Óscar Miró Andreu, Rosa Escoda, Francisco Javier Martín Sánchez, Pablo Herrero Puente, Javier Jacob Rodríguez, Aitor Alquezar, Alfonso Aguirre Tejedo, Víctor Gil, Juan Antonio Andueza, Pere Llorens Soriano
Objetivo. Constatar la calidad percibida de los pacientes con insuficiencia cardiaca aguda (ICA) dados de alta desde urgencias, compararla con la de los ingresados, e investigar las variables asociadas con la calidad percibida.
Método. Estudio diseñado prospectivamente, transversal, tipo caso-control, realizado en 7 servicios de urgencias en pacientes consecutivamente diagnosticados de ICA que valoraron mediante encuesta telefónica la atención médica, atención enfermera, trato global y grado de resolución del problema en urgencias. También se solicitó el grado de acuerdo con la decisión de alta directa desde urgencias. Se compararon los pacientes dados de alta e ingresados, y se investigó si estos resultados diferían en función de la existencia de eventos adversos los 30 días siguientes.
Resultados. Se incluyeron 1.147 casos y se entrevistaron 1.003 (87,4%): 253 pacientes (25,2%) fueron dados de alta.
No hubo diferencias significativas en la valoración que dieron a la asistencia médica, de enfermería, atención global y resolución del problema entre pacientes dados de alta e ingresados. La puntuación global (entre 0 y 10) fue de 7,34 (1,38) y 7,38 (1,52), respectivamente (p = 0,66). Más del 90% estuvieron de acuerdo o muy de acuerdo con la decisión de alta. No hubo diferencias de valoración en función de si habían existido acontecimientos adversos posteriores.
Conclusiones. Los pacientes con ICA califican bien los distintos componentes de la atención que reciben en urgencias, sin diferencias entre pacientes ingresados y dados de alta. Entre estos últimos, su grado de acuerdo con la decisión médica de alta es elevado y su valoración se mantiene estable indistintamente de si con posterioridad se producen eventos adversos.
Objectives. To determine perception of quality of care for acute heart failure (AHF) of patients discharged from the emergency department in comparison with the perception of admitted patients; to explore the variables associated with perception of quality.
Methods. Prospective, cross-sectional case–control study in 7 emergency departments. Consecutive patients diagnosed with AHF were recruited to answer a telephone survey assessing their view of quality of physician care, nurse care, overall treatment, and degree of resolution of their problem in the emergency department. Discharged patients were also asked to state their level of agreement with the decision to send them home from the emergency department.
The answers of patients who were discharged home were compared with patients who were admitted to the ward. The results were analyzed according to whether or not adverse events occurred within 30 days.
Results. A total of 1147 patients were enrolled and 1003 (87.4%) were interviewed; 253 of the patients (25.2%) were discharged home. We found no significant differences in any of the assessments (on physician or nurse care, overall treatment, or degree of resolution) between patients who were discharged home and those who were admitted.
The mean (SD) overall satisfaction assessments (on a scale of 0 to 10) were 7.34 (1.38) and 7.38 (1.52), respectively, in the 2 groups (P=.66). Over 90% of those discharged home agreed with or strongly agreed with the decision.
Evaluations were unrelated to whether or not adverse events occurred in the next 30 dyas.
Conclusions. Patients with AHF have high opinions of the different components of care received in the emergency department, and their evaluations are unrelated to whether they were admitted or discharged home. Those discharged home agree with the decision and their opinion remains firm regardless of whether adverse events occur later.
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