ABSTRACT
BACKGROUND: Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement. METHODS: Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh. RESULTS: Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997-2001 and in 21% in 2003-2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002). CONCLUSION: Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.
ABSTRACT
El 30% de la demanda no atendida del Departamento de Urgencias de la Fundación Santa Fé de Bogotá era ocasionada por el Servicio de Ortopedia y Traumatología debido a tiempos de espera prolongados. Usando metodología Seis Sigma se identifi caron tres puntos críticos en el proceso de atención de pacientes: a) Capacidad física limitada para el alojamiento de pacientes, b) Demora en el llamado de pacientes de ortopedia y c) Demora en la toma de imágenes diagnósticas. Con la asistencia para funciones paralelas del ortopedista y del técnico de radiología se logró una reducción significativa en los tiempos de atención. Puntualmente se logró una reducción del 20% en el tiempo de toma de radiografías (p< 0.05) y la demanda no atendida se redujo a 0 en los últimos cuatro meses.
Subject(s)
Emergencies , Emergency Medical Services , Quality of Health Care , Trauma Centers , ColombiaABSTRACT
La Sección de Cirugía Reconstructiva de Cadera y Rodilla del Departamento de Ortopedia y Traumatología de la Fundación Santa Fe de Bogotá (FSFB) está participando desde marzo de 2003 en el GLORY (Global Orthopaedic Registry), una base de datos observacional, multinacional, que tiene por objetivo registrar en forma prospectiva los desenlaces de pacientes llevados a reemplazo total electivo y primario de cadera (RTC) y/o rodilla (RTR). El objetivo de este trabajo es presentar de manera comparativa los datos de RTR de nuestra Sección y los del resto del mundo, tomando como fuente los reportes trimestrales del GLORY. Los datos principales son: admisión hospitalaria del paciente el día de cirugía (91% vs 71%); tipo de abordaje (anteromedial: 100% vs 89%); tipo de anestesia (general 85% vs 42%,); fijación de componente femoral (cemento 100% vs 90%, poroso 0% vs 9%); fijación de componente tibial (cemento 100% vs 94%, poroso 0% vs 5%); tipo de profilaxis antitromboembólica (medias de compresión graduada 88% vs 59%, HBPM 74% vs 58%, pentasacárido 59% vs 1%), duración de la hospitalización (4.5 vs 4 días); complicaciones (ninguna 85.3% vs 90.9%, infección 0% vs 0.4%, fractura 2.9% vs 0.1%, evento cerebro vascular 2.9% vs 0.1%, evento tromboembólico venoso 0% vs 1.3% y otros 8.8% vs 3.4%).