Medisur (May 2012)
Applying an Instrument for Stratification of Patients with Decompensated Chronic Obstructive Pulmonary Disease in the Emergency Room
Abstract
Background: Chronic obstructive pulmonary disease is a public health problem of enormous magnitude. This has also been considered at the Dr. Gustavo Aldereguía Lima General University Hospital of Cienfuegos. Objective: To assess the implementation process of a tool for stratification of patients with chronic obstructive pulmonary disease treated in the Emergency Room. Methods: The instrument was administered to 192 patients admitted and discharged from the institution with a diagnosis of decompensated chronic obstructive pulmonary disease from May 2010 to April 2011. Several indicators of process and outcome were used for the assessment. Results: The use of the instrument became a medical action quickly and systematically incorporated, although not accompanied by progressive improvement in stratification quality. The prevalence of patients at high risk of adverse outcome and high probability of recovery was determined by a large number of patients with moderate decompensation and association with pneumonia or heart failure, which were mostly stratified as moderate risk and admitted in Internal Medicine rooms. Nevertheless, lethality was relatively low, as well as the frequency of transfers to intensive care units of patients initially admitted to these rooms (10%). Conclusions: The results obtained in the behavior of lethality and the rate of transfers to intensive care units suggest the convenience of performing modifications to the stratification instrument used.
