ABSTRACT
INTRODUCTION: Advances in perinatology have been associated with improved survival of very low birth weight (VLBW;<1500 g) infants. These children have an increased risk of future neurological and development handicaps. A set of quality indicators have been recommended for the neurodevelopment follow-up programs in this group of patients. AIM: To analyze our neurodevelopment follow-up program according to these quality of care indicators in 5 post-discharge follow-up areas: general care; physical health; vision, hearing, speech and language; developmental and behaviour assessment; and psychosocial issues. PATIENTS AND METHODS: Fifty-one VLWB patients born in 2000 who have completed our 6-year follow-up program have been retrospectively studied. The agreement between our program and the standard of quality is evaluated. RESULTS: A copy of a discharge summary of the patient's neonatal course is present in the medical record in 92% of the cases. The inclusion of clinical data and general medical aspects in the medical summary is heterogeneous. Somatometric evaluation for the first two years of age is always present in a filled-in graphic. The international classification of the retinopathy of the preterm (RDP) is used in 100% of the patients. An ophthalmologic examination for RDP is performed in 72% (37/51) of the infants before hospital discharge; of the other 28%, only in 6 patients the date of the outpatient examination is present. Specific evaluations and interventions are performed within the recommended period of time in most of the children with suspected or neurosensory handicaps. More than ninety per cent of the patients are referred to the neurodevelopment specialist and most of them go to the visit (90.2% between 9 and 15 months and 78.4% between 21 and 30 months). Recommendations for a psycho-educational assessment are followed in the extremely premature (BW<1000 g and/or 28 weeks of gestational age) children. The number of patients who follow the program decreases with time. Psychosocial evaluation does not usually appear in the medical records of the patients. CONCLUSION: We have a good adherence to most of the recommended indicators in our follow-up program. The evaluation of these indicators is a useful tool to analyze the quality of a developmental follow-up program and to improve it.
Subject(s)
Child Development , Infant, Very Low Birth Weight , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Infant, Newborn , Nervous System/growth & development , Program Evaluation , Retrospective StudiesABSTRACT
Introducción: Los avances en la perinatología condicionan un aumento del número de recién nacidos de muy bajo peso (RNMBP) (<1.500g) que sobreviven, con el consiguiente riesgo futuro de presentar problemas en el desarrollo. Se han propuesto unos indicadores de calidad para evaluar los programas de seguimiento en este grupo de pacientes. Objetivo: Analizar el cumplimiento de estos indicadores en el programa de seguimiento del neurodesarrollo para los RNMBP de este centro. Material y métodos: Estudio retrospectivo descriptivo de los 51 RNMBP nacidos en el 2000 e incluidos en el programa de seguimiento hasta los 6 años de edad. Se evaluó el cumplimiento de los indicadores en las siguientes áreas: inclusión de datos en la epicrítica; aspectos médicos generales; evaluación visual, auditiva, de la comunicación y del lenguaje; evaluación del desarrollo y del comportamiento; valoración psicosocial. Resultados: Se adjuntó la epicrítica a la historia clínica en el 92% de los casos; el cumplimiento de los datos médicos generales fue heterogéneo. La valoración somatométrica durante los primeros 2 años quedó reflejada en una gráfica. Se utilizó siempre la clasificación internacional de retinopatía. A 37 (72%) de los 51 pacientes se les realizó el fondo de ojo durante el ingreso; sólo en 6 de los 14 restantes se explicitó la fecha de la visita ambulatoria. Se cumplió con los plazos máximos recomendados para la valoración por los especialistas cuando se detectó algún déficit. Se envió a más del 90% de los pacientes al neuropediatra y la gran mayoría acudió a la consulta (el 90,2% entre los 9 y los 15 meses, y el 78,4% entre los 21 y los 30 meses). Se cumplió con las recomendaciones de una valoración psicológica sistemática en los prematuros extremos. La evaluación psicosocial quedó poco reflejada en la historia clínica. Conclusiones: Este programa de seguimiento para RNMBP cumple con la mayoría de los indicadores de calidad propuestos. El análisis de éstos es una herramienta muy útil para evaluar y mejorar los programas de seguimiento para este grupo de pacientes (AU)
Introduction: Advances in perinatology have been associated with improved survival of very low birth weight (VLBW;<1500g) infants. These children have an increased risk of future neurological and development handicaps. A set of quality indicators have been recommended for the neurodevelopment follow-up programs in this group of patients. Aim: To analyze our neurodevelopment follow-up program according to these quality of care indicators in 5 post-discharge follow-up areas: general care; physical health; vision, hearing, speech and language; developmental and behaviour assesment; and psychosocial issues. Patients and methods: Fifty-one VLWB patients born in 2000 who have completed our 6-year follow-up program have been retrospectively studied. The agreement between our program and the standard of quality is evaluated. Results: A copy of a discharge summary of the patient's neonatal course is present in the medical record in 92% of the cases. The inclusion of clinical data and general medical aspects in the medical summary is heterogeneous. Somatometric evaluation for the first two years of age is always present in a filled-in graphic. The international classification of the retinopathy of the preterm (RDP) is used in 100% of the patients. An ophthalmologic examination for RDP is performed in 72% (37/51) of the infants before hospital discharge; of the other 28%, only in 6 patients the date of the outpatient examination is present. Specific evaluations and interventions are performed within the recommended period of time in most of the children with suspected or neurosensory handicaps. More than ninety per cent of the patients are referred to the neurodevelopment specialist and most of them go to the visit (90.2% between 9 and 15 months and 78.4% between 21 and 30 months). Recommendations for a psycho-educational assessment are followed in the extremely premature (BW<1000g and/or 28 weeks of gestational age) children. The number of patients who follow the program decreases with time. Psychosocial evaluation does not usually appear in the medical records of the patients. Conclusion: We have a good adherence to most of the recommended indicators in our follow-up program. The evaluation of these indicators is a useful tool to analyze the quality of a developmental follow-up program and to improve it (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Very Low Birth Weight/growth & development , Nervous System/growth & development , Infant, Premature/psychology , Program Evaluation , Follow-Up StudiesABSTRACT
El objetivo de este artículo es el de determinar la actividad del Servicio de Urgencias como paso previo para elaborar un plan estratégico de mejora que refuerce los puntos débiles y premie los puntos fuertes. Se analizaron las altas de este servicio durante una semana, y se registraron múltiples variables. La mayor actividad del servicio se desarrolla con pacientes obstétricas de tercer trimestre, los días laborables y en turno diurno, el 60,7% son visitas adecuadas, y urgentes el 51,6%. Se ingresan al 28% de las pacientes. Se concluye que existe una gran actividad con pacientes parturientas, de que es inútil el crear un sistema de triage, se constata que existe una buena dotación de medios pero que escasea el personal (AU)
The aim of this work is to determine the activity of the emergency service as a prior step to designing a strategic improvement plan which will strengthen the weak points and reward the strong points. It has been observed that the departments greatest activity is with third-term obstetric patients, on work days and during the daytime. It also concludes that there is intense activity with patients in labour for whom it is useless to create a selection system and, furthermore, the resources are good in spite of staff shortages (AU)
