Pacientes procedentes de un territorio disperso que fallecieron en un hospital universitario: serie de casos

Abstract

Guainía, a department with a dispersed, multi-ethnic and multi-border population, was selected in 2016 as a pilot of the Integral Model of Health Care (MIAS). Within the MIAS operation is the Hospital de San José (HSJ), a university hospital located in Bogotá, which receives air-remited patients from Guainía for specialized care. Objective: To describe the characteristics of Guainía patients who died in HSJ, under the MIAS. Methods: Serial case study of patients from Guainía referred to HSJ, who died during the hospital stay, between July 01, 2016 and December 31, 2017. Demographic and clinical variables were analyzed using descriptive statistics. The inventory of Colombia-adapted avoidable mortality indicators (INIME) was used to identify preventable deaths. Results: Of the 238 patients received, 18 died, 3 of them died before 48 hours of hospital stay. Most required Intensive Care Unit. Among the entrance diagnoses, pneumonia prevailed in the group of infectious pathologies and malnutrition in non-infectious ones. The deaths of all children under the age of 18 and 70 % of adults had potentially avoidable causes according to INIME groups. Discussion: The prevalence of preventable causes of mortality, with deaths from child malnutrition and acute diarrhoeal disease, indicates the need for activities that impact social determinants and social determination of health. Conclusion: The high frequency of avoidable deaths suggests that the implementation of the Primary Health Care strategy was not optimal in the period studied. Moreover, for severe cases, the stress of air travel to Bogotá does not seem like a good option. It is necessary to increase the capacities of Inírida Hospital to reduce critical case referrals.