Análise da influência da retirada do leito de idosos na UTI da continuidade da fisioterapia na enfermaria sobre o tempo de permanência, a readmissão e a mortalidade em um hospital público do Distrito Federal

Abstract

Introduction: Elderly patients who have been hospitalized in intensive care units may present low functional capacity due to the damaging effects of immobility in the bed. It is believed that functional decline may contribute to readmission in critical units, longer hospitalization and mortality. Early bed withdrawal and continuity of care play essential roles in restoring functionality and consequently preventing undesirable outcomes. Objective: To describe the clinical and epidemiological characteristics and the mobilization level of elderly patients who were admitted to the ICUs of a public hospital and to analyze the continuity of physiotherapeutic assistance, especially concerning bed withdrawal, between the ICU and the ward and its relation to length of stay, readmission and mortality. Methods: This is a historical cohort study carried out by means of a survey of the records of hospitalized elderly people who were discharged from the ICUs of a tertiary public hospital in the Federal District, in the period from September 2013 to August 2015. From the collected data two original articles were elaborated, being a descriptive and an analytical one. The clinical and epidemiological characteristics and the level of severity of the elderly according to the SAPS score 3 were verified. The ICU bed removal, the level of mobilization achieved and the continuity of the physiotherapy care after discharge from the ICU were analyzed. It was observed whether there was a relationship between these variables and the outcomes. Results: A total of 133 elderly patients with mean age of 70 ±7 years, male predominance (66.1%) and mean severity score of 55.7 were studied. During ICU admission, 78.2% of the patients were removed from the bed and, after admission to the ward, 51.9% of the patients received physiotherapeutic care within 48 hours. The mean length of stay was 59.7 ± 53 days; 11.2% of the patients were readmitted in critical units and 18% died. Considering whether or not the patient was withdrawn from the bed, no difference was observed between the groups in relation to the length of stay after discharge from the ICU. Patients who were not removed from the ICU bed and those who maintained the level of mobilization after admission to the ward presented higher readmission and mortality. Older patients who were readmitted and those who remained longer hospitalized after discharge from ICU had greater severity. Conclusion: Most of the elderly studied were withdrawn from the ICU bed. There was loss of continuity of physiotherapeutic care for about half of the patients. The elderly who were removed from the bed had better outcomes. Product: From the results of this study, a technical report was made and will be delivered to the hospital where the research was conducted.