RESUMO
La identificación de pacientes en situación de enfermedad crónica avanzada y complejidad, y la fragmentación de cuidados hacia el final de la vida aconsejan trazar un plan terapéutico a largo plazo, congruente con los valores y preferencias de los pacientes, a la vez que con un pronóstico vital y funcional razonables. Disponer de una herramienta de ajuste en la adecuación de la intensidad diagnóstica y terapéutica sería de ayuda en la continuidad de cuidados y podría ser facilitadora de la toma de decisiones en las transiciones y en los cambios dinámicos que presentan los pacientes a medida que se acercan al final del proceso vital
The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process
Assuntos
Humanos , Masculino , Feminino , Idoso , Cuidados Paliativos na Terminalidade da Vida/métodos , Múltiplas Afecções Crônicas/epidemiologia , Planejamento Antecipado de Cuidados/organização & administração , Gestão e Planejamento de Terrenos , Diagnóstico da Situação de Saúde , Técnicas de Apoio para a Decisão , Hospitalização/estatística & dados numéricos , Transplante de Órgãos/estatística & dados numéricos , Avaliação Geriátrica/métodosRESUMO
The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process.
Assuntos
Planejamento Antecipado de Cuidados/normas , Assistência Terminal/normas , Conferências de Consenso como Assunto , Humanos , Cuidados para Prolongar a Vida/normas , Espanha , Saúde da População UrbanaRESUMO
Objetivo: Analizar el impacto de la implementación de medidas para reducir el número de pacientes ubicados en urgencias en es pera de cama de hospitalización. Método: Tipo de estudio: comparativo con un análisis retrospectivo. Se compararon dos periodos: periodo 1 (nov 06-oct 07) y periodo 2 (nov 07-oct 08). Ámbito: Hospitalde Sant Boi, hospital general de 126 camas, en Sant Boi de Llobregat (Barcelona). Medidas implementadas: disminución de la estancia prequirúrgica, incremento de la cirugía mayor ambulatoria (CMA) y potenciación del ingreso en una unidad de corta estancia médica (UCE). Variables estudiadas: admisiones en el SUH, ingresos hospitalarios, ingresos de CMA, el número de días en que hay al menos 1 paciente pendiente de cama hospitalaria en el SUH a las 8:00 horas, estancia promedio hospitalaria, actividad y estancia promedio en la UCE. Resultados: El total de admisiones en el SUH fue de 57.140 en el periodo 1, y 71.280 en el periodo 2, con 4.840 (8,4%) y 5.385 (7,5%) ingresos, respectivamente. La estancia media de hospitalización disminuyó de 5,2 días a 4,5 días (p < 0,001). En 86 días del periodo 1, uno o más pacientes permanecían en el SUH pendientes de cama (307 pacientes/año), frente a 11 días en el período 2 (26 pacientes/año). Conclusiones: En nuestra experiencia, las medidas de gestión aplicadas fueron eficaces en la disminución del número de pacientes pendientes de cama en urgencias (AU)
Objective: To analyze the impact of hospital management measures to reduce the number of patients held in an emergency department while awaiting admission. Methods: Type of study: retrospective, comparing 2 periods, November 2006 to October 2007 and November 2007 to October 2008. Setting: Hospital de Sant Boi, a 126-bed general hospital in Sant Boi de Llobregat in the province of Barcelona. Management measures: decreased presurgical stay, increased use of ambulatory surgical procedures, and increased use of a medical short-stay unit. Variables studied: emergency department admissions, hospital ward admissions, admissions for ambulatory surgical procedures, number of days in which at least 1 patient was in the emergency department at 8 A.M. while waiting for a bed, mean hospital stay, and admissions and average time spent in the short-stay unit. Results: A total of 57140 patients were admitted to the emergency department in the first period and 71280 in the second period; 4840 (8.4%) were admitted to hospital in the first period and 5385 (7.5%) in the second. The average length of stay was 5.19 days in the first period and 4.54 days in the second (P<.001). At least 1 patient was waiting in the emergency department for a hospital bed to become available on 86 days in the first period (307 patients/year) and11 days in the second period (26 patients/year). Conclusions: The management measures applied in this case were effective in reducing the number of patients held in the emergency department while waiting for admission (AU)
