Journal Information
Vol. 220. Issue 9.
Pages 578-582 (December 2020)
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Vol. 220. Issue 9.
Pages 578-582 (December 2020)
Special article
Which surgical patients require shared care?
¿Qué pacientes quirúrgicos necesitan asistencia compartida?
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7
E. Montero Ruiza,
Corresponding author
, D. Rubal Branb, For the Shared Care and Consultations Working Group of the Spanish Society of Internal Medicine
a Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
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Abstract

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.

Keywords:
Referral and consultation
Hospitalized patients
Internal medicine
Perioperative care
Shared care
Resumen

La mayoría de los pacientes quirúrgicos hospitalizados tiene mucha comorbilidad médica y recibe un gran número de medicaciones, o sufre complicaciones importantes, o ambos. La asistencia compartida (AC) es la responsabilidad y autoridad compartidas en el manejo de un paciente hospitalizado. Se discute si se deben seleccionar o no pacientes para la AC. Los diferentes criterios de selección no son seguros o fáciles de aplicar, y dejan fuera a muchos pacientes subsidiarios de AC. El manejo perioperatorio es fundamental para la mortalidad postoperatoria. El fallo del rescate (mortalidad hospitalaria secundaria a complicaciones posquirúrgicas) es el principal factor sobre la mortalidad quirúrgica hospitalaria. Afecta a cualquier paciente, independientemente de su edad, comorbilidad o tipo de cirugía. El componente que reduce más el fallo de rescate es la presencia de internistas en las salas quirúrgicas. Consideramos que todos los enfermos hospitalizados en los servicios quirúrgicos deberían recibir AC.

Palabras clave:
Remisión y consulta
Pacientes hospitalizados
Medicina interna
Atención perioperatoria
Asistencia compartida

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