La urgencia en una Unidad de Agudos de Geriatría

Resumen

Objetivo

Analizar motivos de consulta urgente al equipo de guardia y factores implicados.

Metodología

Estudio descriptivo prospectivo de avisos al médico de guardia en la Unidad de Hospitalización. Recogida de datos: edad, sexo, día de la semana, hora, motivo de llamada, razón del ingreso, tiempo de hospitalización, fármacos, petición de pruebas y modificaciones terapéuticas. Se han comparado pacientes con estancias menores o superiores a 48 horas.

Resultados

Se documentaron 102 llamadas, media diaria superior en días festivos. El 75% eran mujeres y la edad media, 82 años. Motivos de consulta más frecuente, problemas clínicos (delirium, fiebre y dolor), atención nuevos ingresos e información al familiar. La mayoría de avisos atendidos entre 15 y 20 horas, el 68% de pacientes llevaban más de 48 horas hospitalizados. El 55% de llamadas las realizó personal de enfermería y el 36%, a petición familiar. Principales causas de ingreso, de tipo neurológico y respiratorio. El 40% tratado con 6 o más fármacos. Se realizaron exploraciones complementarias al 22% de pacientes y en el 78% de avisos se indicaron modificaciones terapéuticas. Al comparar el grupo de estancia menor y mayor de 48 horas, no se observaron diferencias significativas, excepto para los ingresos de causa respiratoria (p < 0,05).

Conclusiones

La mayoría de avisos procede de pacientes con más de 48 horas de hospitalización, siendo el paciente respiratorio el que genera mayor atención en los primeros momentos; en un grupo numeroso de pacientes se adoptan medidas terapéuticas desde la valoración clínica, sin necesidad de otras pruebas complementarias. Se estima necesaria la búsqueda de un estándar relacionado con un índice de avisos internos que permita, en su caso, acciones de mejora en la atención del paciente geriátrico y su familia.

Summary

Objective

To analyse reasons for emergency calls to staff on duty and factors involved.

Method

Prospective, descriptive study of calls to physicians on duty in the Hospitalization Area. Data collection: age, sex, day of the week, time, reason for the call, reason for admission, hospitalization period, drugs, diagnostic tests, and therapeutic changes. Patients whose stays were longer and shorter than forty eight hours were compared.

Results

One hundred and two calls were documented, with the highest daily mean observed on non-working days. 75% of the calls were from women, and the average age was 82. The most frequent reasons for calls were clinical problems (delirium, fever and pain), new admissions and information to relatives. Most of the calls were attended between 3 and 8 p.m., and 68% of patients had already been hospitalized for more than 48 hours at the time of the call. 55% and 36% of calls were made by nursing staff and relatives respectively. The main reasons for admission were neurological or respiratory problems. 40% of patients were treated with six o more drugs. Complementary examinations were carried out in 22% of patients and therapeutic changes were indicated in 78% of cases. No significant differences were found when comparing those groups of patients with stays longer and shorter than 48 hours, except for the case of admissions due to respiratory problems (p < 0.05).

Conclusions

Most of calls come from patients who have been hospitalized for more than 48 hours. Patients with respiratory problems are those who require more attention at the first moment. Therapeutic measures are adopted immediately after the clinical evaluation in a significant group of patients, without need for complementary tests. It is necessary to look for a standard associated to an index of internal calls in order to improve the attention to the elderly patients and their families.