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1.
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267899

RESUMO

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.


Assuntos
Tratamento de Emergência/métodos , Cirurgia Geral/organização & administração , Avaliação de Resultados (Cuidados de Saúde) , Transferência de Pacientes/organização & administração , Qualidade da Assistência à Saúde , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Relações Interinstitucionais , Tempo de Internação , Masculino , Maryland , Estudos Retrospectivos , Contrato de Transferência de Pacientes
2.
Med. infant ; 26(2): 130-139, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015635

RESUMO

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)


Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease


Assuntos
Humanos , Adolescente , Ambulatório Hospitalar/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Transferência de Pacientes/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/organização & administração , Cardiopatias Congênitas/terapia , Estudos Retrospectivos , Estudo Observacional
3.
Crit Care Nurs Clin North Am ; 31(2): 249-256, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047097

RESUMO

This article reports findings of a qualitative study describing how the US Department of Veterans Affairs cared for vulnerable veterans after Hurricane Sandy while medical center was closed for an extended period. This experience highlights how vulnerable patients continued to need care. Hospital preparedness planning efforts focus primarily on sheltering in place and evacuation. Research is needed to identify how hospitals provided temporary emergency services in alternative settings to inform practical guidance. Hospital planners should anticipate that their most vulnerable patients will continue to need emergency care. Viable solutions should be considered to meet immediate and long-term patient needs.


Assuntos
Tempestades Ciclônicas , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Abrigo de Emergência/organização & administração , Hospitais , Humanos , Transferência de Pacientes/organização & administração , Veteranos/psicologia , Populações Vulneráveis/psicologia
4.
J Stroke Cerebrovasc Dis ; 28(7): 1926-1929, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31010762

RESUMO

BACKGROUND: A major barrier to acute stroke trial enrollment is timely access to participating centers. Establishing referral relationships via telemedicine may broaden trial access. We sought to understand the utilization of telemedicine in trial enrollment at a large academic center. METHODS: This is a single center, retrospective review of subjects consecutively enrolled into cerebrovascular trials requiring urgent consent between January 2005 and December 2016. Subjects were classified to either direct presentation to hub hospital, or transfer from spoke hospitals. We used Pearson linear correlation and a simple linear regression model to describe the relationship between annual trial enrollment rate and the number of spoke sites capable of audio-video evaluation (AVR) as a proxy for the size of the telemedicine network. We correlated the annual increase in enrollment with that of each group using parametric and nonparametric analysis. RESULTS: Sixteen trials met our criteria, enrolling 299 subjects: 117 in the hub group and 182 in the spoke group. There was a direct relationship between the number of AVR-capable sites and annual trial enrollment rate (P = <.05). Annual increase in spoke enrollment was higher compared to hub enrollment (15.55 ± 11.30 versus 0.68 ± 1.03, P <.0005) and better correlated with total increase in enrollments (0.98 versus 0.94, P <.0001). CONCLUSIONS: Telemedicine networks are a major resource for trial enrollment. Expanding the use of remote enrollment could expedite the completion of acute cerebrovascular trials.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Ensaios Clínicos como Assunto/métodos , Consentimento Livre e Esclarecido , Seleção de Pacientes , Acidente Vascular Cerebral/terapia , Telemedicina/organização & administração , Comportamento Cooperativo , Humanos , Transferência de Pacientes/organização & administração , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Tempo para o Tratamento , Fluxo de Trabalho
5.
J Stroke Cerebrovasc Dis ; 28(6): 1759-1766, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879712

RESUMO

GOAL: Interhospital transfer (IHT) facilitates access to specialized neurocritical care but may also introduce unique risk. Our goal was to describe providers' perceptions of safety threats during IHT for patients with nontraumatic intracranial hemorrhage. MATERIALS AND METHODS: We employed qualitative, semi-structured interviews at an academic medical center receiving critically-ill neurologic transfers, and 5 referring hospitals. Interviewees included physicians, nurses, and allied health professionals with experience caring for patients transferred between hospitals for nontraumatic intracranial hemorrhage. Interviews continued until data saturation was reached. Coding occurred concurrently with interviews. Analysis was inductive, using the constant comparative method. FINDINGS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. Insufficient communication highlights the unique communication challenges specific to IHT, which overlay and compound known intrahospital communication barriers. Gaps in clinical practice revolve primarily around the provision of neurocritical care for this patient population, often subject to resource availability, by receiving hospital emergency medicine providers. Lack of structure outlines providers' questions that emerge when institutions fail to identify process channels, expectations, and accountability during complex neurocritical care transitions. CONCLUSIONS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. These themes serve as fundamental targets for quality improvement initiatives. To our knowledge, this is the first description of challenges to quality and safety in high-risk neurocritical care transitions through clinicians' voices.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Hemorragias Intracranianas/terapia , Segurança do Paciente , Transferência de Pacientes/organização & administração , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Hemorragias Intracranianas/diagnóstico , Equipe de Assistência ao Paciente/organização & administração , Lacunas da Prática Profissional , Prognóstico , Pesquisa Qualitativa , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
J Stroke Cerebrovasc Dis ; 28(5): 1219-1228, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30745000

RESUMO

BACKGROUND AND OBJECTIVES: Acute Ischemic stroke (AIS) is a time-sensitive emergency and patients frequently present to, and are transferred from emergency departments (EDs). We sought to evaluate potential factors, particularly organizational, that may influence the timeliness of interfacility transfer for ED patients with AIS. METHODS: We conducted semistructured interviews at 3 EDs that routinely transfer AIS patients. A structured interview guide was developed and piloted prior to use. Staff were asked about perceived facilitators and barriers to timely and high quality emergency care for patients with AIS who require transfer. Each interview was audio recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to build a list of themes and subthemes, and identify supporting quotes. RESULTS: We interviewed 45 ED staff (administrative staff, nurses, and physicians) involved in acute stroke care. We identified 4 major themes influencing the execution of interfacility transfers of AIS patients: (1) processes, (2) historical experiences; (3) communication; and (4) resources. Pre-existing protocols that standardized processes (eg, autoacceptance protocols) and reduced unnecessary communication, combined with direct communication with the neurology team at the comprehensive stroke center, and the flexibility and availability of human and physical resources (eg, staff and equipment) were commonly cited as facilitators. Lack of communication of clinical and operational outcomes back to transferring ED staff was viewed as a lost opportunity for process improvement, interorganization relationship building, and professional satisfaction. CONCLUSIONS: ED staff view the interfacility transfer of AIS patients as highly complex with multiple opportunities for delay. Coordination through the use of protocols and communication pre- and post-transfer represented opportunities to facilitate transfers. Staff and clinicians at transferring facilities identified multiple opportunities to enhance existing processes and ongoing communication quality among facilities involved in the acute management of patients with AIS.


Assuntos
Isquemia Encefálica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Transferência de Pacientes/organização & administração , Avaliação de Processos (Cuidados de Saúde)/organização & administração , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento/organização & administração , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Comportamento Cooperativo , Procedimentos Clínicos/organização & administração , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Equipe de Assistência ao Paciente/organização & administração , Pesquisa Qualitativa , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Tennessee , Fatores de Tempo , Resultado do Tratamento , Fluxo de Trabalho
8.
Home Healthc Now ; 37(1): 44-49, 2019 Jan/Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30608467

RESUMO

The ability to maintain functional status is an essential aspect of self-care for older adults. Instrumental activities of daily living (IADLs) decline within hours of hospitalization and are often overlooked, underassessed, and underreported. The aim of this integrative review was to examine and compare methods used to assess IADLs to determine the best measure for use across the care continuum, especially during transitions of care. A literature search without date restrictions was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases. Twelve studies of moderate quality were included in this review. More than half (58%) of the studies utilized the Lawton and Brody Scale to measure IADL among home-based and hospitalized patients. Implementation of this scale as standard practice and sharing the results with healthcare providers would encourage continuity of care with the goal of supporting older adults aging in place and preventing rehospitalization. In turn, this communication process may improve the transition from the inpatient to home setting, where, since 1999, the Outcome and Assessment Information Set has been mandated.


Assuntos
Atividades Cotidianas , Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Idoso , Serviços de Saúde para Idosos/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Humanos , Masculino
9.
J Cardiovasc Med (Hagerstown) ; 20(4): 253-260, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30676496

RESUMO

AIMS: The aim of this study was to assess the impact of a transition clinic model on adolescent congenital heart disease (CHD) patients' health perception outcomes. The transition clinic model consists of multidisciplinary standardized interventions to educate and support CHD patients and represents a key element in the adequate delivery of care to these individuals during their transition from childhood to adulthood. Currently, empirical data regarding the impact of transition clinic models on the improvement of health perceptions in CHD adolescent patients are lacking. METHODS: A quasi-experimental design was employed. Quality of life, satisfaction, health perceptions and knowledge were assessed at the time of enrolment (T0) and a year after enrolment (T1), respectively. During the follow-up period, the patients enrolled (aged 11-18 years) were involved in the CHD-specific transition clinic model (CHD-TC). RESULTS: A sample of 224 CHD adolescents was enrolled (60.7% boys; mean age: 14.84 ±â€Š1.78 years). According to Warnes' classification, 22% of patients had simple heart defect, 56% showed moderate complexity and 22% demonstrated severe complexity. The overall results suggested a good impact of the CHD-TC on adolescents' outcomes, detailing in T1 the occurrence of a reduction of pain (P < 0.001) and anxiety (P < 0.001) and an improvement of knowledge (P < 0.001), life satisfaction (P < 0.001), perception of health status (P < 0.001) and quality of life (P < 0.001). CONCLUSION: The CHD-TC seems to provide high-quality care to the patient by way of a multidisciplinary team. The results of the present study are encouraging and confirm the need to create multidisciplinary standardized interventions in order to educate and support the delivery of care for CHD adolescents and their families.


Assuntos
Comportamento do Adolescente , Serviços de Saúde do Adolescente/organização & administração , Comportamento Infantil , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias Congênitas/terapia , Transferência de Pacientes/organização & administração , Adaptação Psicológica , Adolescente , Fatores Etários , Criança , Feminino , Nível de Saúde , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/psicologia , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Participação do Paciente , Satisfação do Paciente , Percepção , Qualidade de Vida
10.
Prof Case Manag ; 24(1): 39-45, 2019 Jan/Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30489473

RESUMO

PURPOSE/OBJECTIVE: The Community-based Care Transitions Program (CCTP) defined a broad spectrum of interventions and services for elderly patients at high risk of hospital readmission. The purposes for a CCTP as developed by the Centers for Medicare & Medicaid Services are to improve transitions of beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high-risk beneficiaries, and to document measurable savings. The goals for this CCTP initiative were as follows: achievement of a 20% reduction in the 30-day all-cause readmission rate across all partner hospitals compared with baseline; reduction in the 30-day all-cause readmission rate among the high-risk cohort served; and achievement of the target volumes for full enrollment. PRIMARY PRACTICE SETTINGS: The partnership included acute care institutions and community-based care organizations that have been involved with care transition programs for years and have a long history of working collaboratively to provide services to a largely low-income, underserved, and ethnically and racially diverse target population. FINDINGS/CONCLUSIONS: The program successfully transitioned to full operation within the first year of inception. To date, the partnership of the acute hospital setting and the community-based organizations has reached and provided services to nearly 8,000 total individuals, surpassing our target enrollment goal. To date, the readmission rate has decreased to 12.5%, which is an 11% decline since inception of the program. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The collaboration of health care providers, social workers, nurse practitioners, physicians, community pharmacists, and the visiting nurses is integral to a successful transition from hospital to home. Home visits by the transition facilitators allowed for the coordination of a multitude of services in the community, including those previously available to patients in the past that have rarely been accessed. Including a pharmacist on the team provided teaching regarding medication adherence, medication management, and pharmacy services, which added to interventions to decrease future hospitalizations.


Assuntos
Redes Comunitárias/organização & administração , Colaboração Intersetorial , Transferência de Pacientes/organização & administração , Saúde da População , Qualidade da Assistência à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services (U.S.) , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Estados Unidos
11.
J Nurs Adm ; 48(12): 629-635, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30407929

RESUMO

To avoid penalty through the Hospital Readmission Reduction Program, an academic practice partnership, Health Transitions Alliance, was formed with the local university, resulting in adoption of an innovative transitional care model. Key to the model was a health coach who operationalized transition care to the home setting. Health coaches, interns in their last semester of college, used motivational interviewing to help patients set disease management goals. As a result of this model, the readmission rate for program participants in the initial 7 months was reduced by 72%.


Assuntos
Tutoria/métodos , Transferência de Pacientes/organização & administração , Relações Profissional-Paciente , Melhoria de Qualidade/organização & administração , Humanos , Readmissão do Paciente/estatística & dados numéricos , Cuidado Transicional
12.
Am Surg ; 84(9): 1395-1400, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30268164

RESUMO

Hurricane Irma resulted in the evacuation of 6.3 million people in Florida in September, 2017. Our tertiary Children's Hospital activated our incident command center (ICC) 24 hours before storm landfall, and preparations were made to accommodate vulnerable pediatric patients (VPP) or children with medical complexity. Our ICC was active for 92 hours and the hospital was staffed with 467 associates and 40 physicians. Urgent operative and interventional radiology procedures were performed during the storm. Thirteen patients were transferred to our facility and 13 VPP were sheltered. During the lockdown period, our facility operated at 90 per cent capacity inclusive of VPP. Personnel were used in critical areas in the hospital, independent of their base units. There were no adverse outcomes or complications. Timely activation of ICC and deployment of Team A 24 hours before storm hit allowed for safe hospital operations. Planning for the inflow of patients is imperative to allow for preemptive deployment of staff and resources for inpatients, transfers, emergency room admissions, and VPP. VPP should be monitored regionally as they will consume hospital resources during natural disasters and must be accounted for to allow for safe and effective care delivery for all patients.


Assuntos
Tempestades Ciclônicas , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Hospitais Pediátricos/organização & administração , Transferência de Pacientes/organização & administração , Centros de Atenção Terciária/organização & administração , Adolescente , Criança , Pré-Escolar , Florida , Humanos , Lactente , Recém-Nascido , Adulto Jovem
13.
Endocr Dev ; 33: 1-9, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29886491

RESUMO

Transition has been defined as "the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems." We will here describe the challenges of such a process: challenges coming from the pediatrician, from the adolescent, linked to the disease itself, and those from the parents. We will outline how to overcome those fears and challenges to provide a successful transition process. A key factor to underline that process is that a relationship based on confidence should be established between the pediatrician and the physician for adults, in order for that relationship, based on trust, to be the basis for the transfer of the adolescent from the pediatric system of care to the adult one.


Assuntos
Doença Crônica/terapia , Continuidade da Assistência ao Paciente , Transição para Assistência do Adulto , Adolescente , Adulto , Criança , Doença Crônica/epidemiologia , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Humanos , Transferência de Pacientes/classificação , Transferência de Pacientes/organização & administração , Transferência de Pacientes/normas , Pediatria/métodos , Pediatria/organização & administração , Pediatria/tendências , Transição para Assistência do Adulto/organização & administração , Transição para Assistência do Adulto/normas , Adulto Jovem
14.
Emergencias (Sant Vicenç dels Horts) ; 30(3): 156-162, jun. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-172954

RESUMO

Objetivo. Conocer la supervivencia y los factores asociados a la realización de reanimación cardiopulmonar (RCP) en curso entre los pacientes con parada cardiaca extrahospitalaria (PCR). Método. Análisis retrospectivo de un registro de casos de PCR entre 2008 y 2014. Se incluyeron los pacientes con PCR sin recuperación espontánea de pulso en el momento de la toma de decisión del traslado hospitalario y que fueron desestimados para donación en asistolia. Se realizó un análisis multivariante para determinar las variables que se asociaron al uso de una estrategia de reanimación en curso y se determinó la supervivencia y el resultado neurológico en dicho grupo de casos. Resultados. Se incluyeron 7.241 pacientes, de los cuales 259 (3,6%) fueron trasladados al hospital con RCP en curso. La edad media fue 51,6 (DE 23,6) años, de los cuales 27 (10,1%) casos tenían 16 años. Las variables que se asociaron con el uso de RCP en curso fueron: edad 16 años [OR 6,48 (IC95% 3,91-10,76); p < 0,001)], PCR presenciada [OR 1,62 (IC95% 1,16-2,26); p = 0,004], PCR ocurrida fuera del domicilio [OR 3,17 (IC95% 2,38-4,21); p < 0,001)]; etiología no cardiaca [OR 1,47 (IC95%1,07-2,02); p = 0,019], ritmo inicial desfibrilable [OR 1,67 (IC95% 1,17-2,37); p = 0,004], no existencia de soporte vital previo (SVp) [OR 3,48 (IC95% 2,58-4,70); p < 0,001] y realización de intubación orotraqueal (IOT) [OR 1,93 (IC95% 1,24-2,99); p = 0,003]. Un paciente (0,38%) sobrevivió al alta con buen estado neurológico. Conclusiones. La RCP en curso en servicios de emergencias con médico a bordo es una estrategia poco frecuente en casos de PCR. La juventud del paciente, que la PCR suceda fuera del domicilio, sea presenciada, no exista soporte vital previo, tenga un ritmo inicial desfibrilable, una etiología no cardiaca y que se consiga IOT se asocian con esta estrategia cuyo resultado final puede considerarse fútil


Objective. To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Methods. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non–heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Results. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91–10.76); P


Assuntos
Humanos , Assistência Pré-Hospitalar/organização & administração , Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Intubação Intratraqueal , Ambulâncias/organização & administração , Tratamento de Emergência/métodos , Transferência de Pacientes/organização & administração , Estudos Retrospectivos
15.
Appl Ergon ; 71: 45-56, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29764613

RESUMO

Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva/organização & administração , Transferência de Pacientes/organização & administração , Integração de Sistemas , Teoria de Sistemas , Eficiência Organizacional , Humanos
16.
BMC Health Serv Res ; 18(1): 334, 2018 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-29739395

RESUMO

BACKGROUND: Despite an extensive body of knowledge exists on network outcomes and on how hospital network structures may contribute to the creation of outcomes at different levels of analysis, less attention has been paid to understanding how and why hospital organizational networks evolve and change. The aim of this paper is to study the dynamics of networking behaviors of hospital organizations. METHODS: Stochastic actor-based model for network dynamics was used to quantitatively examine data covering six-years of patient transfer relations among 35 hospital organizations. Specifically, the study investigated about determinants of patient transfer evolution modeling partner selection choice as a combination of multiple organizational attributes and endogenous network-based processes. RESULTS: The results indicate that having overlapping specialties and treating patients with the same case-mix decrease the likelihood of observing network ties between hospitals. Also, results revealed as geographical proximity and membership of the same LHA have a positive impact on the networking behavior of hospitals organizations, there is a propensity in the network to choose larger hospitals as partners, and to transfer patients between hospitals facing similar levels of operational uncertainty. CONCLUSIONS: Organizational attributes (overlapping specialties and case-mix), institutional factors (LHA), and geographical proximity matter in the formation and shaping of hospital networks over time. Managers can benefit from the use of these findings by clearly identifying the role and strategic positioning of their hospital with respect to the entire network. Social network analysis can yield novel information and also aid policy makers in the formation of interventions, encouraging alliances among providers as well as planning health system restructuring.


Assuntos
Administração Hospitalar , Grupos Diagnósticos Relacionados , Planejamento em Saúde , Administradores Hospitalares , Humanos , Transferência de Pacientes/organização & administração , Apoio Social
17.
Consult Pharm ; 33(3): 152-158, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29720300

RESUMO

OBJECTIVE: To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients' self-care and prevent hospital readmissions. SETTING: Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. PRACTICE DESCRIPTION: Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. PRACTICE INNOVATION: Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. MAIN OUTCOME MEASUREMENTS: The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. RESULTS: The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. CONCLUSION: Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams.


Assuntos
Insuficiência Cardíaca/terapia , Transferência de Pacientes/organização & administração , Doença Pulmonar Obstrutiva Crônica/terapia , Autocuidado/métodos , Organizações de Assistência Responsáveis/organização & administração , Progressão da Doença , Humanos , Pacientes Ambulatoriais , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Atenção Primária à Saúde/organização & administração , Papel Profissional , Autogestão
18.
Pediatr Ann ; 47(3): e93-e96, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29538780

RESUMO

Emergencies do occur in pediatric primary care offices. The American Academy of Pediatrics Committee on Pediatric Emergency Medicine recommends that primary care offices perform a self-assessment of office readiness for emergencies. Primary care offices should develop an emergency response plan to recognize, stabilize, and transfer sick children. They should also ensure their offices have the essential equipment, supplies, and medications readily available in case of emergencies. Primary care offices can prepare and practice for office emergencies through "mock codes" and by maintaining certification in basic and advanced life support courses. Partnership with local emergency medical services and emergency departments will allow seamless transfer of an acutely ill child. Careful planning and preparation will help improve outcomes for emergencies in the primary care setting. [Pediatr Ann. 2018;47(3):e93-e96.].


Assuntos
Serviços Médicos de Emergência/organização & administração , Planejamento em Saúde/métodos , Pediatria/organização & administração , Atenção Primária à Saúde/organização & administração , Doença Aguda , Criança , Emergências , Serviços Médicos de Emergência/métodos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Transferência de Pacientes/métodos , Transferência de Pacientes/organização & administração , Pediatria/métodos , Atenção Primária à Saúde/métodos
19.
Int J Qual Health Care ; 30(5): 390-395, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547920

RESUMO

Quality problem: For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). Initial assessment: Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented. The 200 patients (27%) out of the 744 were smokers and only 50% were offered NAM before discharge. Choice of solution: PACU unit staff to determine the smoking status of every patient before discharge from the PACU (later changed to OR nursing staff) and, if a patient was identified as a smoker, to offer NRT (patch and mouth spray only) and initiate therapy prior to transfer of the patient to the ward. Implementation: Data about number of patients admitted, presence of documented smoking status, number of identified smokers, and number offered/accepted nicotine replacement therapy (NRT) were collected at baseline and thereafter quarterly. Engaging video education sessions addressed the education gaps highlighted in a needs assessment. Identification of smoking status was made part of preoperative checklist and NRT was made available in post-operative recovery room. Results: These interventions resulted in an increase in screening for tobacco use from 54% at baseline to 95% and the offer of NRT to smokers from 50 to 89%.


Assuntos
Enfermagem em Pós-Anestésico/métodos , Melhoria de Qualidade/organização & administração , Fumantes/estatística & dados numéricos , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Alberta , Lista de Checagem/estatística & dados numéricos , Humanos , Transferência de Pacientes/organização & administração , Enfermagem em Pós-Anestésico/educação , Sala de Recuperação/organização & administração
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