Estrategias para mejorar el flujo de ingresos y estancias hospitalarias: adaptación del cuestionario Appropriateness Evaluation Protocol (AEP): estudio Delphi / Strategies to improve the flow of admissions and hospital stays: A Delphi study of an adaptation of the Appropriateness Evaluation Protocol

Introducción y objetivo La herramienta Appropriateness Evaluation Protocol (AEP) analiza las estancias e ingresos hospitalarios inadecuados. El objetivo de este estudio fue adaptar el cuestionario AEP para analizar la adecuación de los ingresos y las estancias hospitalarias en nuestra realidad asistencial. Método Se desarrolló un estudio utilizando el método Delphi en el que participaron 15 expertos en gestión clínica y en asistencia hospitalaria. Los ítems del formulario inicial se conformaron a partir de la herramienta AEP tal y como fue definida en su primera versión. En la primera ronda los participantes aportaron nuevos ítems que consideraron relevantes en nuestra realidad actual. En las rondas 2 y 3 evaluaron 80 ítems según su relevancia mediante la utilización de una escala Likert del 1 al 4 (máxima utilidad). De acuerdo al diseño de nuestro estudio los ítems del AEP se consideraron adecuados si la media de la puntuación una vez evaluados por los expertos, era igual o superior a 3. Resultados Los participantes definieron un total de 19 nuevos ítems. Finalmente 47 ítems obtuvieron una puntuación media igual o superior a 3. El cuestionario resultante modificado consta de 17 ítems en «causas de admisiones adecuadas», 5 en «causas de admisiones inadecuadas», 15 en «causas de estancias adecuadas» y 10 en «causas de estancias inadecuadas». Conclusiones La identificación de ítems prioritarios para determinar la adecuación de los ingresos y las estancias prolongadas en nuestro medio y según la opinión de los expertos, podría definir un futuro instrumento para su utilización en nuestro entorno (AU)

Introduction and aim The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyze the appropriateness of hospital admissions and stays in our healthcare reality. Methods A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts’ evaluation was greater than or equal to 3. Results The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in “Reasons for Appropriate Admissions”, 5 in “Reasons for Inappropriate Admissions”, 15 in “Reasons for Appropriate Hospital Stays”, and 10 in “Reasons for Inappropriate Hospital Stays”. Conclusions The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting (AU)

Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP).

INTRODUCTION AND AIM: The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyse the appropriateness of hospital admissions and stays in our healthcare reality. METHODS: A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts' evaluation was greater than or equal to 3. RESULTS: The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in "Reasons for Appropriate Admissions," 5 in "Reasons for Inappropriate Admissions," 15 in "Reasons for Appropriate Hospital Stays," and 10 in "Reasons for Inappropriate Hospital Stays." CONCLUSIONS: The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting.

Situación actual de la atención a las enfermedades emergentes en los servicios de urgencias hospitalarias españoles / Current status of medical care of emerging infectious diseases at hospital emergency services in Spain

Fundamento: Conocer la situación organizativa de los hospitales españoles de cara a facilitar la atención adecuadaen los servicios de urgencias (SUH) de los pacientes queacudan con sospecha de infecciones de origen tropical. Método: Estudio descriptivo transversal mediante cuestionario en formato Google Forms® enviado a los miembros delgrupo de INFURG-SEMES. Se estudiaron variables como eltamaño del hospital a través del número de camas, el númerode urgencias de patología tropical, la existencia de protocolos de medicina tropical, de pruebas diagnósticas urgentes otratamiento antimalárico. Resultados: Se envió el formulario a 75 hospitales, obteniendo respuesta de 42 servicios de urgencias (55%), pertenecientes a 10 comunidades autónomas. Veinticuatro (57,1%)tenían más de 500 camas. Solo cinco hospitales (11,9%) podían diagnosticar malaria y dengue las 24 horas. En 19 hospitales (45,3%) no existía ningún protocolo de enfermedadtropical. En siete hospitales (16,7%) se realizaban diez o másasistencias/día. En los hospitales de mayor tamaño era másfrecuente la existencia de un servicio de enfermedades infecciosas independiente del servicio de Medicina Interna, unaunidad de medicina tropical, un infectólogo de guardia y unmicrobiólogo de guardia. No existen diferencias estadísticamente significativas entre los hospitales de mayor y menortamaño en cuanto a la capacidad para realizar diagnósticos otratamiento adecuados durante las 24 horas. Conclusiones: La atención de la patología importada supone un volumen no despreciable de consultas en los SUH,donde en general, se observa una ausencia de protocolosespecíficos, en especial, el protocolo específico de malaria,así como de escasa disponibilidad de prueba diagnósticaurgente de malaria.(AU)

Background: The aim of this study is to determine the current status of Spanish Hospital Emergency Services (HES) indiagnosing and treating the most prevalent tropical diseases (TD) in Spain. Methods: A cross-sectional descriptive study was carriedout, using a questionnaire in Google Forms® sent to members of the INFURG-SEMES group. The following variableswere analyzed: the size of the hospital in terms of numberof beds, number of tropical disease emergencies, existenceof tropical medicine protocols, urgent diagnostic tests orantimalarial treatment. Results: The form was sent to 75 hospitals. Responses wereobtained from 42 emergency services (55%) in 10 Autonomous Communities. Twenty-four (57.1%) had >500 beds.Only five hospitals (11.9%) have the facilities to diagnosemalaria and dengue 24 hours a day. There was no tropicaldisease protocol in 19 (45.3%) hospitals. Seven (16.7%)hospitals had ≥ 10 attendances/day. Larger hospitals weremore likely to have an infectious disease unit independentfrom Internal Medicine service, along with a tropical medicine unit, and an on-call infectious disease specialist andmicrobiologist. There are no statistically significant differences between larger and smaller hospitals in terms of theircapacity to carry out appropriate diagnoses or treatmentsin 24 hours. Conclusion: Care and treatment of emerging diseases arenow a sizeable percentage of the consultations at an HES.Such units generally lack specific protocols, particularly formalaria. Urgent diagnostic testing for malaria is also needed.(AU)

[Current status of medical care of emerging infectious diseases at hospital emergency services in Spain].

BACKGROUND: The aim of this study is to determine the current status of Spanish Hospital Emergency Services (HES) in diagnosing and treating the most prevalent tropical diseases (TD) in Spain. METHODS: A cross-sectional descriptive study was carried out, using a questionnaire in Google Forms® sent to members of the INFURG-SEMES group. The following variables were analyzed: the size of the hospital in terms of number of beds, number of tropical disease emergencies, existence of tropical medicine protocols, urgent diagnostic tests or antimalarial treatment. RESULTS: The form was sent to 75 hospitals. Responses were obtained from 42 emergency services (55%) in 10 Autonomous Communities. Twenty-four (57.1%) had >500 beds. Only five hospitals (11.9%) have the facilities to diagnose malaria and dengue 24 hours a day. There was no tropical disease protocol in 19 (45.3%) hospitals. Seven (16.7%) hospitals had =?10 attendances/day. Larger hospitals were more likely to have an infectious disease unit independent from Internal Medicine service, along with a tropical medicine unit, and an on-call infectious disease specialist and microbiologist. There are no statistically significant differences between larger and smaller hospitals in terms of their capacity to carry out appropri-ate diagnoses or treatments in 24 hours. CONCLUSION: Care and treatment of emerging diseases are now a sizeable percentage of the consultations at an HES. Such units generally lack specific protocols, particularly for malaria. Urgent diagnostic testing for malaria is also needed.