Prevalencia de caídas en pacientes ingresados en un hospital universitario / Prevalence of falls in patients admitted to a University Hospital

Objetivo: analizar la prevalencia de caídas de los pacientes hos­pitalizados en un hospital universitario, así como los factores asociados con la asistencia sanitaria (motivos de las caídas, especialidad más prevalente, turno más frecuente, si estaban solos o acompañados, etc.) en los pacientes que se cayeron y las posibles consecuencias de las caídas. Métodos: estudio transversal. Se incluyeron a todos los pacientes adultos ingresados en 20 unidades de hospitalización del Hospital Universitario de Burgos, que habían sufrido una caída en 2019 y estaban incluidos en el registro de caídas del programa GACELA Care®. El formulario consta de 28 campos de en­trada de datos, que aportan información relevante sobre la caída. Se llevó a cabo análisis descriptivo y comparativo, usando los test estadísticos correspondientes. Resultados: se registraron 244 caídas (0,9%). La edad media fue 73,3 años. El 54,4% tenía edad igual o mayor a 75 años. El 57,8% era del sexo masculino. En Medicina Interna (29,1%) y Psiquiatría (11,1%) se registró el mayor porcentaje de caídas. El 44,2% se produjo en turno de noche, en pacientes que estaban solos (71,7%), sin protecciones (70,5%); y deambulando (36,1%). El motivo principal fue la inestabilidad motora (48,4%). El 62,7% de los pacientes resultó ileso. La especialidad y el turno de trabajo se asociaron significativamente con las caídas. Conclusiones: la prevalencia de caídas en el hospital fue baja. Los factores que se relacionaron con mayor porcentaje de caídas fueron ser mayor de 75 años, sexo masculino, estar ingresado en unidades de especialidad médica y turno de noche. Las caídas ocurrieron habitualmente cuando el paciente estaba solo, sin protección, al levantarse y caminar. La mayoría de los pacientes no presentó lesiones.(AU)

Objective: to analyse the prevalence of falls in patients admitted to a University Hospital, as well as to identify the characteristics of those patients who experienced falls, the factors associated with patient care (reasons for falls, the most prevalent specialty, the most frequent shift, whether they were alone or accompanied, etc.) among patients who fell down, and the potential consequences of said falls. Methods: a cross-sectional study, including all adult patients admitted to 20 hospitalization units from the Hospital Universitario de Burgos, who had experienced a fall in 2019 and were included in the register of falls from the GACELA Care® program. The form consisted of 28 data entry fields, and included information about date, time and place of the fall; reasons for falls; consequences of falls, and action by professionals. Descriptive and comparative analysis was conducted, using the relevant statistical tests. Results: in total, 244 (0.9%) falls were registered. The mean age was 73.3 years; 57.8% were male. The highest proportion of falls was recorded at Internal Medicine (29.1%) and Psychiatry (11.1%); 44.2% occurred during the night shift, in patients who were alone (71.7%); without protections (70.5%); and walking around (36.1%). The main reason was motor instability (48,4%); 62.7% of patients remained unharmed. There was a significant association between specialty and work shift and falls. Conclusions: there was a low prevalence of falls in the hospital. The factors associated with a higher proportion of falls were being >75-year-old, male gender, being admitted to medical specialty units, and night shift. Falls commonly occurred when the patient was alone, without protection, when getting up and walking. Most patients did not present any lesions.(AU)

[A phase model of trauma rehabilitation : How can we avoid the "rehab-hole"?] / Phasenmodell der Traumarehabilitation : Wie können wir das "Rehaloch" vermeiden?

Advances in the rescue chain and first aid of polytrauma patients, which have consequently increased their chance of survival, have led to an increase in demands for rehabilitation. However, there is still a large hole in the continuity of rehabilitation between acute patient care and in-patient rehabilitation, the so-called "rehab-hole". The consequences are untapped rehabilitation potential, loss of strength, endurance and motivation as well as impairment of function of the patient.Based on the phase model of neurological/neurosurgical rehabilitation, we propose a step model for the rehabilitation of polytrauma patients that ensures an uninterrupted chain of rehabilitation. After acute patient care (phase a) and a potentially required early patient rehabilitation (phase b), trauma rehabilitation should seamlessly continue on to phase c. The implementation of phase c after acute patient rehabilitation requires changes in the structure of "orthopaedic" rehabilitation clinics and financial support due the large consumption of resources by more complexly injured patients in this phase. The subsequent rehabilitation in phase d is well established and complies with current rehabilitation measures (AHB, BGSW). Further rehabilitation measures may be essential for social and occupational reintegration of the patient (phase e), depending on the complexity of their injuries after the accident. For patients with long-lasting results after an accident, it is crucial to implement continuous follow-ups (phase f) to ensure a better long-term outcome.In order to implement this phase model it is necessary to establish specialized facilities that meet the particular requirements needed for phase c. This tri-phased treatment model in trauma centres can therefore be used in trauma rehabilitation. In addition to the already established local and regional rehabilitation centres, nationwide trauma rehabilitation centres have adopted phase c rehabilitation.