Unidad de preingreso (UPI): análisis de los ingresos hospitalarios evitados en una unidad de nueva creación

Abstract

OBJETIVES: 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.