários de Alta do Paciente Hospitalar/normas , Competência Clínica , Estudos de Avaliação como Assunto , Espanha
17.
BMC Fam Pract ; 19(1): 168, 2018 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-30309316

RESUMO

BACKGROUND: Follow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication. Little is known about General Practitioners (GPs') views on medication changes during the transition from hospital to primary care. We conducted a qualitative interview study to understand GPs' views on the medication changes made for their patients by hospital physicians in a geriatric ward and the GPs' actions after discharge. METHODS: Qualitative semi-structured interviews comprising ten GPs from general practices in the Region of Southern Denmark, using a phenomenological approach. The GPs were selected strategically based on the principle of maximum variation. The analysis process was a cross-sectional analysis based on a phenomenological analysis. RESULTS: The GPs identified many reasons for the lack of medication continuation, including miscommunication between hospital doctors and GPs and delayed discharge letters. Several factors were involved, including patients not taking responsibility for their medication, no structure for follow-up visits to their GPs and for the renewal of their prescriptions. CONCLUSION: The main reason for the poor continuity of medication changes for geriatric patients at sector transition was neither the GPs' deliberate actions of removing the patients' medications, nor the patients' lack of compliance or of willingness to take the medication. It is largely due to procedural errors in the follow-up on the patient after discharge, due to the lack of a structured process and due to miscommunication between the primary sector and the hospital.


Assuntos
Assistência ao Convalescente , Atitude do Pessoal de Saúde , Tratamento Farmacológico , Clínicos Gerais , Cuidado Transicional , Assistência Ambulatorial , Comunicação , Estudos Transversais , Dinamarca , Geriatria , Médicos Hospitalares , Hospitalização , Humanos , Alta do Paciente , Sumários de Alta do Paciente Hospitalar , Pesquisa Qualitativa
18.
Enferm. glob ; 17(52): 487-499, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173992

RESUMO

Estratificar a los pacientes en relación con la complejidad y fragilidad durante la hospitalización, nos permite planificar de manera más eficiente los cuidados y el ámbito de atención que precisa al alta. El objetivo de este trabajo es evaluar la efectividad de la traducción al español de índice de BRASS en la planificación del alta hospitalaria por enfermeras gestoras de casos de atención hospitalaria. Método: Se analizaron variables relacionadas con la estancia hospitalaria, destino al alta, utilización de recursos sanitarios y mortalidad en 370 pacientes. Resultados: La edad media fue 72.6 años (DE 14.05), 191 (51.6%) eran mujeres. Cuando analizamos la relación entre mortalidad e índice de BRASS-Sp en relación al sexo y número de días de ingreso encontramos una HR=1.73 (95% CI de 1.22 a 2.46) con una p=0.002 para sexo masculino y una HR=2.08 (95% CI 1.43 a 3.04) con una p<0.001 para puntuación del índice de BRASS_Sp. Los pacientes que continuaron en gestión de casos en Atención Primaria obtuvieron una media del BRASS-Sp de 20.97 (DE 6.11) mientras que en los demás fue de 19.35 (DE 5.60), p=0.02. Conclusiones: La traducción al español del índice de BRASS se muestra como un instrumento fácil de usar y con validez de contenido y efectividad para cribado de pacientes hospitalizados por enfermeras gestoras de casos


Classifying patients according to complexity and frailty during hospitalization allows efficient planning of the scope of care required by the patient at discharge. The aim of this study was to measure the screening validity of the Blaylock Risk Assessment Screening Score and its effectiveness in discharge planning. Methods: We analyzed the variables hospital stay, destination at discharge, use of healthcare resources and mortality in 370 patients. Results: Analysis of the relationship between mortality and the BRASS-Sp index with regard to gender and number of days of stay yielded a hazard ratio of 1.73 (95% CI 1.22-2.46; p=0.002) for male gender and 2.08 (95% CI 1.43-3.04; p<0.001) for the BRASS-Sp score. Patients who continued in case management in Primary Care had a mean BRASS-Sp of 20.97 (standard deviation 6.11), while in the other patients the mean was 19.35 (standard deviation 5.60), p=0.02. Conclusions: The BRASS-Sp proved easy-to-use with verified content validity that is effective for screening hospitalized patients by case management nurses


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sumários de Alta do Paciente Hospitalar/normas , Hospitalização/estatística & dados numéricos , Continuidade da Assistência ao Paciente/normas , Planejamento de Assistência ao Paciente/normas , Alta do Paciente/estatística & dados numéricos , Cuidados de Enfermagem/métodos , Administração de Caso/normas , Programas de Rastreamento/métodos
19.
Acta Oncol ; 57(12): 1663-1670, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30169991

RESUMO

BACKGROUND: Accurate information about treatment is needed to evaluate cervical cancer prevention efforts. We studied completeness and validity of reporting cervical treatments in the Cancer Registry of Norway (CRN). MATERIAL AND METHODS: We identified 47,423 (92%) high-grade cervical dysplasia patients with and 3983 (8%) without recorded treatment in the CRN in 1998-2013. We linked the latter group to the nationwide registry of hospital discharges in 1998-2015. Of patients still without treatment records, we randomly selected 375 for review of their medical history. Factors predicting incomplete treatment records were assessed by multiple imputation and logistic regression. RESULTS: Registry linkage revealed that 10% (401/3983) of patients received treatment, usually conization, within one year of their initial high-grade dysplasia diagnosis. Of those, 11% (n = 44) were missing due to unreporting and 89% (n = 357) due to misclassification at the CRN. Of all cases in medical review, patients under active surveillance contributed almost 60% (223/375). Other reasons of being without recorded treatment were uncertain dysplasia diagnosis, invasive cancer or death. Coding error occurred in 19% (73/375) of randomly selected cases. CRN undercounted receipt of treatment by 38% (n = 1526) among patients without recorded treatment which translates into 97% overall completeness of treatment data. Incomplete treatment records were particularly associated with public laboratories, patients aged 40-54 years, and the latest study years. CONCLUSIONS: CRN holds accurate information on cervical treatments. Completeness and particularly validity can be further improved through the establishment of new internal routines and regular linkage to hospital discharges.


Assuntos
Confiabilidade dos Dados , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Colo do Útero/patologia , Colo do Útero/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Hospitais/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Noruega/epidemiologia , Alta do Paciente/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/normas , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Sistema de Registros/normas , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/epidemiologia
20.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174804

RESUMO

Background: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance. Objectives: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge. Methods: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted. Results: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received'long-term' benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents. Conclusions: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Transtornos Mentais/tratamento farmacológico , Hipnóticos e Sedativos/administração & dosagem , Benzodiazepinas/administração & dosagem , Assistência Farmacêutica/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Estudos Retrospectivos , Ansiolíticos/uso terapêutico , Sumários de Alta do Paciente Hospitalar
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