Eficacia de la asistencia compartida entre cirujanos e internistas para ancianos con fractura de cadera / Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture

Fundamento y objetivo: La fractura de cadera es una lesión frecuente en ancianos con comorbilidades, lo que aumenta los riesgos de morbimortalidad, que podrían reducirse con asistencia compartida (AC) entre cirujanos ortopédicos e internistas. El objetivo de este trabajo fue evaluar la eficacia de esta AC. Pacientes y método: Estudio prospectivo de 138 pacientes mayores de 64 años con fractura de cadera tratados con AC y seguimiento de un año. Se comparó con una cohorte de 153 pacientes tratados con asistencia convencional y similares criterios de inclusión. Se analizaron diversas variables prequirúrgicas y posquirúrgicas, complicaciones, y factores de riesgo potenciales de mortalidad. Se utilizaron el índice de Charlson, un test mental, el de calidad de vida de Katz y el SF-12, y para la función de cadera, la escala de Merle D’Aubigné. Resultados: La demora quirúrgica fue menor en la cohorte AC (p = 0,001). Las tasas de complicaciones y reingresos fueron similares en ambas cohortes. La estancia media fue menor (p = 0,001) en la cohorte AC. La mortalidad intrahospitalaria y a 3 meses fueron similares, pero era menor en la cohorte AC a los 6 (p = 0,04) y 12 meses (p = 0,03). En ambas cohortes no fueron predictores de mortalidad el sexo, el número de comorbilidades, la puntuación ASA, el índice de Charlson ni el tipo de cirugía. En la cohorte AC era predictora la demora quirúrgica > 2 días, mientras que en la cohorte convencional lo era la edad. Los resultados funcionales finales fueron similares en ambas cohortes. Conclusión: Nuestros resultados muestran la efectividad de la AC para reducir la demora quirúrgica, la estancia y la mortalidad a partir de 6 meses (AU)

Background and objective: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. Patients and method: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D’Aubigne' hip score were used. Results: Surgical delay was lower in the CM cohort (P = .001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P = .001) in the CM cohort. In hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P = .04) and 12 months (P = .03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay > 2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. Conclusion: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months (AU)

[Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture]. / Eficacia de la asistencia compartida entre cirujanos e internistas para ancianos con fractura de cadera.

BACKGROUND AND OBJECTIVE: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS: Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.

Estudio de prevalencia de la enfermedad arterial periférica en las unidades médicas de corta estancia en España. Estudio UCEs / Prevalence study of peripheral arterial disease in short stay units in Spain. UCEs study

Las unidades médicas de corta estancia (UMCE) tienen un área de actuación preferente sobre una población en general anciana y pluripatológica cuyos diagnósticos más frecuentes suelen ser enfermedades de alta prevalencia, entre ellas las enfermedades cardiovasculares, conocidas o no. La enfermedad arterial periférica (EAP) es una manifestación de la arteriosclerosis en las extremidades inferiores. Un alto porcentaje de los pacientes no presentan sintomatología alguna o su diagnóstico resulta dificultoso. La detección de la EAP mediante el índice tobillo-brazo (ITB) es un método no invasivo y eficiente en la detección de la lesión vascular subclínica. Tiene una alta sensibilidad y especificidad para una estenosis (..) (AU)

The Medical Short Stay Units (UMCE) have an area of preferred on an elderly population and multipathological patients whose most common diagnoses for admission usually are high prevalence diseases. They coincide in a high presence of cardiovascular disease, whether known or not. Peripheral arterial disease (PAD) is one manifestation of arteriosclerosis that is defined by an obstruction of the arterial blood flow in the lower extremities. A high percentage of patients do not exhibit any symptoms and others have a difficult diagnosis. The detection of the PAD through the Ankle–Brachial Index Measurement (ITB) is a non-invasive method, the scope of clinical, highly efficient in the detection of subclinical vascular injury. Objectives This technique offers a high sensitivity and specificity for stenosis (..) (AU)

[Conciliation discrepancies at hospital discharge]. / Discrepancias de conciliación en el momento del alta hospitalaria en una unidad médica de corta estancia.

OBJECTIVE: To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies. DESIGN: Cality study. SETTING: Short Stay Medical Unit in Elda General Hospital, Alicante, Spain. PARTICIPANTS: All patients discharged were included. INTERVENTION: The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation. CONCLUSION: Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.

Discrepancias de conciliación en el momento del alta hospitalaria en una unidad médica de corta estancia / Conciliation discrepancies at hospital discharge

Objetivo. Evaluar y describir las discrepanciasno justificadas encontradas al conciliar lamedicación crónica de los pacientes con lamedicación prescrita en el momento del altahospitalaria. En una segunda parte, se evaluóel impacto del proceso de conciliación y sevaloró la gravedad de las discrepancias.Diseño. Estudio de calidad.Emplazamiento. Unidad Médica de CortaEstancia del Hospital General de Elda,Alicante.Participantes. Pacientes dados de alta.Intervención. Tras realizar una entrevistapersonal previa al alta, se obtuvo lamedicación que tomaba el paciente antesdel ingreso. Un farmacéutico identificólas discrepancias no justificadas con eltratamiento en el momento del alta y conla historia farmacoterapéutica, y en los casosnecesarios se modificó tras consultarlo conel médico.Mediciones y resultados principales. Serealizaron intervenciones en 434 pacientes yse detectaron 249 errores de conciliación, loque supone 0,57 discrepancias por pacienteintervenido.Dentro del 35,2% de lospacientes que presentaron errores deconciliación, la media de discrepanciasfue de 1,62. De estos errores, 153 (61,5%)se produjeron en el momento del altahospitalaria, mientras que 96 (38,5%) fueronerrores de omisión o comisión en la historiafarmacoterapéutica. El 11% de los informesde alta revisados no recogían informaciónsobre el tratamiento previo del paciente. Eltipo de error mayoritario tanto en la historiacomo en el momento del alta fue el deomisión. Respecto al daño potencial de loserrores detectados, un 30% podría habercausado lesiones temporales o lahospitalización.Conclusión. Los errores de medicación en lahistoria farmacoterapéutica en el momentodel ingreso son comunes y potencialmenteimportantes si se mantienen en el tiempo.La incorporación del farmacéutico al equipomédico, así como la disponibilidad de accesoa datos de distintos niveles asistenciales,podrían contribuir a reducir la frecuenciade estos errores

Objective. To evaluate and describe the nonjustifieddiscrepancies found on reconcilingchronic medication prescribed to patientswhen discharged from hospital. Secondly,the impact of the reconciliation process isevaluated by assessing the seriousness of thediscrepancies.Design. Cality study.Setting. Short Stay Medical Unit in EldaGeneral Hospital, Alicante, Spain.Participants. All patients discharged wereincluded.Intervention. The medication that the patientwas taking before admission was obtained bypersonal interview before being discharged.The discrepancies that were non-justifiablewith the treatment on discharge and withthe pharmacotherapeutic history wereidentified and modified, where necessary,after consulting with the doctor.Meditions and results. Of the 434 patientsinterviewed, 249 conciliation errors weredetected, which was 0.57 discrepanciesper treated patient. Among the 35.2%of patients who had conciliation errors,the mean number of discrepancies was 1.62.Of these errors, 153 (61.5%) were producedwhen being discharged, while 96 (38.5%)were errors of omission or commission inthe pharmacotherapeutic history. Of all thedischarge reports reviewed, 11% did notrecord information on the previous treatmentof the patient. Omission was the main type oferror, both in the history and on discharge.As regards the potential harm of thedetected errors, 30% could have causedtemporary harm or hospitalisation.Conclusion. Medication errors in thepharmacotherapeutic history at the time ofbeing admitted are common and potentiallysignificant if they are continued. Includingthe pharmacist in the medical team, alongwith being able to access data at the differentcare levels, could help to reduce thefrequency of these errors