RT info:eu-repo/semantics/article
T1 Does my patient really need this at admission? Seven opportunities for improving value in patient care during their hospitalization
A1 Corral Gudino, Luis
A1 Rivas-Lamazares, Alicia
A1 González-Fernández, Ana
A1 Rodríguez-María, Miriam
A1 Aguilera-Sanz, Carmen
A1 Tierra-Rodríguez, Ana
A1 Runza-Buznego, Paula
A1 Hernández-Martín, Ester
A1 Ortega-Gil, Martín
A1 Bahamonde-Carrasco, Alberto
K1 Evidence-based medicine; Health services misuse; Medicalization; Quality control; Unnecessary procedures.
K1 3205 Medicina Interna
AB Introduction: Besides the main treatment for their disease, hospital patients receive multiple care measures which include venous lines (VL), urinary catheters (UC), dietary restrictions (DR), mandatory bed rest (BR), deep venous thrombosis prophylaxis (VTP), stress ulcer prophylaxis (SUP) and anticoagulation bridge therapy for atrial fibrillation (BAF). In many cases these practices are of low value.Methods: We analysed patients admitted to Internal Medicine wards throughout 2018 (2714 inpatients). We used different methodologies to identify low-value clinical practices.Results: BR or DR at admission were recommended in 37% (32-44) and 24% (19-30) of the patients respectively. In 81% (71-87) and 33% (21-45) of the cases this restriction was deemed unnecessary. Ninety-six percent (92-98) had VL and 25% (19-32) UC. VL were not used in 10% (6-12), UC had no indications for insertion in 21% (11-35) and for maintenance in 31% (12-46) patients. Fifty-seven percent (49-64) of the patients were administered VTP and 69% (62-76) were prescribed SUP. Twenty-two percent (15-31) of patients with VTP and 52% (43-60) with SUP had no indication. Chronic anticoagulation for AF was interrupted in 65% (53-75) with BAF was prescribed in 38% (25-52) of them. An intervention to reduce low-value care supporting clinical practices addressed only to the Internal Medicine Wards showed very poor results.Conclusion: These results demonstrate that there is ample room for reduction of low-value care. Interventions to implement clinical guidelines at admissions should be addressed to cover the entire admission process, from the emergency room to the ward. Partial approaches are discouraged.
PB Elsevier
SN 0953-6205
YR 2019
FD 2019
LK https://uvadoc.uva.es/handle/10324/65043
UL https://uvadoc.uva.es/handle/10324/65043
LA eng
NO European Journal of Internal Medicine, Agosto 2019, vol 66, p. 92-98.
NO Producción Científica
DS UVaDOC
RD 24-nov-2024