High Complexity Public Hospital Research Articles

Model for managing scientific research in a public hospital: case study: Chilean National Cancer Institute, from 2015-2022.

Research is an essential element in the practice of healthcare, and hospitals play a fundamental role in its promotion. Research in hospitals can improve the quality of care, knowledge of diseases and the discovery of new therapies. Hospitals can conduct research in various fields, including basic research, clinical research, population-based research and even hospital management research. The findings of hospital research can be directly applied to clinical practice and management, thereby enhancing the quality of patient care, a central paradigm in translational health. This article details the experience of the National Cancer Institute of Chile over the past 8 years in its role as a high-complexity public hospital, specialised institute, healthcare centre, teaching institution, and research facility. It reviews the work of generating and strengthening its institutional research model since its redesign in 2018, the key elements that underpin it, and discusses the challenges the institute faces in its growth amidst the increasing cancer epidemiology in Chile, the recent enactment of a National Cancer Law, the post-pandemic scenario that has left a significant waiting list of oncology patients, and the initiation of the design and construction process for the new institute building.

Effectiveness of a skin care nursing unit on in-hospital pressure injuries in a Chilean hospital

Introduction: pressure injuries constitute a public health problem that impacts on people's health status and quality of life, increasing costs for hospital organisations. Aim: to evaluate the impact of a specialised skin care nursing unit on hospital-acquired pressure injuries in a high complexity public hospital in Chile. Methods: quantitative, quasi-experimental, prospective study. A non-probabilistic convenience sample of users who presented at least one pressure injury of in-hospital origin during the study year was used. Persons hospitalised in closed-care clinical services were included, including adult and paediatric emergency services. Results: 5106 people were evaluated, of whom 9,77 % presented pressure injuries. The average age was 67,27 years, the distribution by age group corresponded to 62,73 % in the elderly, 32,67 % in adults and 4,61 % in the paediatric/neonatal population. The clinical services with the highest number of pressure injuries corresponded to internal medicine and the adult intensive care unit. In relation to the anatomical area, the highest incidence was in the sacral area and then the heel, with category 2 being the most frequent. The incidence prior to the implementation of the intervention during the year 2021 corresponded to 28,75 %, while after the strategy it was quantified as 9,7 % (p<0,001). Conclusions: implementing a specialised skin care nursing unit has an impact on reducing the incidence of pressure injuries in hospitalised persons

Quality analysis of prescriptions of polymyxin B in a high-complexity public hospital

Objectives: The study proposed to evaluate the quality of polymyxin B prescription in a Brazilian high-complexity public teaching and reference hospital. Methods: This study of drug use describes the medical prescription habits, with the retrospective collection carried out with critically ill patients using polymyxin B. The dose by weight for each patient's first prescription was calculated from the Infectious Diseases Society of America (IDSA) guideline to assess the loading dose adequacy. The glomerular filtration rate (GFR) was estimated to evaluate the adequacy of the dose prescribed at the onset of treatment, based on the Kidney Disease – Improving Global Outcomes (KDIGO). Results: 346 prescriptions were analyzed, representing 259 patients. Only 61 (17.6%) included a loading dose of polymyxin B. On the other hand, no adjusted doses were identified in 147 (73.1%) prescriptions for patients whose GFR range requires renal adjustment. A total of 438 cultures were analyzed, and 97 carbapenem-resistant GNB were selected for the study (22.2%). A loading dose was identified in only 13 (13.4%) of these prescriptions, and 80 (82.5%) prescriptions had no dose adjustment by renal function. The prevalent microorganism was Klebsiella pneumoniae (70 [16.0%]). Conclusion: The study identified high rates of non-compliance with the protocol for using polymyxin B concerning the loading dose and a high percentage of cases in compliance with the protocol regarding the nonindication of renal adjustment. The development of institutional clinical protocols and the performance of the ASP team are critical to rationalizing the use and avoiding unsatisfactory clinical and microbiological results.

Implementation of advanced triage in the Emergency Department of high complexity public hospital: Research protocol.

To evaluate the efficacy of advanced nurse triage based on the quality of care outcomes of patients attending the Emergency Department of a high-complexity hospital. To analyse the concept of advanced triage and the essential elements of the construct. Mixed longitudinal study, divided into 4 steps; which will include an initial qualitative step, two observational studies and finally, a quasi-experimental study. NCT05230108. Step 1 will consist of a concept analysis. Step 2 will include a mapping of advanced practice protocol terminologies. Step 3 will analyse the opinion of health professionals on advanced triage. In step 4: in the retrospective phase (n=1095), sociodemographic and clinical variables and quality indicators such as waiting time will be analysed. After that, in the prospective phase (n=547), advanced triage will be implemented and the two cohorts will be compared. The whole study will be carried out from January 2022 to January 2024. Patients classified as low complexity at triage are more vulnerable to emergency department overcrowding. The implementation of advanced triage would make it possible to respond to patient needs by offering equitable and quality healthcare, facilitating accessibility, safety and humanization of the emergency department.

Maternal and neonatal factors associated with hospital readmission of newborns of adolescent mothers.

To analyze the maternal and neonatal factors in newborns of adolescent mothers associated with hospital readmission in the neonatal period. Quantitative cross-sectional, retrospective and analytical study, with 489 newborns of adolescent mothers, born in 2019 and 2020 in a high-complexity public hospital in southern Brazil. Data were collected through a query and analyzed in the SPSS software using the chi-square or Fisher's exact tests. To control for confounding factors, the multivariate Poisson regression model was used. The prevalence of hospital readmissions for newborns of adolescent mothers was 9.2%, mainly due to respiratory conditions, being the most prevalent the diagnosis of acute bronchiolitis, at 22.3%. Neonatal hospital readmission was associated with prematurity, 1st minute Apgar <7 and maternal origin.

Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

BackgroundDelayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care.MethodsA descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007–2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student’s T test and Pearson’s chi-square test (χ2) were used.ResultsA total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

Causality and avoidability of adverse drug reactions of antibiotics in hospitalized children: a cohort study.

Adverse drug reactions are a problem in healthcare systems worldwide. Children are more susceptible than adults, especially when exposed to specific drug classes, such as antibiotics. To assess the incidence, causality, severity, andavoidabilityof antibiotic-associated adverse drug reactions in hospitalized pediatric patients. Pediatric ward of a high-complexity public hospital in northeast Brazil. A prospective cohort study was conducted over six months, including children aged between 28days and 12years, hospitalized for more than 48h, and receiving antibiotics. Liverpool's causality and avoidability assessment tools were used.Primary outcome measures: Incidence of adverse drug reactions, causality, severity, and avoidability,major antibiotics implicated, risk factors. A total of 183 patients were followed, and 35 suspected adverse drug reactions were recorded overall incidence equal to 14.7%. Most adverse drug reactions were classified as moderate severity (76.7%), probable (57.1%) and defined (28.6%) causality, and unavoidable (66.7%). The affected organs were the gastrointestinal system (74.1%) and skin (25.9%). Major antibiotics implicated were ceftriaxone (40.7%), azithromycin (25.9%), and crystalline penicillin (11.1%). The number of antibiotics prescribed per patient during hospitalization and the length of stay were the risk factors identified. Causality and severity assessment indicated that most adverse drug reactions were probable and moderate. Possibly avoidable reactions occurred due to inappropriate prescribing when preventive measures were not implemented. Monitoring the use of antibiotics in children is essential to ensure the safety of these patients.

Psychometric Properties of the Spanish Version of the Work Ability Index in Working Individuals.

It is increasingly important to have validated instruments to assess the ability to work. Thus, the aim of this study was to evaluate the psychometric properties of the Spanish version of the Work Ability Index (WAI) in working individuals. A cross-sectional study was conducted on 360 workers (men and women) in a high-complexity public hospital and in a public university. The participants were between 40 and 75 years, with a contract of at least 11 h weekly. The ability to work was assessed using the WAI and the perception of health through the Short Form 36 Health Survey version 2 (SF-36 v2). The concurrent validity was analyzed, correlating the WAI with the SF-36 v2. An exploratory factor analysis was performed to test construct validity. In addition, the internal consistency of the WAI was analyzed using the standardized Cronbach's alpha coefficient. The WAI showed a positive and statistically significant correlation (p < 0.001) with the SF-36 v2. The exploratory factor analysis showed three factors interpreted as, "Mental Resources", "Diseases and Health-Related Restrictions", and "Self-perception of Work Ability". The reliability of the factors was acceptable, except for the second factor, which was poor. The WAI demonstrated acceptable psychometric properties, such as internal consistency, concurrent and construct validity, constituting a reliable instrument to measure work ability for the population of active working individuals in the service sector.

Assessment of safety culture in a public hospital in the Federal District, Brazil.

to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil. cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out. 358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7. the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

Sintomas osteomusculares em profissionais de enfermagem de um hospital público

Introdução: A enfermagem é uma profissão exaustiva, acarretando desgaste físico e mental, que podem adoecer o trabalhador e, no Brasil, perfaz um número expressivo de profissionais. Objetivo: identificar sintomas osteomusculares, sua frequência e interferências em profissionais de enfermagem de um hospital público de alta complexidade. Métodos: Trata-se de um estudo observacional com 37 técnicos de enfermagem que responderam um questionário semi-estruturado e o Questionário Nórdico de Sintomas Osteomusculares (QNSO). Na análise dos dados utilizaram-se estatística descritiva e índices de correlação. Resultados: Os profissionais de enfermagem investigados eram adultos jovens, trabalhando em período matutino (56,7%), mulheres (59,5%), em união estável (51,3%), brancos (54%), católicos (35,1%) e com escolaridade a nível técnico (56,7%). De acordo com os resultados do QNSO em relação aos últimos 12 meses, 97,3%apresentaram alguma dor, desconforto ou dormência como queixa e 67,5% nos últimos sete dias sendo as regiões mais citadas a parte inferior e superior das costas. Não houve correlação da idade com a intensidade dos sintomas avaliados. Conclusão: Medidas de promoção e prevenção devem ser tomadas para tentar reduzir os sintomas na saúde desses trabalhadores, proporcionando bem estar e consequente melhoria do atendimento prestado ao paciente.

Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury

BackgroundPain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience. AimsTo investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury. MethodsThis was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury. ResultsThe BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001). ConclusionsOur results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.

Perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil

BackgroundDuring the process of implementation of clinical pharmacy services, internal and external factors may favor or hinder the incorporation of care into the hospital routine. This study aimed to understand the perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil.MethodsA focus group with 16 pharmacists and interviews with tree key stakeholders including managers in the pharmaceutical, medical, and nursing profession were conducted to understand their perceptions of the implementation clinical pharmacy services in a high complexity public hospital in Brazil. The service proposal was presented to the selected participants before conducting the focus group. Professionals with an overview of the hospital and influence on the relevant departments for the implementation of clinical pharmacy at the institution were selected. Data collected were transcribed and analyzed using the Bardin Content Analysis technique. Data analyzed were systematized into categories and registration units. The methodology involves the organization and analysis of reported content to make inferences.ResultsThe data obtained were divided into four categories: “Perception of the current situation”, “Implementation expectations”, “Barriers to implementation”, “Implementation facilitators”. Participants discussed the stagnation of clinical activities of the pharmaceutical profession in Brazil, a reality that results from a lack of clinical training in the country. Pharmacists expressed their expectations for changes in professional performance. According to the managers, such services would positively affect clinical outcomes for patients. Gaps in academic education, lack of knowledge, and poor communication skills were barriers reported in this study. Pharmacists’ clinical experience has been reported to facilitate the provision of services.ConclusionsThis study highlights factors that may influence the implementation of clinical pharmacy services in the institution analyzed, such as resistance, fear, and frustration as barriers, as well the experience in clinical pharmacy of some pharmacists in the institution was one of the facilitators most cited by participants. This knowledge may aid future planning for the implementation of clinical pharmacy in hospitals.

Early readmission in a high complexity public hospital in cardiology

Objective: to evaluate the early readmission of patients in a high complexity public hospital in cardiology. Methods: this is a descriptive, documental and retrospective study, carried out in a public hospital. Results: in 2012, 729 of the 9,218 hospitalized patients were readmitted, 47.9% of them were readmitted within 30 days after discharge, 61% were men, with a mean age of 57 years old, with the main medical diagnosis of heart disease (heart failure, treatment of acute coronary syndrome, among others) on admission (44.7%) and readmission (45.8%). Most were readmitted for the same medical reason that led to their first hospitalization. Conclusion: considering the profile of the population admitted and readmitted to the institution, it is believed that the rate of readmission is mainly due to the profile of the patients, considering the high prevalence of non-communicable chronic diseases, and coronary artery disease considered unapproachable for percutaneous or surgical when hospitalized.

Profile of otorhinolaryngology emergency unit care in a high complexity public hospital

Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations. ObjectiveTo evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital. MethodEpidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngealstomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits. Results17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/ urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology. ConclusionAmong the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.

RISK, MEDICINE AND WOMEN: A CASE STUDY ON PRENATAL GENETIC COUNSELLING IN BRAZIL

Genetic counselling is an important aspect of prenatal care in many developed countries. This tendency has also begun to emerge in Brazil, although few medical centres offer this service. Genetic counselling provides prenatal risk control through a process of individual decision-making based on medical information, in a context where diagnostic and therapeutic possibilities overlap. Detection of severe foetal anomalies can lead to a decision involving possible termination of pregnancy. This paper focuses on medical and legal consequences of the detection of severe foetal anomalies, mainly anencephaly and Down syndrome, and in light of the fact that abortion is illegal in Brazil. The discussion is based on the literature and empirical research at a high-complexity public hospital in Rio de Janeiro.