Rojas J, Fernández I, Pastor J C, Gómez-Ulla F, Piñero A
Instituto de Oftalmobiología Aplicada, Grupo de Retina, Universidad de Valladolid, España.
Arch Soc Esp Oftalmol. 2007 May;82(5):279-84. doi: 10.4321/s0365-66912007000500006.
To identify problems in the urgent management of retinal detachments (RD) in hospitals of the Spanish National Health System (NHS).
A questionnaire was submitted confidentially to the heads of Ophthalmic Departments of 217 hospitals of the NHS to obtain information on the management of urgent RD during the last year. Data was stored in a Microsoft Access database and statistically analyzed by Excel and Statgraphics. Qualitative variables were analyzed by Chi-Square and Fisher exact tests and quantitative variables by the Kruskall-Wallis test.
A global response rate of 54.8% was achieved with higher participation of the Teaching Hospitals (TH). District Hospital and non-Teaching Hospital responses were similar and grouped as non-TH. Eighteen percent of centers, mostly non-TH, had no ophthalmologist on duty. Thirty-six percent had a vitreoretinal specialist on call. Eighty percent of centres admitted to have problems handling urgent RD during weekends. Twenty-four had no ophthalmic surgical theatre available. Fifty percent referred to have problems having an anaesthesiologist available and only 22% had ophthalmic trained personnel (nurses) available. Sixty-four percent of centres performed pars plana vitrectomy (PPV) and 77% of those were able to perform an urgent PPV. Ninety percent admitted that a patient with a macula-threatening RD occurring at the beginning of the week-end would not be treated until at least 24 hours had elapsed, although 84% considered this to be inadequate.
Despite the methodological problems and bias of this questionnaire, we did identify several important problems in the management of urgent RD by NHS hospitals. The data obtained provides useful information to enable the quality of the NHS care of RD to be improved, particularly that available at the week-end.
确定西班牙国家卫生系统（NHS）医院中视网膜脱离（RD）紧急处理方面的问题。
向NHS的217家医院眼科主任保密发放问卷，以获取去年紧急RD处理情况的信息。数据存储在微软Access数据库中，并通过Excel和Statgraphics进行统计分析。定性变量采用卡方检验和Fisher精确检验分析，定量变量采用Kruskal-Wallis检验分析。
总体回复率为54.8%，教学医院（TH）参与度更高。地区医院和非教学医院的回复相似，归为非TH组。18%的中心（大多是非TH）没有值班眼科医生。36%有玻璃体视网膜专科医生随叫随到。80%的中心承认在周末处理紧急RD存在问题。24家没有眼科手术室可用。50%表示难以找到麻醉医生，只有22%有经过眼科培训的人员（护士）可用。64%的中心进行玻璃体切除术（PPV），其中77%能够进行紧急PPV。90%承认周末开始时出现黄斑受累的RD患者，至少要等24小时后才会得到治疗，尽管84%认为这样不够。
尽管本问卷存在方法学问题和偏差，但我们确实发现了NHS医院在紧急RD处理方面的几个重要问题。所获数据为提高NHS对RD的护理质量提供了有用信息，尤其是周末的护理质量。
