Análise dos resultados do atendimento ao paciente com infarto agudo do miocárdio com supradesnivelamento do segmento ST nos períodos diurno e noturno

Abstract

Background: Primary coronary angioplasty with stent implantation has been considered the treatment of choice in acute myocardial infarction with ST segment elevation, leading to more favorable outcomes and lower incidence of complications when compared to other treatments. The efficacy of patient care in routine duty hours and off-hours and the in-hospital course of these patients were analyzed. Methods: Two hundred and seventy-four patients undergoing primary angioplasty between July 2004 and August 2008 were retrospectively analyzed and divided into two groups: those treated during routine duty hours and those treated during off-hours. Clinical and angiographic characteristics, door-to-balloon time, primary angiographic success, and the occurrence of complications were analyzed. Results: Of 274 patients studied, 186 (67.8%) were treated during routine duty hours and 88 (32.2%) were treated during off-hours. Clinical and angiographic characteristics were similar in both periods. Door-to-balloon time at night (64.1 minutes) was lower than at daytime (72.5 minutes). Primary angiographic success was similar (93%) in both shifts. There was a greater number of major complications at night due to stroke (0% vs. 3.4%; P = 0.032), reinfarction (1% vs. 5.6%; P = 0.037) and target lesion revascularization (1% vs. 5.6%; P = 0.037). Conclusion: At our service, medical care provided in the off-hours was quick and effective with angiographic success rates similar to those obtained in routine duty hours. However, clinical com-

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

“…Great centers of reference, with long-term established services have not identified differences in mortality in the "off-hours" period 4,9,10 . This fact points to the idea that the various adverse conditions (holes in the barriers) can and should be neutralized through critical analysis of the context of each service and higher organizational level.…”

“…The cumulative presence of a number of unfavorable conditions is remarkable and very common in these periods, situations that favor and increase vulnerability to error [1][2][3][4][5][6][7][8][9][10] . Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] .…”

“…Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] . This highlights the need to analyze these situations trough of a model to interpret the error with a systemic view.…”

“…The fact that the causal error condition arise from potentially identifiable factors, and not appended the human factor, allows a better interpretation and a search for a permanent solution to the problem at hand. Because correct logistical failures is more viable than changing human behavior, this interpretation becomes of great value to the improvement of results.Great centers of reference, with long-term established services have not identified differences in mortality in the "off-hours" period 4,9,10 . This fact points to the idea that the various adverse conditions (holes in the barriers) can and should be neutralized through critical analysis of the context of each service and higher organizational level.…”

“…This fact points to the idea that the various adverse conditions (holes in the barriers) can and should be neutralized through critical analysis of the context of each service and higher organizational level. These studies suggest that the relationship between level of organization and higher mortality in the periods "off hours" should be recognized and used as an important indicator to improve care processes as well as the reformulation of these processes over the years 3,4 .Although well known for aviation and other business sectors, the Swiss cheese model is misunderstood and poorly put into practice in health care 24 . It is important to understand that the period "off hours" has its organizational peculiarities and should be managed in order to solve these peculiarities, not similar to daytime shift so there is the improvement of services.…”