Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España. Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, España.
Área de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
Emergencias. 2022 Apr;34(2):85-94.
To describe routine diagnostic and therapeutic care processes and assignment of resources available for treating patients with acute heart failure (AHF) in Spanish hospital emergency departments (EDs).
We surveyed the heads of all hospital EDs in the Spanish national health service concerning their routine diagnostic, therapeutic, and decision-making processes for treating patients with AHF. Questions also covered processes related to continuity of care for patients after discharge. Responses were grouped by hospital size and location (Spanish autonomous community) for comparison.
Heads of 250 of the 282 EDs (89%) responded. Thirty-two percent had a cardiologist on call, and a specialized AHF unit was present in 35%. Such untis were present in more than half the EDs in the Community of Madrid and in Catalonia. Eighty-four percent of EDs measured natriuretic peptide (NP) levels, 80% carried out echocardiographic assessments (although only 24% reported that more than half their staff were trained to undertake echocardiography), and 64% had high-flow nasal cannula (HFNC) systems. Only the Community of Valencia, Navarre, and La Rioja had the capacity for NP analysis, echocardiography, and HFNC therapy in 80% or more of their hospital EDs. Forty-six percent had admission protocols for patients with AHF, and 60% scheduled outpatient clinic appointments on discharge. Fifty-seven percent of the hospitals with AHF units had consensus-based protocols with their EDs, and 40% of them could schedule clinic appointments from the ED. Large hospitals had significantly better conditions with respect to some of these aspects of organization and care.
There is room for improvement in the diagnosis and treatment of patients with AHF. We detected opportunities to ensure more effective continuity of care for these patients.
描述西班牙医院急诊科（ED）治疗急性心力衰竭（AHF）患者的常规诊断和治疗护理流程以及资源分配情况。
我们对西班牙国家卫生服务系统中所有医院 ED 的负责人进行了调查，了解他们治疗 AHF 患者的常规诊断、治疗和决策流程。问题还涉及到患者出院后的连续性护理流程。根据医院规模和所在地（西班牙自治区）对回答进行分组比较。
282 家 ED 的负责人中，有 250 家（89%）做出了回应。32%的 ED 有随叫随到的心脏病专家，35%的 ED 设有专门的 AHF 病房。马德里自治区和加泰罗尼亚自治区的大多数 ED 都设有这种病房。84%的 ED 测量了利钠肽（NP）水平，80%进行了超声心动图评估（尽管只有 24%的 ED 报告称超过一半的员工接受过超声心动图培训），64%配备了高流量鼻导管（HFNC）系统。只有瓦伦西亚自治区、纳瓦拉自治区和拉里奥哈自治区有能力在 80%或以上的医院 ED 中进行 NP 分析、超声心动图和 HFNC 治疗。46%的 ED 有 AHF 患者入院协议，60%的 ED 在出院时预约了门诊。57%的设有 AHF 病房的医院与 ED 之间有基于共识的协议，其中 40%的医院可以从 ED 预约门诊。大型医院在这些组织和护理方面的某些方面具有明显更好的条件。
在 AHF 患者的诊断和治疗方面仍有改进的空间。我们发现了一些机会，可以确保这些患者更有效的连续性护理。
