Metástasis pulmonares e intracardiacas de un carcinoma renal de células claras intervenido 20 años antes

espanolOBJETIVOS: Analizar las caracteristicas de los pacientes en los que se ha evitado el ingreso hospitalario tras su paso por una Unidad de Preingreso (UPI) y las vias de seguimiento de los mismos. Describir las patologias mas frecuentes, la tasa de reingresos y mortalidad a 30 dias de los pacientes dados de alta. MATERIAL Y METODOS: Estudio descriptivo y prospectivo de las altas hospitalarias de la UPI entre 1 de Junio de 2007 a 1 de Abril de 2008. En la UPI permanecen aquellos pacientes ingresados que estan a la espera de una cama de hospitalizacion en su servicio correspondiente. Los pacientes analizados fueron aquellos dados de alta segun el criterio de los medicos de la unidad y antes de ser requeridos en la planta de hospitalizacion convencional. Se analizan datos demograficos, diagnostico, destino al alta, reingreso a 72 horas, 10 y 28 dias, caracteristicas del reingreso y mortalidad a 30 dias. RESULTADOS: Se evitaron 1005 ingresos, con una tasa de ingreso evitado de 100.5/ mes. La edad media era de 67.7± DE 17.1 (Rango 16-102 anos), siendo la mayoria varones con 626(62.3%) casos. El diagnostico mas frecuente fue de infeccion respiratoria de vias bajas con 149(14.9%) casos, seguido de dolor toracico con 122(12.2%), insuficiencia cardiaca 117(17.7%), exacerbacion de EPOC 81(8.1%) y enfermedad vascular cerebral con 61(6.1%) de casos. Al alta 564(54.3%) fueron remitidos a su medico de cabecera, a 138(13.7%) pacientes se les hizo un seguimiento precoz en la consulta de la UPI, 34 pacientes fueron derivados a Hospitalizacion a domicilio, requiriendo el resto algun tipo de seguimiento especializado a nivel ambulatorio. El numero de reingresos a las 72 horas, 10 y 28 dias fue de 14(0.1%), 42(0.4%) y 123 (12.3%), respectivamente. Del total de reingresos a 28 dias 77(62.3%) pacientes reingresaron por la misma patologia. Las patologias que mas reingresaron fueron exacerbacion de EPOC, insuficiencia cardiaca e infeccion respiratoria con 20(15.7%), 19(15%) y 14(11%) pacientes. La mortalidad a 30 dias fue de 14(1,4%) pacientes; 6 (42.9%) de los cuales por la misma enfermedad principal que motivo el alta indice. CONCLUSIONES: Un manejo especializado y multidisciplinar en un area de preingreso, permite disminuir el numero de ingresos por distintas patologias, principalmente a costa de un seguimiento ambulatorio estricto y precoz en cuadros agudos y optimizacion del estudio de determinadas patologias a nivel ambulatorio, todo ello sin mermar significativamente la calidad asistencial. EnglishOBJETIVES: Analyze the characteristics of the patients who had avoided hospital admission after passing through a pre admission unit (UPI) and the ways of tracking them. Describe the most common diseases, the rate of readmissions and mortality at 30 days of discharged patients. MATERIAL AND METHODS: Prospective, descriptive study of discharged patients from the UPI between June 1, 2007 to April 1, 2008. Patients are admitted to the UPI while waiting for a hospital bed in its respective service. Patients analyzed were those discharged from the UPI before being transferred to wards. We analyzed demographic data, diagnosis, discharge destination, readmission at 72 hours, 10 and 28 days, and mortality at 30 days. RESULTS: 1005 admissions were studied, with a rate of 100.5/month admissions to wards avoided. Mean age was 67.7 (SD 17.1, range 16-102 years), with 626 (62.3%) males. The most frequent diagnosis were low respiratory tract infection with 149 (14.9%) cases, chest pain in 122 (12.2%), heart failure 117 (17.7%), COPD exacerbation 81 (8.1%) and cerebral vascular disease with 61 (6.1%) cases. At discharge 564 (54.3%) were referred to their general practitioner, 138 (13.7%) patients were followed up early at the UPI clinic, 34 patients were referred to hospitalization at home, and the remaining were referred to specialized outpatient clinic. 14 (0.1%), 42 (0.4%) and 123 (12.3%) patients were readmitted at 72 hours, 10 and 28 days, respectively. 77 (62.3%) patients were readmitted during the first 28 days because of the same disease. The most frequent diagnosis in readmitted patients were exacerbation of COPD, heart failure and low respiratory tract infection in 20 (15.7%), 19 (15%) and 14 (11%) patients. Mortality at 30 days was 14 (1.4%) patients, 6 (42.9%) of them with the same disease that prompted the previous admission. CONCLUSIONS: A specialized and multi-disciplinary management in an area of pre-admission reduces the number of admissions to medical wards for various diseases, mainly at the expense of a strict and ambulatory monitoring in acute diseases and early optimization study of certain diseases at the outpatient clinic, without significantly impairment of the quality of care.