Tiempo de demora para la hospitalización tras la implantación del ingreso directo a cargo del Servicio de Urgencias / Changes in emergency admission times after the introduction of direct admission from emergency services

ObjetivoValorar el impacto en el tiempo de espera para el ingreso urgente dependiendo del facultativo responsable de éste, el médico de urgencias o el especialista del área médica.Material y métodoTras la autorización al servicio de urgencias hospitalarias para el ingreso directo de pacientes en las especialidades médicas, se definieron dos períodos de estudio: período A (previo al ingreso directo) y período B (tras su implantación). Se analizaron el número de pacientes atendidos, su gravedad, el número y porcentaje de ingresos y el tiempo medio de estancia.ResultadosEn ambos períodos se atendieron 41.917 pacientes (228,07 pacientes/día) y 41.948 (230,48 pacientes/día), respectivamente. El tiempo medio de estancia de los pacientes ingresados directamente desde urgencias disminuyó en 1h y 42m (p=0,001); por el contrario, los ingresos en planta de hospitalización del servicio de medicina interna mantuvieron un tiempo medio de espera similar en los dos períodos analizados.ConclusionesEl traspaso de la competencia del ingreso a los facultativos de urgencias disminuye el tiempo medio de estancia de los pacientes en dicha área, sin modificar el número de ingresos y reduciendo la carga asistencial de los facultativos de la planta de hospitalización(AU)

ObjectiveTo measure the differences of waiting time for the emergency admission depending on which professional is in charge ie. the emergency doctor or the specialist of a specific area.Patients and methodsOnce the Hospital Emergency Service was permitted to admit patients directly to the specialities, two periods of study where taken: Period A (before the direct admission) and Period B (after the implementation of it). The following was analysed: the number of patients taken, the complexity of their problem, the number of admissions and length of their stay.ResultsDuring Period A 41,917 patients were seen (228.07 patients/day) and during Period B 41,948 (230.48 patients/day). The average of the stay for those patients that were admitted directly from Emergencies had decreased by 1h and 42min (p=0.001). The admissions in the Internal Medicine Service kept the same waiting time in both periods.ConclusionsThe transfer of the responsibility of the admissions to emergency doctors has decreased the average waiting time of the patients in this area. The total number of admissions has not increased and has reduced the amount of work the different specialist(AU)

[Changes in emergency admission times after the introduction of direct admission from emergency services]. / Tiempo de demora para la hospitalización tras la implantación del ingreso directo a cargo del Servicio de Urgencias.

OBJECTIVE: To measure the differences of waiting time for the emergency admission depending on which professional is in charge ie. the emergency doctor or the specialist of a specific area. PATIENTS AND METHODS: Once the Hospital Emergency Service was permitted to admit patients directly to the specialities, two periods of study where taken: Period A (before the direct admission) and Period B (after the implementation of it). The following was analysed: the number of patients taken, the complexity of their problem, the number of admissions and length of their stay. RESULTS: During Period A 41,917 patients were seen (228.07 patients/day) and during Period B 41,948 (230.48 patients/day). The average of the stay for those patients that were admitted directly from Emergencies had decreased by 1h and 42 min (p=0.001). The admissions in the Internal Medicine Service kept the same waiting time in both periods. CONCLUSIONS: The transfer of the responsibility of the admissions to emergency doctors has decreased the average waiting time of the patients in this area. The total number of admissions has not increased and has reduced the amount of work the different specialist.

[Acute mushrooms poisoning]. / Intoxicaciones agudas por setas.

The collection and consumption of wild mushrooms by individuals with no mycological knowledge and their accidental ingestion by minors are responsible for a growing increase of poisonings. It is not usual for emergency care of a patient affected by mushroom poisoning to be based on recognition of the responsible species of fungus or access to a sample of the mushroom consumed. It is this reason knowledge of toxidromes is crucial. In the majority of cases, the symptoms are weak. Mortality is usually related to the development of potentially fatal liver necrosis after consumption of the fungus Amanita phalloides and others which contain amatoxins. Treatment is based on support measures but no specific treatments exist that are based on scientifically proven studies. In the following article the clues used in diagnosing which make it possible to carry out a syndromic diagnosis based on a period of latency will be analyzed. The mushrooms that are responsible for the most common syndromes, therapeutic options, as well as varieties of toxic fungus which may produce peculiar and exceptional symptoms are also reported.

Relación entre factores precipitantes y mortalidad en el delirio agitado en Cuidados Paliativos / Relation of precipitating factors and mortality in agitate delirum of Palliative Care patients

Objetivo: el delirio agitado aparece con frecuencia en los pacientes con enfermedad oncológica avanzada. El objetivo de este estudio es analizarla etiología del delirio agitado y su relación con la mortalidad observada. Método: estudio retrospectivo de 631 pacientes de Cuidados Paliativos. Los factores etiológicos se clasificaron en: opioides, infección, iones metabólico, insuficiencia respiratoria, lesión del sistema nervioso central, o desconocido. Analizamos su relación con la mortalidad y el momento de aparición del delirio. Se aplicó el test de Chi cuadrado para variables cualitativas y t de Student para variables cuantitativas. Resultados: el delirio agitado se diagnosticó en 53 pacientes (8,4%). Edad media 67 años (DE 12,9). La neoplasia primaria se localizaba en pulmón (39,6%), aparato genitourinario (24,5%), aparato digestivo (17,0%), mama (9,4%) y otros (9,4%). Los precipitantes fueron: opioides (26,4%), infección (26,4%), iones-metabólico (17,0%), insuficiencia respiratoria(15,1%), lesión en el sistema nervioso central (7,5%) y desconocido (7,5%). La presencia de estos factores fue distinta dependiendo de que el delirio fuese el motivo de ingreso (opioides 32,4%, infección 29,4%) o apareciese durante la hospitalización (insuficiencia respiratoria 36,8%, infección 21,1%); p = 0,019. Se observó mayor mortalidad durante la hospitalización en los pacientes que presentaron delirio respecto a los que no (67,9vs. 41,2%, OR 3,03, IC 95%: 1,7-5,7). No encontramos diferencia en el número acumulado de factores etiológicos en los pacientes con delirio que fallecieron y en los que no (2,56 vs. 2,59). La mortalidad fue inferior, casi significativo, cuando la infección fue el factor precipitante (50,0 vs. 75,0-78,6%); p = 0,23. Conclusión: la infección y el inicio o aumento de dosis de opioides, factores tratables, fueron los precipitantes más frecuentes de delirio. Ninguno de los factores estudiados, ni el número acumulado de los mismos, se relacionó de una manera significativa a menor mortalidad (AU)

Objective: agitated delirium is frequently detected in patients suffering from advanced cancer. The objective of this study was to analyze the etiology of agitated delirium and the relation to mortality. Method: retrospective study of 631 terminally ill cancer patients. Putative etiologic factors were: opioid therapy, infection, metabolic disorders, respiratory insufficiency, central nervous system lesion or unknown. We tried to find their relation to mortality and onset of delirium. It was used the Chi square test for qualitative variables and t Student for quantitative variables. Results: agitated delirium was diagnosed in 53 patients (8.4%). Mean age was 67 years (SD 12.9); male: female 2: 1. Primary neoplasms were located at lung (39.6%), genitourinary system (24.5%), digestive system (17.0%), breast (9.4%) and others (9.4%). Inducing factors were: opioid therapy (26.4%), infection (26.4%), metabolic disorders (17.0%), respiratory insufficiency (15.1%), central nervous system lesion (7.5%) and unknown (7.5%). Frequency of precipitating factors was different whether the delirium was the cause of admission (opioid therapy 32.4%, infection 29.4%) or was developed during hospitalization (respiratory insufficiency 36.8%, infection 21.1%); p = 0.019. Higher mortality during hospitalization was observed in patients with delirium contrasting with those without it (67.9 vs. 41.2%, OR 3.03, 95% CI: 1.7-5.7). There was no difference in the accumulated number of etiologic factors inpatients with delirium who died and those who did not: 2.56 vs. 2.59. Mortality was lower, near significantly, when infection was the precipitating factor (50.0 vs. 75.0-78.6%); p = 0.23. Conclusion: infection and onset or an increase in the doses of opioids, two treatable causes, were the most recurrent precipitating factors of delirium. None of studied factors neither the accumulated number of them was related to mortality with statistical difference (AU)