Derivación de pacientes y sus familias desde el enfermero de urgencias y emergencias a la enfermera gestora de casos comunitaria

Abstract

1. Objectives. 1.1. General Purpose. Implementation of a bidirectional communication system between the emergency nurse (EN) and the Community nurse case manager (CNCM). 1.2. Specific objectives Phase 1: Identify the referral criteria of patients from the EN to the CNCM Phase 2: Develop and implement a communication protocol between the EN and the CNCM Phase 3: Analyze and modify the established communication protocol Phase 4: Describe the patient's profile referred from the EN to the CNCM and the relation between the variables and the referral criteria. Phase 5: Extend the protocol to the rest of the Public Health System of Andalusia. 2. Identification of referral criteria A qualitative descriptive study using Delphi technique was performed, 23 CNCM and 22 Care Coordinators of the Primary Care Districts of the province of Huelva. The initial questionnaire was based on the assessment sheet available, used by the CNCM, in the management information system "DIRAYA". The median of the medians of each item was used as a cutoff to pass from one questionnaire to the next. All criteria that were part of the final results had a median of 9 or more points. The results of this study provided nine nuclear criteria for referral of patients and their families from the EN to the CNCM. These nine indicators were: 1. Oxygen. 2. Parenteral Nutrition 3. Loss of continuity of the skin 4. Compliance with the Pharmacological treatment plan. 5. Identity of the Primary Caregiver. 6. Barthel Index 7. Pfeiffer Index. 8. Caregiver stress Index 9. Reintegration 3. Development and Implementation of the protocol. A software called "ENLA" which allowed the referral of patients from the emergency nurses from the Public Enterprise of Health Emergencies (PEHE) and the Emergency nurses of Health Service of Andalusia (HSA) to the CNCM was designed. 4. Qualitative Analysis of Status Protocol. After the implementation of the protocol a focus group in which several EN and CNCM participated was developed to analyze the performance of the referral tool "ENLA". 5. Identification of the patient profile referred from EN to the CNCM. A descriptive study analyzing the referrals from EN to the CNCM was performed. A total of 118 patients were analyzed. The gender distribution was 60.2% (71) males and 39.8% (47) females. The mean age was 66.8 years (95% Cl 63.14 to 70.45) with a median of 74.5 years and a standard deviation of 20.03, Patients were referred to 25 different primary care centers. 65.3% were referred to rural centers and 34.7% to urban centers. 59.3% were referred from the welfare foundations of PEHE and 40.7% from the welfare foundation of HSA. The most used criteria were: Patients who do not comply with the pharmacological treatment plan (35.6%) Barthel Index >60 (30.5%) Primary Caregiver: Without treatment (23.7%) Pfeiffer Index > 4 (22%) Reintegration (19.5%) Caregiver Stress Index >7 (18.8%) This study detects that the patient profile referred from the EN to the CNCM is a patient of advanced age with poor management of his pharmacological treatment plan, with a high level of dependency and mostly cared for by his family. After analyzing the relationship of some variables with the referral criteria, the following results were established: � Males demonstrated a worse level of chronic pain management. © Patients in rural centers were patients with higher levels of dependency and a larger network of support from family, friends and neighbors, compared to patients in urban centers. ® Patients, referred from PEHE, presented a poor management of their pharmacological treatment plan and care needs to be filled, while patients, referred from HSA, were dependent, with cognitive impairment, and were taken care of by their families. © Patients referred, for having a high Pfeiffer index, were older than other patients. 6. Extension of the protocol and current status of the project. This project is functioning today and continues functioning with the intention of establishing a unique system of communication between all the CNCM and the EN of the Public Health System of Andalusia.