Un antes y un después en la hospitalización a domicilio para pacientes quirúrgicos: estudio transversal descriptivo

• Autores: Mª Carmen Mias Carballal, Frank Fulthon Vela-Polanco, María Rufas Acín, Noemí Martín Ruano, Alfredo Escartin Arias, Rafael Villalobos Mori, Jorge Juan Olsina Kissler
• Localización: Hospital a Domicilio, ISSN-e 2530-5115, Vol. 8, Nº. 2, 2024, págs. 47-60
• Idioma: español
• Títulos paralelos:
  • From past to present in surgical home hospitalization: a descriptive retrospective cross-sectional study
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• Resumen
  • español

    Introducción: La Hospitalización a domicilio quirúrgica (HaDQ) es una prestación hospitalaria para pacientes quirúrgicos con indicación de HaD, estabilidad clínica, cuidador y voluntariedad. Facilita acortar estancias hospitalarias quirúrgicas (early discharge), o evitar ingresos hospitalarios (admission avoidance). Es segura y eficiente. Su flexibilidad organizativa le permite adaptarse a las necesidades cambiantes de los servicios hospitalarios quirúrgicos. Método: Estudio transversal comparativo de la actividad de la HaDQ de nuestro hospital en dos momentos de su funcionamiento: inicio (2010) y ahora (2021), para analizar los cambios que se han producido y si justifican la evolución y el futuro de la HaDQ.Se analizan las variables: ingresos, estancia media, procedimientos, visitas, modalidad de HaD, unidad derivativa, procedencia, zona de cobertura. Resultados: Los cambios destacados en el 2021 son: mayor demanda de HaD para pacientes quirúrgicos (+69%), representando el 22% de las altas del servicio de cirugía general; cam-bio del perfil de pacientes, más pacientes quirúrgicos no operados, y postoperatorios complicados; incremento de curas complejas (+10%) y controles de drenajes abdominales (+20%); cambio del número y tipo de visitas, realizan-do menos visitas domiciliarias programadas y no esperadas (-43%), pero incorporando visitas telefónicas de seguimiento, visitas en Hospital de Día, e incrementando CCEE preferentes médicas (+189%); incremento de la modalidad admission avoidance (30%) ; e inclusión de pacientes de fuera de zona de cobertura (33%). Conclusiones: Los cambios en la HaDQ han permitido atender con hospitalización a domicilio a un mayor número de pacientes quirúrgicos, adaptándose a las necesidades del servicio de cirugía general.

  • English

    Introduction: Surgical Home Hospitalization (SHH) is a program for surgical patients eligible for Home Hospitalization (HH), focusing on clinical stability and voluntary participation. It aims to reduce surgical hospital stays or prevent unnecessary admissions, prioritizing safety and efficiency. Its adaptable structure meets evolving surgical service needs. Method: A comparative cross-sectional study of SHH activity was conducted in our hospital spanning two periods: from its establishment in 2010 to the present year, 2021. The objective was to analyze the observed changes and assess whether they justify the progression and sustainability of SHH. Various variables were examined, including admissions, average length of stay, procedures, visits, SHH modality, derivative unit origin, and coverage area. Results: Significant changes were observed in 2021, including a substantial 69% increase in demand for SHH among surgical patients, comprising 22% of discharges from the general surgery ward. There was a notable shift in patient demographics, with a higher proportion of non-operated surgical cases and complex postoperative scenarios. Additionally, complex wound care saw a 10% increase, while abdominal drainage controls rose by 20%. Although there was a 43% decrease in scheduled and unscheduled home visits, alternative forms of engagement such as follow-up phone calls, Day Hospital visits, and preferred medical consul-tations increased by 189%. Furthermore, there was a 30% rise in the utilization of admission avoidance modalities and a 33% expansion in patients from outside the coverage area. Conclusions: In conclusion, SHH evolution has enhanced care for surgical patients, aligning with general surgery service needs.