Abstract
ABSTRACTObjective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding.Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs.Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management.Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.
Highlights
Severe hemorrhage is an important cause of mortality and morbidity in several clinical settings, including trauma, surgery and obstetrics.[1,2,3,4,5,6,7] The estimated total number of deaths associated with hemorrhage and hemorrhagic shock is 1.9 million per year, worldwide.[8]. Hemorrhagic shock is characterized by severe blood loss, which leads to inadequate oxygen delivery at cell level and quickly results in death
At the Hospital Israelita Albert Einstein (HIAE), from January 2013 to April 2016, the number of catastrophic adverse events related to failure in bleeding management was 29% (n=14) among the total catastrophic adverse events at the organization (n=49) (Figure 1)
The main objectives of Code H are early identification of signs and symptoms of bleeding, and the rapid implementation of treatment, through the emergency services of the hospital. This protocol requires a wellcoordinated team from different departments of the hospital, such as the intensive care unit (ICU), anesthesia team, blood bank, clinical laboratory, diagnostic imaging services, vascular intervention team and operating room (Figure 3)
Summary
Severe hemorrhage is an important cause of mortality and morbidity in several clinical settings, including trauma, surgery and obstetrics.[1,2,3,4,5,6,7] The estimated total number of deaths associated with hemorrhage and hemorrhagic shock is 1.9 million per year, worldwide.[8]. Non-fatal hemorrhagic events require additional therapies, prolonged hospital stay, use of hemostatic agents, and discontinuing antithrombotic agents. This interruption, in turn, can result in a negative outcome for patients at risk for thrombosis.[1,2,3,4,5,6]. At the Hospital Israelita Albert Einstein (HIAE), from January 2013 to April 2016, the number of catastrophic adverse events related to failure in bleeding management was 29% (n=14) among the total catastrophic adverse events at the organization (n=49) (Figure 1). One of the key points of a successful treatment is the timing of the intervention. In addition to rapid interventions, a coordination between the different services in the hospital environment and a preventive bleeding management plan are essential.[7]
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