Nivel asistencial por definir en hospitalización pediátrica

Résumé

Introduction: In many pediatric hospitalization wards, there exist patients who require a higher level of care than routine inpatient pediatric general care. The aim of that study is to document this situation and to propose care improvements. Methods: Admissions of 2012, 2014 and 2016 in a secondary hospital without a PICU were reviewed. Criteria for the need of Intermediate care were recorded. A survey was carried out in the Spanish Society of Hospital Pediatrics (SEPHO). Results: Patients who met the criteria for Intermediate Care accounted for 18.2% (2012), 20.8% (2014) and 19.8% (2016) of the total pediatric (medical) admissions of the secondary hospital analyzed. 15 hospitals have participated. 80% of them (12), including all tertiary centers with PICU, refer that patients with criteria for intermediate care are admitted in the ward. Hospitals with PICU have transferred from ward to intensive care 1.22% of admitted patients and hospitals without PICU 1.23% (p = 0.98). Secondary hospitals without PICU have transferred 1% and primary hospitals, 3% (p<0,001). Hospitals with perception of that fact have transferred 1.12% of admitted patients and the hospitals without this perception, 2.45% (p<0,001). Conclusions: Patients with a higher level of care than routine inpatient care are admitted in many wards. This is done safely, but it turns part of our care at a level not well defined between the standard hospitalization and intensive care. Collaboration should be established to define, regulate and address this situation