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New concept of triage in patients with heart failure due to specialized nursing

Session Poster Session 2

Speaker Ramon Bover Freire

Event : Heart Failure 2019

  • Topic : cardiovascular nursing and allied professions
  • Sub-topic : Cardiovascular Nursing and Allied Professions - Other
  • Session type : Poster Session

Authors : MPS Monica Perez Serrano (Madrid,ES), JGA Josebe Goirigolzarri Artaza (Madrid,ES), DEV Daniel Enriquez Vazquez (Madrid,ES), CNP Carlos Nicolas Perez (Madrid,ES), MFE Marcos Fernandez Escarbajal (Madrid,ES), RBF Ramon Bover Freire (Madrid,ES), CMM Carlos Macaya Miguel (Madrid,ES), CRR Concepcion Ramirez Ramos (Madrid,ES), MGB Marcos Gonzalez Barja (Madrid,ES), NRL Noemi Ramos Lopez (Madrid,ES), AJB Adrian Jeronimo Baza (Madrid,ES), EMG Eduardo Martinez Gomez (Madrid,ES), IVC Isidre Vila Costa (Madrid,ES), PMS Paula Martinez Santos (Madrid,ES)

MPS Monica Perez Serrano1 , JGA Josebe Goirigolzarri Artaza1 , DEV Daniel Enriquez Vazquez1 , CNP Carlos Nicolas Perez1 , MFE Marcos Fernandez Escarbajal1 , RBF Ramon Bover Freire1 , CMM Carlos Macaya Miguel1 , CRR Concepcion Ramirez Ramos1 , MGB Marcos Gonzalez Barja1 , NRL Noemi Ramos Lopez1 , AJB Adrian Jeronimo Baza1 , EMG Eduardo Martinez Gomez1 , IVC Isidre Vila Costa1 , PMS Paula Martinez Santos1 , 1Hospital Clinic San Carlos, HEART FAILURE - Madrid - Spain ,


PURPOSE:The pre-discharge is a fundamental step after an IC admission, a poor management of the transicon of care have been shown to increase the hopsitalar re-entry and the morbi-mortality.
The objective is to demonstrate that the realization of a new method of triage by specialized nursing, as it is done in the emergency services, allows to stratify the risk of the patient from discharge, until his / her entrance in the UIC, through the prealta .

METHODS:A prospective observational study will be conducted in all patients admitted with a diagnosis of HF and compared with the standard pre-discharge method, based on an early visit to the unit.
The admitted patient will be assessed at 24-48 hours by the IC specialist nurse who will perform a comprehensive biopsychosocial assessment, as well as the pre-discharge, where he will define the "care route" in which the patient should be included, stratifying the risk and the patients. months of follow-up In this way, from the hospital discharge, a "triage" of referral to the UIC will be carried out by the nursing specialist according to the risk and the clinical profile.Triage method;
Low / medium risk patients (3-6 months follow-up / Yellow label):Preserved LVEF and absence of valvular heart disease / severe PHT and Absence of important cardiorenal sd or high diuretic requirements.
High-risk patients (12 months follow-up / Red label):First episodes of heart failure,Patients with ventricular dysfunction who require adjustment of medical treatment or are candidates for devices, Carriers of devices (DAI / DAI CRT or TAVI / mitraclip) especially to clinical stabilization, Revenue despite treatment optimization, Need for high doses of diuretics and / or important cardiorenal sd, In cases of previous strategy failure with high diuretic requirement, income despite treatment optimization and HDD visits. Advanced IC patients: (Prognostic study and close management / Black label): Patients admitted to UCOR by IC,Candidates to Tx / LAVD and Palliative patients.
RESULTS: Since December 2018 a pilot is being carried out in the CI unit to assess the efficacy and safety of this new method described above compared to standard peraltas that are performed
We included 12 patients in the heart failure program of our center, 7 women and 5 men with an average age of ± 74.9 In the triage of the prealta 5 were stratified to the high risk arm, 6 in the low arm - medium risk and 1 patient in the advanced therapies that was referred to our referral center for transplantation. None of them re-enter since the discharge and continue in the established care route.

CONCLUSIONS:The nurse will carry out the pre-discharge, where she will define the care route with the aim of creating individualized care plans (NANDA) where she can perform interventions (NIC) and evaluate them (NOC). With the implementation of this method, the aim is to demonstrate the effectiveness and safety of the program in reducing re-entry rates and early intervention.

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