Integrated medical records for surgical services: a new tool for a new hospital model

According to a modern definition, the patient's medical record is a tool shared by health-care professionals whose purpose is to support the planning, providing and documenting of patient-centred care. The requirements and regulations of medical records, which date back to the sixties, need now be adapted to more recent organisational models based on different levels of care intensity and strongly integrated patient-oriented care approaches designed to create connectivity, alignment and collaboration within and between different professional fields. On this basis, the SS. Cosma and Damiano Hospital Chief Physician endorsed a multiprofessional project providing for the complete reorganisation of surgical activities according to the above-mentioned approach and, at the same time, for the elaboration of an "integrated" medical record, capable of overcoming the traditional separation between medical and nursing documents. This paper presents the results of a long period of complex teamwork consisting in revising and sharing a new medical record model based on principles of professional integration and patient-centredness in health-care provision

Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083