ABSTRACT
Objetivos Describir y evaluar la repercusión de un sistema de detección e intervención precoz en pacientes de riesgo fuera de la UCI en la evolución de los pacientes ingresados en UCI y el número de paradas cardiorrespiratorias (PCR) hospitalarias. Ámbito Hospital de nivel 2 en la Comunidad de Madrid con historia clínica electrónica. Métodos Un intensivista revisa cada uno de los pacientes que cumplan los criterios de inclusión y decide la necesidad o no de intervención. Posteriormente, junto al médico a cargo del paciente, se determina cuál es el nivel de cuidados que necesita y se decide la pauta a seguir a continuación. Diseño Estudio descriptivo y cuasi-experimental «before-after». Resultados En el periodo de estudio se intervino en un total de 202 pacientes. Ciento cuarenta y siete fueron incluidos tras detectarse analíticas alteradas a través de nuestro programa informático. En el periodo de control la mortalidad en UCI fue 9 frente al 4,4% en el periodo de intervención (p=0,03). En el análisis multivariable, los 2 factores que guardaron relación significativa con la mortalidad fueron el haber ingresado durante el periodo de intervención OR 0,42 (IC95%; 0,18 a 0,98) (p=0,04) y el SAPS 3 OR 1,11 (IC95%; 1,07 a 1,14) (p<0,05). El número de avisos por PCR en el periodo control fue 10 frente 3 en el periodo de intervención (p=0,07).Conclusiones La actividad de detección precoz de pacientes en riesgo fuera de la UCI puede producir un efecto beneficioso sobre los pacientes ingresados en UCI así como una reducción de las PCR hospitalarias (AU)
Objectives To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. Setting A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories Methods An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. Design A descriptive and quasi-experimental before-after study was made. Results A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07).Conclusions Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests (AU)
Subject(s)
Humans , Intensive Care Units/organization & administration , Case Management/organization & administration , Risk Factors , Early Diagnosis , Patient-Centered Care/organization & administration , Electronic Health RecordsABSTRACT
OBJECTIVES: To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. SETTING: A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories. METHODS: An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. DESIGN: A descriptive and quasi-experimental "before-after" study was made. RESULTS: A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07). CONCLUSIONS: Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests.
Subject(s)
Early Diagnosis , Early Medical Intervention , Intensive Care Units , Adolescent , Adult , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Risk Factors , Young AdultSubject(s)
Echinococcosis/complications , Hypertension, Portal/etiology , Humans , Male , Middle AgedABSTRACT
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