ABSTRACT
INTRODUCCIÓN: La capacidad organizativa en términos de recursos y circuitos asistenciales que permiten acortar el tiempo de respuesta ante un nuevo caso de ictus es clave para obtener un buen resultado. En este estudio se compararon el abordaje terapéutico y los resultados del tratamiento de centros de asistencia tradicional (equipos de ictus, sin Unidad de Ictus) y con Unidad de Ictus. MÉTODOS: Estudio de tipo prospectivo, cuasiexperimental (sin aleatorización de las unidades analizadas) para realizar comparaciones entre 2 centros con Unidad de Ictus y 4 centros con atención tradicional por Neurología, sobre una selección de indicadores consensuados para monitorizar la calidad de la atención en ictus. Participaron 225 pacientes. Además, se utilizaron cuestionarios autoadministrados para recoger la valoración del servicio y la asistencia sanitaria recibida por parte de los pacientes. RESULTADOS: Los centros con Unidad de Ictus mostraron menores tiempos de respuesta tras el inicio de los síntomas, tanto al tiempo para llegar al centro, como para el diagnóstico por imagen considerando la hora de llegada del paciente al hospital. La capacidad de respuesta para aplicar tratamiento con trombólisis intravenosa fue mayor entre los hospitales con Unidad de Ictus frente a los centros con atención tradicional por Neurología. CONCLUSIÓN: Los centros con Unidad de Ictus mostraron un mejor ajuste a los estándares de tiempos de respuesta de referencia en el ictus, calculados en el estudio Quick frente a los centros con atención tradicional por Neurología
INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department
Subject(s)
Humans , Male , Female , Aged , Medicine , Stroke/diagnosis , Stroke/drug therapy , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Health Resources , Hospitals , Prospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department.
Subject(s)
Medicine , Stroke , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , Female , Health Resources , Hospitals , Humans , Male , Prospective Studies , Spain , Stroke/diagnosis , Stroke/drug therapy , Surveys and Questionnaires , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Neurology/education , Neurology/ethics , Hospitals/ethics , Hospitals , Stroke/complications , Stroke/diagnosis , Neurology , Neurology/methods , Hospitals/classification , Hospitals , Observational Study , Stroke/metabolism , Stroke/pathologyABSTRACT
Objetivo: Las interconsultas hospitalarias (ICh) constituyen un servicio que se ofrece de unas especialidades médicas a otras con la función de ayudar a resolver las complicaciones de los pacientes ingresados en las distintas unidades del hospital. El objetivo de este trabajo es analizar descriptivamente y con carácter temporal las ICh recibidas en nuestro servicio durante el último quinquenio. Método: Estudio retrospectivo de las ICh realizadas. Periodo: 2005-2009. Los datos analizados son: servicio de origen de la interconsulta, motivo de consulta, fecha, prioridad en la atención, diagnóstico definitivo, necesidad de seguimiento, necesidad de traslado y datos demográficos de los pacientes. Resultados: n=1458 ICh. Edad media 58,2±19,10. Varones: 837 (57,6%). Por año el número de ICh fue: 2005: 263; 2006: 226; 2007: 239; 2007: 239, 2008: 329 y 2009: 401. El 86,8% tenían prioridad normal, 8,5% preferente y 4,7% urgentes. Urgencias (12%), Cardiología (10,9%), Medicina Interna (9,8%) y Psiquiatría (8,9%) fueron los servicios con mayor demanda. Los motivos de consulta más frecuente fueron: pérdidas de conciencia y crisis epilépticas (24,6%), patología vascular cerebral (21,1%) y cuadros confusionales y deterioro cognitivo (13,4%). El 36,8% se resolvieron en la primera consulta y el resto (63,8%) precisaron de seguimiento. Precisaron traslado a Neurología el 8,4% de los casos valorados. Conclusiones: La ICh es una actividad compleja que no se resuelve en una única visita. Provoca una carga asistencial que crece cada año. La creciente complejidad diagnóstica de la neurología y los tratamientos cada vez más específicos son los factores que condicionan este aumento de la demanda(AU)
Objective: In-hospital consultation (IHC) is a service that some medical specialties provide to others with the aim of resolving complications in patients admitted to different hospital units. The aim of this study is to perform a descriptive analysis and longitudinal study of IHCs received in our department during the last 5 years. Method: A retrospective study was conducted on the IHCs made within the period 2005-2009. The data analysed were as follows: department of origin of the IHC, reason for consult, date, priority of care, definitive diagnosis, need for follow-up, need for transfer, and the demographic data of the patients. Results: There were a total of 1458 IHCs in the period studied. The mean age of the patients was 58.2±19.10 years, and 837 (57.6%) were males. The number of IHCs per year was: 2005: 263; 2006: 226; 2007: 239; 2007: 239, 2008: 329 and 2009: 401. The majority (86.8%) had normal priority, 8.5% high priority, and 4.7% were urgent. The Emergency Department (12%), Cardiology (10.9%), General Medicine (9.8%) and Psychiatry (8.9%) were the services with the highest demand. The most frequent reasons for consulting were loss of consciousness and epileptic seizures (24.6%), cerebral vascular disease (21.1%), and confusional states and cognitive impairment (13.4%). Over one third (36.8%) were resolved in the first consultation, and the remainder (63.8%) required follow up. Of all the cases assessed, 8.4% required transfer to Neurology. Conclusions: IHC is a complex activity that may not resolve all questions in a single visit. It involves a health care burden which is increasing annually. The increasing diagnostic complexity of the neurology, as well as the increasingly more specific treatments are the factors that lead to this higher demand(AU)
Subject(s)
Humans , Referral and Consultation/statistics & numerical data , Tertiary Healthcare , Nervous System Diseases/epidemiology , Quality Improvement/trends , Patient Transfer/trendsABSTRACT
OBJECTIVE: In-hospital consultation (IHC) is a service that some medical specialties provide to others with the aim of resolving complications in patients admitted to different hospital units. The aim of this study is to perform a descriptive analysis and longitudinal study of IHCs received in our department during the last 5 years. METHOD: A retrospective study was conducted on the IHCs made within the period 2005-2009. The data analysed were as follows: department of origin of the IHC, reason for consult, date, priority of care, definitive diagnosis, need for follow-up, need for transfer, and the demographic data of the patients. RESULTS: There were a total of 1458 IHCs in the period studied. The mean age of the patients was 58.2 ± 19.10 years, and 837 (57.6%) were males. The number of IHCs per year was: 2005: 263; 2006: 226; 2007: 239; 2007: 239, 2008: 329 and 2009: 401. The majority (86.8%) had normal priority, 8.5% high priority, and 4.7% were urgent. The Emergency Department (12%), Cardiology (10.9%), General Medicine (9.8%) and Psychiatry (8.9%) were the services with the highest demand. The most frequent reasons for consulting were loss of consciousness and epileptic seizures (24.6%), cerebral vascular disease (21.1%), and confusional states and cognitive impairment (13.4%). Over one third (36.8%) were resolved in the first consultation, and the remainder (63.8%) required follow up. Of all the cases assessed, 8.4% required transfer to Neurology. CONCLUSIONS: IHC is a complex activity that may not resolve all questions in a single visit. It involves a health care burden which is increasing annually. The increasing diagnostic complexity of the neurology, as well as the increasingly more specific treatments are the factors that lead to this higher demand.
Subject(s)
Hospital Units/organization & administration , Nervous System Diseases/therapy , Neurology , Referral and Consultation/statistics & numerical data , Referral and Consultation/trends , Documentation , Humans , Longitudinal Studies , Retrospective Studies , Spain , Tertiary Care CentersABSTRACT
No disponible
