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Clasificación de la disposición de pacientes hospitalizados para la creación de capacidad de aumento de la capacidad

Gabor D Kelen¹, Chadd K Kraus, Melissa L McCarthy

¹Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. gkelen@jhmi.edu

Lancet (London, England)

|December 5, 2006

Resumen

Un nuevo sistema de cinco categorías clasifica a los pacientes hospitalizados para un alta temprana segura durante las cirugías hospitalarias. Este enfoque de clasificación inversa ayuda a gestionar el aumento del volumen de pacientes mediante la identificación de individuos de bajo riesgo para el alta.

Área de la Ciencia:

Gestión de Sistemas de Salud Gestión de Sistemas de Salud
Preparación para desastres Preparación para desastres
Disposición del paciente.

Sus antecedentes:

Los sistemas de salud se enfrentan a desafíos para gestionar el volumen de pacientes durante las emergencias.
El alta temprana segura de los pacientes hospitalizados (triaje inverso) puede aumentar la capacidad de aumento del hospital.
Se necesita un sistema para clasificar a los pacientes para el alta con base en el riesgo.

Objetivo del estudio:

Desarrollar un sistema de clasificación de disposición para categorizar a los pacientes hospitalizados en función de su idoneidad para el alta temprana.
Para evaluar la tolerancia al riesgo de eventos adversos después de la alta temprana.

Principales métodos:

Se llevó a cabo un ejercicio de laboratorio de análisis de guerra.
Se utilizaron técnicas basadas en la evidencia y un proceso de consenso que involucró a 39 panelistas expertos.
Los panelistas definieron categorías, asignaron tolerancia al riesgo, identificaron intervenciones críticas y clasificaron los riesgos de descarga.

Principales resultados:

Se acordó por unanimidad un sistema de clasificación de disposición en cinco categorías.
La tolerancia al riesgo de eventos adversos osciló entre <4% en el grupo de riesgo más bajo y 100% en el más alto.
Se identificaron 28 intervenciones críticas con probabilidades variables de eventos adversos si se retenían.

Conclusiones:

El sistema desarrollado clasifica conceptualmente a los pacientes para una disposición segura, incluida la alta temprana durante los picos de demanda.
Todavía se necesitan criterios clínicos para la categorización de pacientes en tiempo real dentro de este sistema.

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