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1.
Surg Clin North Am ; 101(1): 57-69, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212080

RESUMO

Interhospital transfers play a key role in ensuring that patients receive necessary care. However, patients who are transferred between hospitals are a vulnerable population, and outcomes of transferred patients are suboptimal. Despite the critical nature of interhospital transfers, only limited effort has been dedicated to standardization and improvement of the transfer process. Studying and adapting quality improvement efforts directed at other transitions of care, particularly those that cross between different facilities and care teams "such as the transition from hospital to home or extended care facilities" may improve the care of surgical patients transferred between acute care institutions.


Assuntos
Segurança do Paciente/normas , Transferência de Pacientes/normas , Melhoria de Qualidade , Humanos , Transferência de Pacientes/organização & administração
2.
Healthc (Amst) ; 9(1): 100512, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33383393

RESUMO

Little is known about the follow-up healthcare needs of patients hospitalized with coronavirus disease 2019 (COVID-19) after hospital discharge. Due to the unique circumstances of providing transitional care in a pandemic, post-discharge providers must adapt to specific needs and limitations identified for the care of COVID-19 patients. In this study, we conducted a retrospective chart review of all hospitalized COVID-19 patients discharged from an Emory Healthcare Hospital in Atlanta, GA from March 26 to April 21, 2020 to characterize their post-discharge care plans. A total of 310 patients were included in the study (median age 58, range: 23-99; 51.0% female; 69.0% African American). The most common presenting comorbidities were hypertension (200, 64.5%), obesity (BMI≥30) (138, 44.5%), and diabetes mellitus (112, 36.1%). The median length of hospitalization was 5 days (range: 0-33). Sixty-seven patients (21.6%) were admitted to the intensive care unit and 42 patients (13.5%) received invasive mechanical ventilation. The most common complications recorded at discharge were electrolyte abnormalities (124, 40.0%), acute kidney injury (86, 27.7%) and sepsis (55, 17.7%). The majority of patients were discharged directly home (281, 90.6%). Seventy-five patients (24.2%) required any home service including home health and home oxygen therapy. The most common follow-up need was an appointment with a primary care provider (258, 83.2%). Twenty-four patients (7.7%) had one or more visit to an ED after discharge and 16 patients (5.2%) were readmitted. To our knowledge, this is the first large study to report on post-discharge medical care for COVID-19 patients.


Assuntos
/terapia , Hospitalização/tendências , Alta do Paciente/normas , Transferência de Pacientes/normas , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos
3.
Med. intensiva (Madr., Ed. impr.) ; 44(6): 371-388, ago.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-187189

RESUMO

El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia


On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Pneumonia Viral , Pessoal de Saúde/normas , Transferência de Pacientes/normas , Cuidados Críticos/normas , Espanha/epidemiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Segurança do Paciente , Pandemias , Cuidados Críticos/organização & administração
5.
Am Surg ; 86(5): 400-406, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684018

RESUMO

INTRODUCTION: This study sought to compare the outcomes of trauma patients taken directly from the field to a level I trauma center (direct) versus patients that were first brought to a level III trauma center prior to being transferred to a level I (transfer) within our inclusive Delaware trauma system. METHODS: A retrospective review of the level I center's trauma registry was performed using data from 2013 to 2017 for patients brought to a single level I trauma center from two surrounding counties. The direct cohort consisted of 362 patients, while the transfer cohort contained 204 patients. Linear regression analysis was performed to investigate hospital length of stay (LOS), while logistic regression was used for mortality, complications, and craniotomy. Covariates included age, gender, county, and injury severity score (ISS). Propensity score weighting was also performed between the direct and transfer cohorts. RESULTS: When adjusting for age, gender, ISS, and county, transferred patients demonstrated worse outcomes compared to direct patients in both the regression and propensity score analyses. Transferred patients were at increased risk of mortality (OR 2.17, CI 1.10-4.37, P = .027) and craniotomy (OR 3.92, CI 1.87-8.72, P < .001). Age was predictive of mortality (P < .001). ISS was predictive of increased risk of mortality (P < .001), increased LOS (P < .001), and craniotomy (P < .001). Older age, Sussex County, and higher ISS were predictive of patients being transferred (P < .001). DISCUSSION: Delays in presentation to our level I trauma center resulted in worse outcomes. Patients that meet criteria should be considered for transport directly to the highest level trauma center in the system to avoid delays in care.


Assuntos
Seleção de Pacientes , Transferência de Pacientes/normas , Centros de Traumatologia , Triagem/normas , Ferimentos e Lesões/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento , Centros de Traumatologia/classificação , Resultado do Tratamento
6.
Am Surg ; 86(5): 467-475, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684019

RESUMO

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.


Assuntos
Transferência de Pacientes/normas , Centros de Traumatologia , Triagem/normas , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Traumatologia/classificação
7.
J Aging Soc Policy ; 32(4-5): 334-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32496899

RESUMO

This perspective addresses the challenges that assisted living (AL) providers face concerning federal guidelines to prevent increased spread of COVID-19. These challenges include restriction of family visitation, use of third-party providers as essential workers, staffing guidelines, transfer policies, and rural AL hospitalizations. To meet these challenges we recommend that AL providers incorporate digital technology to maintain family-resident communication. We also recommend that states adopt protocols that limit the number of AL communities visited by home health care workers in a 14-day period, appeal to the federal government for hazard pay for direct care workers, and to extend the personal care attendant program to AL. It is further recommended that states work with AL communities to implement COVID-19 comprehensive emergency management plans that are well-coordinated with local emergency operation centers to assist with transfers to COVID-19 specific locations and to assist in rural areas with hospital transfers. Together, these recommendations to AL providers and state and federal agencies address the unique structure and needs of AL and would enable AL communities to be better prepared to care for and reduce those infected with COVID-19.


Assuntos
Moradias Assistidas/organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Moradias Assistidas/normas , Betacoronavirus , Comunicação , Planejamento em Desastres/organização & administração , Família , Fidelidade a Diretrizes , Humanos , Pandemias , Transferência de Pacientes/normas , População Rural , Estados Unidos/epidemiologia
8.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32434760

RESUMO

BACKGROUND: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. METHODS: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. RESULTS: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. CONCULSIONS: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.


Assuntos
Serviço Hospitalar de Emergência/normas , Internato e Residência/normas , Admissão do Paciente/normas , Transferência de Pacientes/normas , Medicina de Emergência Pediátrica/normas , Melhoria de Qualidade/normas , Baltimore/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitais Urbanos/normas , Hospitais Urbanos/tendências , Humanos , Internato e Residência/tendências , Masculino , Admissão do Paciente/tendências , Transferência de Pacientes/tendências , Medicina de Emergência Pediátrica/tendências , Melhoria de Qualidade/tendências , Fluxo de Trabalho
10.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32299822

RESUMO

BACKGROUND AND OBJECTIVES: High-quality cardiopulmonary resuscitation (CPR) increases the likelihood of survival of pediatric out-of-hospital cardiac arrest (OHCA). Maintenance of high-quality CPR during transition of care between prehospital and pediatric emergency department (PED) providers is challenging. Our objective for this initiative was to minimize pauses in compressions, in alignment with American Heart Association recommendations, for patients with OHCA during the handoffs from prehospital to PED providers. We aimed to decrease interruptions in compressions during the first 2 minutes of PED care from 17 seconds (baseline data) to 10 seconds over 12 months. Our secondary aims were to decrease the length of the longest pause in compressions to <10 seconds and eliminate encounters in which time to defibrillator pad placement was >120 seconds. METHODS: Our multidisciplinary team outlined our theory for improvement and designed interventions aimed at key drivers. Interventions included specific roles and responsibilities, CPR handoff choreography, and empowerment of frontline providers. Data were abstracted from video recordings of patients with OHCA receiving manual CPR on arrival. RESULTS: We analyzed 33 encounters between March 2018 and July 2019. We decreased total interruptions from 17 to 12 seconds during the first 2 minutes and decreased the time of the longest single pause from 14 to 7 seconds. We saw a decrease in variability of time to defibrillator pad placement. CONCLUSIONS: Implementation of a quality improvement initiative involving CPR transition choreography resulted in decreased interruptions in compressions and decreased variability of time to defibrillator pad placement.


Assuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Parada Cardíaca Extra-Hospitalar/terapia , Transferência de Pacientes/normas , Melhoria de Qualidade/normas , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/diagnóstico , Transferência de Pacientes/métodos
11.
Plast Reconstr Surg ; 145(5): 975e-983e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332548

RESUMO

BACKGROUND: Patients with craniomaxillofacial injuries are frequently transferred for specialist evaluation. Although transfer guidelines have improved outcomes for trauma care, no standards exist for craniomaxillofacial injuries. As a result, many patients are unnecessarily transferred emergently between facilities, resulting in high costs to patients and the health care system. This study assesses the regional frequency and necessity of transfers for isolated craniomaxillofacial injury. METHODS: A retrospective review was conducted of all transfers with a diagnosis of "facial trauma" from 2013 to 2018. Using a previously validated framework, emergency interfacility transfers were deemed either necessary or unnecessary. RESULTS: A total of 368 transfers were identified with isolated craniomaxillofacial injuries. Only 27 percent of transfers required admission. Half of transfers were unnecessary, none of which required intervention by the facial trauma service. Of 49.5 percent of necessary transfers, 38 percent required admission for surgery or management of symptoms related to facial injury, 62 percent were discharged from the emergency department, and three patients required emergency surgery. CONCLUSIONS: Isolated craniomaxillofacial trauma rarely requires emergency surgery; however, transferred patients occasionally require urgent and elective procedures. Unnecessary transfers result in substantial expense to the patient and the health care system, and patients ultimately experience a delay in definitive care. Unnecessary patient evaluation diverts emergency staff and resources, increasing wait times and morbidity for other patients. This study demonstrates an opportunity for transfer guidelines to improve interfacility triage of patients with facial injury. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Traumatismos Faciais/diagnóstico , Sobremedicalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Triagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Traumatismos Faciais/cirurgia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Sobremedicalização/prevenção & controle , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Centros de Traumatologia/normas , Triagem/normas
12.
Intensive Crit Care Nurs ; 59: 102853, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32223920

RESUMO

OBJECTIVES: Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. RESEARCH DESIGN: An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. SETTING: Two intensive care units in a university hospital setting. MAIN OUTCOME: An understanding of patients' experiences of the intrahospital transport process. FINDINGS: The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. CONCLUSIONS: Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events.


Assuntos
Segurança do Paciente/normas , Transferência de Pacientes/normas , Pacientes/estatística & dados numéricos , Adulto , Idoso , Antropologia Cultural/métodos , Cuidados Críticos/métodos , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Feminino , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Pesquisa Qualitativa
13.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32217533

RESUMO

Patients admitted to the hospital and requiring a subsequent transfer to a higher level of care have increased morbidity, mortality and length of stay compared with patients who do not require a transfer during their hospital stay. We identified that a high number of patients admitted to our intermediate care (IMC) unit required a rapid response team (RRT) call and an early (<24 hours) transfer to the intensive care unit (ICU). A quality improvement project was initiated with the goal to reduce subsequent early transfers to the ICU and RRT calls. We started by focusing on IMC patients, implementing acuity-based nursing assignments and standardised daily nursing rounds in the IMC aiming to reduce early patient transfers to the ICU. Then, we expanded to all patients admitted to a hospital medical unit from the emergency department (ED), targeting patients with gastrointestinal (GI) bleed and sepsis who were at a higher risk for early transfer to the ICU. We then created an ED intake huddle process that over time was refined to target patients with SIRS criteria with an elevated serum lactic acid level greater than 2.0 mmol/L or a GI bleed with a haematocrit value less than 24%. These interventions resulted in an 10.8 percentage points (31.7% (225/710) to 20.9% (369/1764)) decrease in the early transfers to the ICU for all hospital medicine patients admitted to the hospital from the ED. Mean RRT calls/day decreased by 17%, from 3.0 mean calls/day preintervention to 2.5 mean calls/day postintervention. These quality improvement initiatives have sustained successful outcomes for over 6 years due to integrating enhanced team communication as organisational cultural norm that has become the standard.


Assuntos
Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Relações Interprofissionais , Transferência da Responsabilidade pelo Paciente/normas , Transferência de Pacientes/normas , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos
15.
Rev. esp. anestesiol. reanim ; 67(3): 119-129, mar. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197699

RESUMO

OBJETIVO: El objetivo principal se centra en determinar si la implantación de un protocolo de traslado intrahospitalario (TIH) modifica la tasa anual de incidentes relacionados con la seguridad del paciente. Los objetivos secundarios son, en primer lugar, clasificar los eventos identificados, en segundo lugar, analizar los factores que se asocian a la presencia de dichos eventos adversos y, por último, analizar el grado de seguimiento del protocolo. MATERIAL Y MÉTODOS: Análisis descriptivo retrospectivo que incluyó a pacientes ingresados en la Unidad de Cuidados Intensivos que requirieron TIH entre 2009 y 2018. Se desarrolló un protocolo multidisciplinar y se clasificaron las incidencias según la gravedad y el tipo de eventos. RESULTADOS: Se incluyeron 1.662 traslados. El número total de traslados con incidentes ha sido 153 (9,2%), en los que se han registrado 189 incidentes, de los cuales 17 (9%) fueron descritos como eventos adversos, mientras que 172 (91%) se clasificaron como incidentes sin daño (IsD). Las incidencias clínicas fueron las más frecuentes (70,37%). En el análisis multivariante encontramos como factores asociados las arritmias cardíacas (OR: 2,88 [IQR 2,01-4,12]), antecedentes de accidente cerebrovascular (OR 1,72 [IQR 1,06-2,78]) y anemia (OR 1,55 [IQR 1,02-2,37]). La tasa de incidentes relacionados con la seguridad fue menor a lo largo del tiempo a medida que aumentaba la adhesión a la cumplimentación del protocolo. CONCLUSIONES: La implementación de un protocolo de transporte del paciente crítico y su aplicación mediante listas de verificación permite reducir tanto la incidencia de eventos adversos en estos pacientes como de IsD


OBJECTIVE: The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. MATERIAL AND METHODS: Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. RESULTS: We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]). The rate of safety-related incidents was less over time as adherence to protocol compliance increased. CONCLUSIONS: The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/normas , Segurança do Paciente/normas , Transferência de Pacientes/normas , Gestão de Riscos/métodos , Medidas de Segurança , Estudos Retrospectivos
16.
Lima; IETSI; mar. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1095418

RESUMO

OBJETIVOS: Brindar lineamientos sobre el procedimiento a seguir y las condiciones de bioseguridad necesarias para realizar el traslado de pacientes sospechosos o confirmados con enfermedad por Coronavirus (COVID-19). MÉTODOS: Búsqueday selección de protocolos, guias de práctica clínica y documentos técnicos prévios. El 18 de marzo de 2020 se buscaron protocolos de manejo, guías de práctica clínica, y documentos técnicos que aborden los procedimientos a seguir para el traslado de pacientes con sospecha o confirmación de infección por la nueva variante de coronavirus (COVID-19), cuya versión a texto completo se encuentre en español o inglés. Luego de eliminar los duplicados, se identificaron 14 documentos que abordaron el traslado de pacientes con sospecha o confirmación de enfermedad por Coronavirus (COVID-19). Posterior a ello, se procedió a evaluar y seleccionar los documentos que cumplan los siguientes criterios en su totalidad. Formulación de los recomendaciones clínicas.Para la formulación de los recomendaciones clínicas se revisaron los lineamientos propuestos por los protocolo encontrados que describieron ampliamente los procedimientos a realizar para el traslado de pacientes con sospecha o confirmación de enfermedad por Coronavirus (COVID-19), los cuales fueron contrastados con el Documento Técnico de Atención y Manejo Clínico de Casos de COVID-19 del Ministerio de Salud de Perú (aprobado mediante Resolución Ministerial 084-2020)(4), y fueron adaptados para el contexto de EsSalud. Producto del ello se identificaron cuatro momentos principales del proceso de traslado y se emitieron recomendaciones en base a la concordancia entre los lineamientos de los documentos encontrados y se formuló un flujograma. DESARROLLO DE LAS RECOMENDACIONES CLÍNICAS: Recomendaciones previasal traslado del paciente. El presente documento iniciará luego de recibir la solicitud de traslado de un paciente con sospecha o confirmación de enfermedad por Coronavirus (COVID-19) desde un domicilio auna IPRESS o entre IPRESS. Consideraciones para el personal de salud: El equipo que realizará el traslado del paciente debe ser el mínimo indispensable, el cual por lo general estará conformado por: conductor de la ambulancia, médico(a), y enfermero(a). En caso de ser necesario, se puede incluir la presencia de personal de salud adicional. El personal de salud deberá disponer del equipo de protección personal (EPP) necesario para atender y trasladar al paciente.


Assuntos
Humanos , Protocolos Clínicos/normas , Transferência de Pacientes/normas , Infecções por Coronavirus/prevenção & controle , Peru , Avaliação da Tecnologia Biomédica
17.
Crit Care Med ; 48(3): e227-e232, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31913986

RESUMO

OBJECTIVES: We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care. DESIGN: Cohort study using data from the Toronto Intensive Care Observational Registry. SETTING: Seven academic ICUs in Toronto, Ontario. PATIENTS: Critically ill mechanically ventilated adult patients. INTERVENTIONS: We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents). Two practices that are less guided by evidence (early discontinuation of antibiotics and extubation attempts) served as positive controls. We conducted the analysis using generalized estimating equations to account for clustering at the patient level. MEASUREMENTS AND MAIN RESULTS: The cohort consisted of 10,570 patients admitted between June 2014 and August 2018. Compliance varied for each practice (63.6%, 42.5%, and 21.1% for lung-protective ventilation, spontaneous breathing trials, and neuromuscular blockade, respectively). There was no effect of transitions of care on compliance with spontaneous breathing trials (odds ratio, 1.00; 95% CI, 0.95-1.07), lung-protective ventilation (odds ratio, 1.07, 95% CI, 0.90-1.26), or neuromuscular blockade use (odds ratio, 0.95; 95% CI, 0.75-1.20). However, early antibiotic discontinuation was more likely (odds ratio, 1.23; 95% CI, 1.06-1.42) and extubation attempts were less frequent (odds ratio, 0.77; 95% CI, 0.65-0.93) after a transition of care. CONCLUSIONS: We observed no significant impact of transitions of care between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood of extubation and higher odds of earlier discontinuation of antibiotics.


Assuntos
Estado Terminal/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Transferência de Pacientes/organização & administração , Guias de Prática Clínica como Assunto/normas , Centros Médicos Acadêmicos , Adulto , Idoso , Extubação/métodos , Extubação/normas , Antibacterianos/administração & dosagem , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Transferência de Pacientes/normas , Indicadores de Qualidade em Assistência à Saúde , Respiração Artificial/métodos , Respiração Artificial/normas , Desmame do Respirador/métodos , Desmame do Respirador/normas
19.
Neurology ; 94(8): e851-e860, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-31980580

RESUMO

OBJECTIVE: Current prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C. METHODS: In this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort). RESULTS: The M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts. CONCLUSIONS: The M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.


Assuntos
Serviços Médicos de Emergência/métodos , Transferência de Pacientes/normas , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Idoso , Feminino , Humanos , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Sensibilidade e Especificidade
20.
Intensive Crit Care Nurs ; 58: 102800, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31964557

RESUMO

OBJECTIVE: This study aimed to develop the Relocation Stress Syndrome Scale-Short Form as an assessment tool for relocation stress experienced by intensive care unit patients after transfer to general wards. METHODS: This study included 535 intensive care unit patients at two tertiary care hospitals in South Korea from May to December 2018. Data were collected through face-to-face interview, using a structured questionnaire. Study 1 was conducted to estimate the factorial structure, and reliability of the scale. Study 2 was conducted to confirm the factorial structure of the scale. MAIN OUTCOMES: Study 1 found that the new instrument had a good reliability (α = 0.92) and validity. In study 2, confirmatory factor analysis supported a three-factor structure and the scale continued to demonstrate good psychometric properties. The criterion validity showed that a low level of relocation stress syndrome was associated with higher satisfaction with the transfer process (r = -0.58, p < .001) and good general health status (r = -0.51, p < .001). CONCLUSION: The 10-item Relocation Stress Syndrome Scale was developed with appropriate validity and reliability. This scale can be used to assess relocation stress of patients in transition periods. This new scale requires cross-cultural validation.


Assuntos
Transferência de Pacientes/normas , Psicometria/normas , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Quartos de Pacientes/organização & administração , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , República da Coreia , Inquéritos e Questionários
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