Estado de la provisión de cuidados nutricionales al paciente quemado. Auditoría de procesos en un Servicio de Quemados de un hospital terciario / Current status of nutritional care provision to burnt patients. Processes audit of a burnt patients department from a tertiary hospital

Justificación: La respuesta al tratamiento médico-quirúrgico del paciente quemado pudiera depender tanto de los estragos provocados por la agresión térmica, a saber las demandas metabólicas incrementadas, la aparición del Síndrome de Respuesta Inflamatoria Sistémica, y las infecciones microbianas; como de las prácticas culturales incluidas dentro de los procesos institucionales de cuidados nutricionales. Objetivo: Evaluar cómo la conducción de los procesos nutricionales de evaluación e intervención influye sobre los indicadores de la efectividad terapéutica de los Servicios de Quemados. Serie de estudio: Cuarenta y dos pacientes atendidos con una superficie corporal quemada (SCQ) > 10 por ciento, entre enero del 2001-diciembre del 2003, en el Servicio de Quemados del Hospital Clínico Quirúrgico Hermanos Ameijeiras (Ciudad La Habana, Cuba). Métodos: Los procesos nutricionales de evaluación e intervención conducidos en el paciente quemado se auditaron mediante revisión de las historias clínicas. Los procesos auditados se declararon como Completados (o no). El grado de completamiento del proceso se relacionó con las tasas de complicaciones y mortalidad, y el índice de hospitalización predicho de la SCQ. Resultados: Los procesos nutricionales de evaluación e intervención se completaron en el 49,4 por ciento y 22,6por ciento de las historias auditadas, respectivamente. El registro evolutivo del peso corporal se asoció con una menor mortalidad. La evaluación nutricional temprana y un aporte energético suficiente en lesionados con SCQ > 20 por ciento se asociaron con menores tasas de complicaciones y un mejor cumplimiento del índice de hospitalización. Conclusiones: Este trabajo constituye la primera aproximación al comportamiento del Servicio de Quemados de la institución, como antesala del diseño e implementación de un programa de mejoría continua de la calidad en la atención médica......(AU)

Rationale: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal agression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. Goal: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. Study serie: Forty-two patients with a Burn Body Surface Area (BBSA) > 10 percent assisted at the Burn Service of the Hermanos Ameijeiras Clinical Surgical Hospital (La Habana, Cuba), between January 2001-December 2003. Methods: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. Results: Nutritional care processes of assessment and intervention were completed in 49.4 percent and 22.6 percent of the audited charts, respectively. Prospective recording of patient's body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA > 20percent were associated with lower complications rates and better compliance with BBSA-predicted length of stay. Conclusions: This work is the first enquiry into the behaviour of the institution's Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service's effectiveness indicators(AU)

[Current status of nutritional care provision to burnt patients: processes audit of a burnt patients department from a tertiary hospital]. / Estado de la provisión de cuidados nutricionales al paciente quemado: Auditoría de procesos en un Servicio de Quemados de un hospital terciario.

RATIONALE: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal aggression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. GOAL: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. STUDY SERIES: Forty-two patients with a Burn Body Surface Area (BBSA)>10% assisted at the Burn Service of the "Hermanos Ameijeiras" Clinical Surgical Hospital (La Habana, Cuba), between January 2001-December 2003. METHODS: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. RESULTS: Nutritional care processes of assessment and intervention were completed in 49.4% and 22.6% of the audited charts, respectively. Prospective recording of patient's body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA>20% were associated with lower complications rates and better compliance with BBSA-predicted length of stay. CONCLUSIONS: This work is the first enquiry into the behaviour of the institution's Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service's effectiveness indicators.