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Mejorar la atención de los enfermos críticos: enfoques institucionales y del sistema de atención médica
1Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. angusdc@ccm.upmc.edu
Lancet (London, England)
|April 20, 2004
Resumen
La mejora de los cuidados intensivos requiere un enfoque multifacético, que combine estrategias institucionales con el cuidado de enfermos. Se recomienda una combinación de educación, directrices, informes de rendimiento, incentivos y reorganización del sistema para lograr un impacto sostenido.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Servicios de salud Investigación Servicios de salud Investigación
- Política de salud Política de salud
Sus antecedentes:
- La prestación de cuidados críticos se enfrenta a desafíos por el aumento de la demanda y las presiones de costos.
- Las estrategias de enfermería por sí solas son insuficientes para una atención óptima de pacientes en estado crítico.
- Los enfoques institucionales y del sistema de atención médica son complementos cruciales para dirigir la atención al paciente.
Objetivo del estudio:
- Revisar las estrategias institucionales y del sistema de atención médica para mejorar la atención crítica.
- Identificar enfoques efectivos para mejorar la atención de pacientes en estado crítico en los EE.UU. y el Reino Unido.
- Recomendar una estrategia integral para optimizar la prestación de cuidados intensivos.
Principales métodos:
- Revisión enfocada de siete enfoques institucionales y a nivel de sistema en los EE.UU. y el Reino Unido.
- Análisis de la educación, directrices organizacionales, informes de rendimiento, incentivos, regulación, requisitos legales y reorganización del sistema.
- La consideración de las iniciativas actuales y las direcciones futuras para la mejora de la atención crítica.
Principales resultados:
- Ningún enfoque único garantiza una mejora sostenida; es necesaria una combinación.
- Los informes de rendimiento vinculados a los incentivos financieros son prometedores.
- Se recomienda la educación pública y las directrices organizativas (por ejemplo, los criterios de admisión a la UCI, la dotación de personal).
- La reorganización de los servicios fundamentales, incluida la atención regionalizada y el uso de médicos extensores, es esencial.
Conclusiones:
- Se requiere una estrategia combinada de múltiples intervenciones institucionales y a nivel de sistema para una mejora sostenida en la atención crítica.
- Se recomienda el desarrollo continuo de informes de rendimiento, educación pública y directrices organizativas.
- La reorganización fundamental de los servicios de atención médica, incluida la regionalización y la ampliación del uso de profesionales avanzados, es vital para la prestación óptima de cuidados intensivos.
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