Características epidemiológicas de los pacientes atendidos en el sector de reanimación de un servicio de emergencia en un hospital de tercer nivel de Argentina / Epidemiological features of patients admitted to the resuscitation unit at an emergency department of a third level hospital in Argentina

Introducción. Conocer las características epidemiológicas (CE) de una población resulta primordial para la definición de estrategias sanitarias. Nuestro objetivo es describir las características de pacientes críticos ingresados al sector reanimación (SR). Materiales y métodos. Estudio descriptivo y retrospectivo realizado en un servicio de urgencias de un hospital de tercer nivel entre 2/7/2018 y 1/7/2019. Se incluyeron todos los pacientes ingresados a SR. Se registró edad, sexo, motivo de ingreso, condición crónica, procedimientos diagnósticos y terapéuticos efectuados. Los datos fueron obtenidos del libro de registro y la historia clínica informatizada, y analizados con software Redcap Versión 8.9.2. Las variables categóricas se expresaron como frecuencias y porcentajes y las continuas con mediana y rango intercuartílico. Resultados. Ingresaron 2292 pacientes. El 94% fueron menores de 16 años. El 56,5% presentaba condiciones crónicas (CC), siendo más frecuentes las enfermedades neurológicas (29%), endocrino/metabólicas (15,5%) y cardiovasculares (11%). Los motivos de ingreso más habituales: enfermedad respiratoria aguda baja (31%), estado epiléptico (13%), sepsis (13%) y deshidratación grave (7%). Estudios complementarios más utilizados: laboratorio (54%), radiografía (28%), hemocultivos (23%). Los procedimientos realizados con más frecuencia fueron la colocación de acceso venoso periférico (67%), cánula nasal de alto flujo (6%) y ventilación mecánica (5%). Las drogas más indicadas: oxígeno (42%), fluidos (34%), antibióticos (22%). El 14% ingresó a cuidados intensivos. Hubo 11 paros cardiorrespiratorios y 6 óbitos. Conclusiones. En el SR se asisten pacientes críticos con patologías de alta prevalencia como también pacientes con enfermedades crónicas complejas. La evaluación periódica de CE resulta una herramienta fundamental para detectar dificultades y elaborar estrategias de mejora (AU)

Introduction. Knowledge on the epidemiological characteristics (EC) of a population is essential to define healthcare strategies. Our aim was to describe the characteristics of critical patients admitted to the resuscitation unit (RU). Materials and methods. A descriptive and retrospective study was conducted at an emergency department of a third-level hospital between 2/7/2018 and 1/7/2019. All patients admitted to the RU were included. Age, sex, reason for admission, underlying disease, and diagnostic and therapeutic procedures performed were recorded. The data were obtained from the logbook and electronic records, and analyzed using Redcap software Version 8.9.2. Categorical variables were expressed as frequencies and percentages and continuous variables as median and interquartile range. Results. 2292 patients were admitted; 94% were younger than 16 years of age. Overall, 56.5% had underlying diseases (UD), the most common of which were neurological (29%), endocrine/metabolic (15.5%), and cardiovascular (11%) disorders. The most common reasons for admission were acute lower respiratory tract disease (31%), status epilepticus (13%), sepsis (13%), and severe dehydration (7%). The most frequently used complementary studies were laboratory tests (54%), x-rays (28%), and hemocultures (23%). The most frequently performed procedures were peripheral venous line (67%), high-flow nasal cannula (6%), and mechanical ventilation (5%) placement. The most frequently indicated medications were oxygen (42%), fluids (34%), and antibiotics (22%). Overall, 14% required admission to the intensive care unit. There were 11 cardiorespiratory arrests and six deaths. Conclusions. Critical patients with highly prevalent diseases as well as patients with complex underlying diseases are seen at the RU. Periodic EC evaluation is a key tool for detecting difficulties and developing improvement strategies (AU)

Uso de tarjetas de medicación en el manejo de estado epiléptico en un servicio de emergencias. Mejoras en prescripción, preparación y administración de drogas / Use of medication cards in the management of statu epilepticus at an emergency department. Improvements in drug prescription, preparation and administration

Introducción: Los errores de medicación (EM) causan una elevada morbimortalidad y generan costos innecesarios. El servicio de emergencias (SE) presenta un mayor riesgo de EM que otras áreas. El desarrollo de una herramienta que estandarice el uso de fármacos podría mejorar la seguridad y el proceso de medicación. Objetivos: Evaluar las mejoras en el proceso de medicación mediante el uso de tablas de medicación (TM) durante la atención del estado epiléptico (EE). Materiales y métodos: Se realizó un estudio de tipo antes y después no controlado. La intervención fue el desarrollo e implementación de TM. Se relevó in situ la prescripción, preparación y administración de fármacos incluidos en las TM durante segunda quincena de Octubre y mes de Noviembre 2016, previo a la implementación de la herramienta, y en el mismo período de 2017, luego de la inducción e implementación de las tablas. Se registraron los EM y se categorizaron de acuerdo a la etapa del proceso en que ocurrieron. Resultados: En el período pre-intervención se realizaron 14 registros, 86% (12) tenía al menos un error; 57% (8) errores en la etapa de prescripción, 57% (8) en la de preparación y 21% (3) en la de administración. En el período post-intervención se realizaron 17 registros, 12% (2) tenía por lo menos un EM. No se registraron errores en la fase de prescripción, hubo 12% (2) de errores de preparación y 6% (1) de administración. Conclusión: La implementación de las TM para la estandarización del uso de fármacos en EE resultó una medida muy positiva, mejorando la seguridad en el proceso de medicación (AU)

Introduction: Medication errors (ME) are associated with high morbidity mortality and lead to unnecessary costs. The risk of ME is higher at the emergency department (ED) than in other areas. Developing a tool that standardizes drug use may improve safety and medication processes. Objectives: To evaluate improvements in the medication process by using medication cards (MCs) during status epilepticus (SE) care. Materials and methods: An uncontrolled before-and-after study was conducted. The intervention was the development and implementation of MCs. The in situ prescription, preparation, and administration of drugs included in the MCs was recorded during the second half of October and November 2016, prior to the implementation of the tool, and in the same period of 2017, after the introduction and implementation of the MCs. ME were recorded and categorized according to the stage of the process in which they occurred. Results: In the pre-intervention period 14 episodes were recorded; in 86% (12) at least one error occurred; 57% (8) were ME in the prescription stage, 57% (8) were ME in the preparation stage, and 21% (3) were ME in the administration stage. In the post-intervention period 17 errors were recorded, in 12% (2) at least one ME occurred. No errors were recorded in the prescription stage, 12% (2) were preparation errors, and 6% (1) administration errors. Conclusion: The implementation of MCs for the standardization of medications used in the RU was successful, improving safety in the medication process (AU)

Treinamento teórico-prático de equipe multidisciplinar para atendimento de parada cardiorrespiratória em enfermaria / Theoretical and practical training of multidisciplinary team for cardiac arrest care in a ward

Objetivo: Avaliar se o treinamento teórico-prático integrado de médicos e enfermeiros traz melhorias ao atendimento no caso de parada cardiorrespiratória em enfermaria. Métodos: Trata-se de estudo prospectivo quase-experimental por meio da análise de questionários pré e pós-capacitação. Os participantes foram médicos, enfermeiros e técnicos de enfermagem que atuavam nas alas de enfermaria de um hospital em Belo Horizonte (MG), submetidos a um questionário pré-curso. Em seguida, eles participaram do curso de capacitação. Após o treinamento, foi respondido novo questionário. Os resultados pré e pós-curso foram comparados. Resultados: Nas questões objetivas, houve aumento de acertos no questionário pré-capacitação de 68,1% para 85,6% no questionário pós-capacitação, com diferença estatística significante (p<0,001). Nas questões subjetivas, também houve aumento de acertos de respostas positivas no questionário pré-capacitação de 45,3% para 73,3% na pós-capacitação, com diferença estatística significante (p<0,001). Conclusão: Ao se compararem os dois questionários, constataram-se mudanças estatisticamente significantes nas respostas dos participantes após a capacitação, o que reflete o potencial de melhoria no atendimento à parada cardiorrespiratória na enfermaria do hospital avaliado. (AU)

Objective: To evaluate whether an integrated theoretical -practical training of physicians and nurses improves medical care of cardiac arrest at an inpatient ward. Methods: This is a prospective quasi-experimental study through the analysis of pre- and post-training questionnaires. Participants included physicians, nurses, and nursing technicians who worked in the inpatient wards of a hospital in the city of Belo Horizonte, state of Minas Gerais. They responded a pre-training questionnaire. Afterwards, they participated in training course. Following training, they answered a new questionnaire. Pre- and post-training results were compared. Results: In the multiple-choice questions. the correct answers improved from 68.1% in the pre-qualification questionnaire to 85.6% in the post-qualification questionnaire, with a statistically significant difference (p<0.001). in the subjective questions, there was also an improvement of positive answers from 45.3% in the pre-qualification questionnaire to 73.3% in post-qualification questionnaire, with a statistically significant difference (p<0.001). Conclusion: When comparing the two questionnaires, statistically significant changes were observed in participants' responses after the training, reflecting improvement potential in care for cardiorespiratory arrest in the ward of the hospital evaluated. (AU)

Alteración de signos vitales dentro de las 72 h previas a la activación de código azul en pacientes adultos hospitalizados de un hospital universitario / Deterioration of vital signs as predictors of major medical emergencies in hospitalized patients

Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.

Falha na ativação da equipe de emergência intra-hospitalar: causas e consequências / Failure to activate the in-hospital emergency team: causes and outcomes

RESUMO Objetivo: Determinar a incidência de falha na ativação da via aferente da Equipe de Emergência Médica intra-hospitalar, caraterizando-a e comparando a mortalidade dessa população com a da população em que não se verificou falha na ativação da via aferente. Métodos: Entre janeiro de 2013 e julho de 2015, ocorreram 478 ativações da Equipe de Emergência Médica do Hospital Pedro Hispano. Após a exclusão de registos incompletos e ativações para doentes com menos de 6 horas de internamento hospitalar, obtivemos uma amostra de 285 ativações. A amostra foi dividida em dois grupos: o grupo com falha na ativação da via aferente e o grupo em que não ocorreu falha na ativação da via aferente da Equipe de Emergência Médica. As duas populações foram caracterizadas e comparadas. A significância estatística foi considerada para p ≤ 0,05. Resultado: Em 22,1% das ativações, verificou-se falha na ativação da via aferente. Relativamente ao estudo causal, verificamos existir diferença estatisticamente significativa quanto aos critérios de ativação da Equipe de Emergência Médica (p = 0,003) no grupo com falha na ativação da via aferente, encontrando taxa mais elevada de ativação da Equipe de Emergência Médica por paragem cardiorrespiratória e disfunção cardiovascular. Em relação às consequências, no grupo em que ocorreu falha na ativação da via aferente houve uma maior taxa de mortalidade imediata e à data de alta hospitalar, sem significado estatístico. Não encontramos diferenças significativas com relação aos outros parâmetros. Conclusão: Nos doentes em que houve falha da ativação da via aferente da Equipe de Emergência Médica, a incidência de paragem cardiorrespiratória e a taxa de mortalidade foram maiores. Este estudo reforça a necessidade de as unidades de saúde investirem na formação de todos os profissionais de saúde sobre os critérios de ativação da Equipe de Emergência Médica e o funcionamento do sistema de resposta a emergência médica.

ABSTRACT Objective: To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. Methods: A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Result: Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. Conclusion: The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

Experience of pediatric rapid response team in a tertiary care hospital in Pakistan.

Objective. To report our experience before and after implementation of pediatric rapid response team (RRT) in pediatric wards of a tertiary care hospital in Pakistan. Methods. An audit of RRT activity from December 2007 to August 2008 was conducted and reviewed patient diagnoses at the time of call placement, interventions done and post-intervention clinical outcomes. Clinical Outcomes in the nine months before RRT implementation were compared with those in the first operational nine months after RRT. Results. Eighty-three calls were generated during the post-intervention study period of 9-month (21 calls/1000 admissions). The median age of patients was 27 months; 37% calls were for infants. The majority of patients were under care of medical services (93% vs 7% under care of surgical services). Greater numbers of calls were made during 0800-1600 hours (45%). Respiratory issues were the most common reason for activation of RRT. Because of early interventions, majority (61%) of patients avoided unnecessary PICU stay and expenditure; only 17% required mechanical ventilation in PICU. The code rate per 1000 admissions decreased from 5.2 (pre-RRT) to 2.7 (post-RRT) (p=0.08; OR 1.88(95%CI 0.9 -3.93). The mortality rate of patients admitted in PICU from wards decreased from 50% to 15% (p=0.25; OR 1.64 (95%CI 0.63 – 4.29). Conclusion. Our experience with implementation of RRT was associated with reduction in cardiorespiratory arrest, mortality and saved a lot of PICU resource utilization. It is an excellent patient-safety initiative especially in resource-constrained countries by bringing PICU reflexes outside the PICU.