Mejora de parámetros asistenciales y económicos mediante asistencia compartida con medicina interna en pacientes psiquiátricos ingresados / Benefits of comanagement with internal medicine on health care and economic outcomes in psychiatric inpatients

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Efecto de la asistencia compartida (comanagement) con Medicina Interna sobre la estancia hospitalaria de los pacientes ingresados en el servicio de Oftalmología / Effect of co-management with Internal Medicine on hospital stay in Ophthalmology

OBJETIVO: Los pacientes ingresados en el Servicio de Oftalmología (OFT) están aumentando su edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en OFT. MÉTODOS: Estudio observacional retrospectivo de los pacientes ≥14 años ingresados desde el 1/1/2009 al 30/06/2013 en OFT; desde mayo de 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, número total de diagnósticos al alta, índice de comorbilidad de Charlson (ICh), fallecimiento, reingresos y estancia hospitalaria. RESULTADOS: Entre ambos grupos, hubo diferencias estadísticamente significativas en el porcentaje de pacientes operados (odds ratio [OR] 2,3, intervalo de confianza del 95% [IC 95%]: 1,5 a 3,6), peso administrativo (0,1160; IC 95%: 0,0738 a 0,1583) y número de diagnósticos (0,9; IC 95%: 0,5 a 1,3). Al ajustar, observamos que la AC redujo el 27,8% la estancia en OFT, 0,5 días (IC 95%: 0,1 a 1). CONCLUSIONES: Los enfermos ingresados en OFT están aumentando su comorbilidad y complejidad. La AC se asocia a una disminución de la estancia y costes en OFT, similares a los observados en otros servicios quirúrgicos

OBJECTIVE: Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH. METHODS: Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS. RESULTS: There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1). CONCLUSIONS: Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services

Effect of co-management with Internal Medicine on hospital stay in Ophthalmology.

OBJECTIVE: Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH. METHODS: Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS. RESULTS: There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1). CONCLUSIONS: Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.

Análisis de las interconsultas hospitalarias al servicio de medicina interna / Analysis of in-hospital consultations with the department of internal medicine

Objetivo: Una actividad importante y poco estudiada de los servicios de medicina interna (MI) son las interconsultas. Hemos analizado las solicitudes de interconsulta a MI y posibles diferencias entre las consultas de los servicios médicos y quirúrgicos. Pacientes y métodos: Estudio observacional prospectivo de 8 meses de duración. Se analizaron variables demográficas, relacionadas con la procedencia de la interconsulta, comorbilidad, estancia y mortalidad hospitalaria, urgencia, demora ingreso-solicitud, adecuación (no adecuado si otro servicio había sido consultado por el mismo motivo o porque la enfermedad motivo de consulta era propia del servicio solicitante) y, en los pacientes intervenidos quirúrgicamente, si fue solicitada antes o después de la intervención. Resultados: En el tiempo de estudio se recibieron 215 interconsultas (27 consultas/mes). La edad media fue de 69,8 años (mujeres 50%). El 30,7% fueron solicitadas por servicios médicos y el 69,3% por servicios quirúrgicos. Un 13% de las interconsultas estuvieron duplicadas. El servicio de MI no era el servicio consultado adecuado en el 23,3% (13,0% solicitadas por el mismo motivo a otro servicio y en el 14,3% la enfermedad era propia del servicio solicitante). Los lunes y viernes se formularon más interconsultas que los jueves (25,1 y 23,7% versus 15,3%; respectivamente, p=0,03). La demora entre el ingreso y la solicitud de interconsulta fue de 12,6 días. El 90,7% de las interconsultas solicitadas a pacientes intervenidos se emitieron después de la intervención. No hubo diferencias en las características de las interconsultas entre los servicios médicos y quirúrgicos. Conclusiones: Las interconsultas dirigidas a MI con frecuencia son duplicadas, no están bien dirigidas al servicio adecuado y se aprecia una incorrecta valoración de su urgencia. Estas características son similares para las consultas de los servicios médicos y quirúrgicos (AU)

Objective: An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. Patients and methods: This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. Results: During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. Conclusions: In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments (AU)

Analysis of in-hospital consultations with the department of internal medicine.

OBJECTIVE: An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. PATIENTS AND METHODS: This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. RESULTS: During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. CONCLUSIONS: In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments.

Problemas en la transmisión de información durante el proceso de la interconsulta médica hospitalaria / Problems in the transmission of information during within-hospital medical consultations and referrals

Objetivo: La interconsulta médica (ICM) tiene múltiples problemas, entre ellos están los relacionados con la transmisión oral y escrita de información. Nuestro objetivo es analizar problemas en la transmisión de información relacionada con la ICM, y posibles diferencias entre los servicios del área médica (AM) y quirúrgica (AQ). Material y métodos: Estudio observacional prospectivo de las ICM recibidas por Medicina Interna durante 8 meses. Analizamos edad, sexo, servicio peticionario, tipo de ICM, tipo de ingreso, comorbilidad, estancia y mortalidad hospitalarias, duración de la ICM, número de médicos del servicio solicitante responsables del paciente durante la ICM, repetición de ICM, información en la solicitud, historia clínica disponible, contacto verbal, conflicto entre médicos e información en el informe de alta. Resultados: Se recibieron 215 ICM, 66 (30,7%) solicitadas por AM y 149 (69,3%) por AQ. Duración de la ICM 3 días (desviación estándar [DE] 4,8). Médicos responsables 1,7 (DE 1,1). Hubo 43 repeticiones (20%). Urgentes 14 (6,5%). En 6 ICM (9,1%) del AM la información en la solicitud fue mínima y en 21 (27,5%) del AQ. Historia clínica disponible mínima en 2 ICM (3%) del AM y en 50 (33,6%) del AQ. Sin contacto verbal en 33 ICM (15,4%). Conflicto entre médicos 13 (6%). Información aceptable-buena en la solicitud de ICM urgente 100% AM y 80% AQ. Dos de cada 3 ICM sin referencia en el informe de alta. Conclusiones: Durante el proceso de la ICM existen pérdidas significativas en la transmisión de información, mayores en los servicios quirúrgicos que en los médicos (AU)

Objective: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. Material and methods: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. Results: Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request,6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. Conclusions: There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments (AU)

[Problems in the transmission of information during within-hospital medical consultations and referrals]. / Problemas en la transmisión de información durante el proceso de la interconsulta médica hospitalaria.

OBJECTIVE: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. MATERIAL AND METHODS: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. RESULTS: Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was 1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request, 6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. CONCLUSIONS: There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments.