Original Article
Quality Standards in a Rheumatology Day-Care Hospital Unit. The Proposal of the Spanish Society of Rheumatology Day Hospitals’ Working Group
Estándares de calidad en una Unidad de Hospitalización de Día reumatológica. Propuesta del Grupo de Trabajo de Hospitales de Día de la Sociedad Española de Reumatología
Rosario García-Vicuñaa,
, María Montorob, César Antonio Egües Dubucc, Sagrario Bustabad Reyesd, Antonio Gómez-Centenoe, Santiago Muñoz-Fernándezf, Eva Pérez Pampíng, Jose Andrés Román Ivorrah, Alejandro Balsai, Estíbaliz Lozaj
Corresponding author
a Servicio de Reumatología, Hospital Universitario La Princesa, IISP, Madrid, Spain
b Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Reumatología, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, Spain
d Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
e Servicio de Reumatología, Hospital de Sabadell, Corporació Parc Taulí, Sabadell, Barcelona, Spain
f Sección de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
g Servicio de Reumatología, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, Spain
h Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
i Servicio de Reumatología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
j Instituto de Salud Musculoesquelética, Madrid, Spain
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"Loza" "email" => array:1 [ 0 => "estibaliz.loza@inmusc.eu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">j</span>" "identificador" => "aff0050" ] ] ] ] "afiliaciones" => array:10 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario La Princesa, IISP, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de Sabadell, Corporació Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Instituto de Salud Musculoesquelética, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estándares de calidad en una Unidad de Hospitalización de Día reumatológica. Propuesta del Grupo de Trabajo de Hospitales de Día de la Sociedad Española de Reumatología" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1350 "Ancho" => 1000 "Tamanyo" => 215684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sequence of activities for a Day Hospital Unit in Rheumatology.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">DHU is defined as hospital units that care for patients for a few hours, either for diagnostic issues, clinical research and/or multiple examinations, as well as to administer treatments that cannot be performed in the outpatient clinic, but do not justify a stay in hospital.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As an organizational and specific health management formula, and depending on the range of services it offers, the DHU requires structural and functional conditions to ensure both efficiency, quality and patient safety.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first DHU emerged in the field of Hematology and Oncology to meet the needs of intravenous administration of chemotherapy and supportive care of a group of patients with specific monitoring needs. This, coupled with its monovalent nature, has led to most of the information in our environment in terms of management or efficiency indicators being generated by oncologists and hematologists.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Internationally, there have been descriptions about the remarkable efficiency of DHU, monographic or polyvalent, in areas such as HIV/infectious, psychiatric and geriatric patients or patients with multiple diseases,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> but the literature on quality standards in the DHU remains very low.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on this limited documentation, in 2009, the Ministry of Health, Social Services and Equality of Spain developed a set of quality standards and recommendations for DHU, including aspects relating to the rights and interests of the patient, safety, organization and management of DHU, its structure, materials and human resources, as well as the quality of care provided.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the field of Rheumatology, DHU have arisen since the introduction of intravenous biologic therapies, a little over a decade ago, for the treatment of rheumatoid arthritis and spondyloarthritis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However, they have ended up covering diagnostic and therapeutic needs in many other autoimmune and metabolic diseases. This development not only has resulted in a significant increase in the efficiency of care for patients who previously needed more resources, but has resulted in better quality of life and patient satisfaction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of this document is to provide rheumatologists, as well as governments, managers and other health professionals, with criteria to further promote generalization of Rheumatology DHU by developing specific quality standards and other indicators, thus contributing to the improvement in the security and quality of their practice, in all its dimensions.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This document forms part of the proceedings and the methodology of the Icarus Plan to improve quality of care in Rheumatology, draft of the Spanish Society of Rheumatology (SER) (<a id="intr0010" class="elsevierStyleInterRef" href="http://www.ser.es/investigacion/Proyectos/Icaro/Icaro.php">http://www.ser.es/investigacion/Proyectos/Icaro/Icaro.php</a>), which promotes the development of quality standards for implementation in clinical practice.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In connection with this project, initiated in December 2010, an expert methodologist performed a systematic literature search in Medline, Embase and Cochrane Central. In addition, other relevant documents on DHU generated in Spain by rheumatologists and included in previous research projects with a similar approach<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> were analyzed. A synthesis of the information obtained was performed and a working paper focused on developing standards was developed. Prior to the definition of standards, the selection of quality criteria was adjusted to the usual practice in rheumatology and in line with the dimensions proposed by the Ministry of Health, Social Services and Equality of Spain<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>: (1) rights and guarantees of patients, (2) patient safety; (3) organization and management of DHU Rheumatology, (4) physical structure and material resources of these units, (5) human resources, (6) quality of care, and (7) review criteria and monitoring standards and recommendations.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A specific working group (WG) was formed, which included a panel of 8 experts of 5 different regions with extensive professional experience in the field and who had expressed particular interest in DHU projects. In a nominal group meeting, in addition to explaining the methodology of the project the results of the previous reviews were presented and discussed, experiences and knowledge were incorporated, new materials were developed and tasks assigned. Once all the material produced was collected, a standards proposal was developed and a second round was set for review, with suggestions made throughout the WG under the methodological supervision of an expert. Once the content had been agreed upon, the final report was written in March 2012, which served as the basis for writing this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">In the concept of a framework with a structure of its own, with common core standards to ensure high quality,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the WG considered defining relevant portfolio performance and the performance criteria of rheumatic DHU, which in turn determine the structure, process and more specific results standards.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Service Portfolio of Day Hospital Units of Rheumatology</span><p id="par0050" class="elsevierStylePara elsevierViewall">The portfolio of services must be adapted to the individual and contextual circumstances of each center.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this regard, the provisions included in the portfolio of DHU (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>) are divided into essential and optional. The first are what all DHU should offer, with points 1 and 2, being the fundamental basis for these units. The latter contribute to its character and excellence contemplating the optimization of the unit with diagnostic, teaching (undergraduate and graduate), training and research activities. Regarding the diagnostic examinations referred to as optional (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>, points b, c, d and e paragraph II<span class="elsevierStyleSmallCaps">)</span> (1), its implementation will be performed by appropriate specialists and post-procedure care may be shared with the doctor in charge of the DHU.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Configuring the Episode in a Day Hospital Unit Rheumatology</span><p id="par0060" class="elsevierStylePara elsevierViewall">The general criteria for the design of a functional DHU program (<a class="elsevierStyleCrossRef" href="#sec0070">Annex 1</a>) are fully described in another document<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and depend essentially on the specific care functions and characteristics of the population served, but eventually could include aspects such as teaching or clinical research. The functional program, along with the performance criteria of the units (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a>), allows the organization and planning of DHU, and serves as a guide to define the care circuits, always tailored to individual circumstances and the resources of each center.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In this regard, in outline, the optimal circuit for setting the episode of care in these units is illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Ideally, the design of the physical structure of a DHU must consider the logical sequence of activities for which it is conceived: physical access, admission, waiting, consultation, treatment or procedure, recovery and medical discharge. All areas must be properly labeled, be of adequate dimensions and ensure patient privacy. For a polyvalent DHU (i.e., shared by more than one specialty), most areas are shared with other hospital services, but should include: reception area, spaces for administration of treatment, nursing and general support, administrative and support areas for staff.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Along with the spaces dedicated to providing treatment, DHU's should have at least one medical area for clinical evaluation, information, obtaining consent and eventually performing diagnostic processes. The control area must allow nursing observation of patients during administration of treatments and recovery, so the central location with direct view of patients is the most appropriate. Ideally, the incorporation of a nursing area with its own telephone would facilitate the implementation of the various standards described below.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Quality Standards</span><p id="par0075" class="elsevierStylePara elsevierViewall">In total, 52 quality standards were developed and agreed upon: 17 related to structure (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a>), 25 to process (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a>) and 10 to results (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 5</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Regarding the structure standards, these must cover all activity of the DHU and all those involved in these units, so the creation of a multidisciplinary working group for its development and implementation was recommended. Aspects of the physical structure and the necessary materials were included in first place. One of the recommendations that the panel considered a priority is the use of new technologies and information systems for better management.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Second, standards relating to human resources and organization were included. Rigorous logging and strict definition of the DHU lines of responsibility are imperative, so the obligations, rights and responsibilities of all personnel, as well as the hierarchical structure should be clearly defined. There needs to be a dedicated line for management of responsibility and another one for patient care. However, it is contemplated that both can coincide on the same person. Key documents that should be available, located and accessible, either on paper or electronic format, for all personnel involved (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a>) in the structure standards.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Process standards listed in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a> provide for any activity within the unit, not only in terms of care, but also administrative or management. The WG points out that, among strategic processes, the development of a manual of organization and operation, which will direct the translation of key processes.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding support processes, one of the core standards is to ensure efficient coordination between the Hospital Pharmacy and DHU without delay between prescription and administration, including the possibility that the medication preparation is done by the DHU itself.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The WG considered relevant to introduce a quality standard process that advocated taking advantage of DHU stays, prolonged sometimes for hours, for health education to the patient, to become involved in managing their own health and managing their illness. Education should also include family members or caregivers.</p><p id="par0105" class="elsevierStylePara elsevierViewall">As for the discharge patient report and given the regular and frequent nature of many therapeutic procedures, the WG states that this is not necessary in every patient coming to the DHU, but must be done in the following situations: definitive discharge from the DHU, changes in medication or dosage, in case of adverse events and other circumstances, including the patient's decision, involving changes in treatment. The report should include detailed discharge aftercare.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Finally, standards of performance, shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 5</a>, indicate how we should measure the result of the structure and processes of all DHU. It is considered essential to have an electronic system that allows the recording and periodic analysis of both the activity and the results. Health outcomes assessed should be able to register, through the preset specific outcomes, manifestation and analysis according to disease. Indices of activity and function in: rheumatoid arthritis (e.g., DAS28, Simplified Disease Activity index, Clinical Disease Activity Index, HAQ), spondylitis (BASDAI, Ankylosing Spondylitis Disease Activity Index, BASFI, etc.), systemic lupus erythematosus (SLEDAI, SLICC, etc.), vasculitis (BVAS, Five factor score, etc.), scleroderma (Raynaud severity indices and digital ulcers, modified Rodnan skin index), osteoporosis (new fractures, bone mineral density) and other specific diseases or manifestations which may be seen at the DHU, and whose enumeration exceeds this document. It is considered highly recommended to also record quality of life indices, which allow, among other things, a more rigorous evaluation of direct costs than a simple economic evaluation.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regular assessment of performance and competence of staff, both assistance care as well as the management and administration staff, also should be performed.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Considering that one of the pillars of quality is safety, registration and evaluation of adverse events and incidents is imperative. Finally, the perceived quality through surveys of patient satisfaction should be assessed.</p><p id="par0125" class="elsevierStylePara elsevierViewall">All the proposed standards are subject to change and should be reviewed periodically in the light of developments, with the best available evidence and experience in a given context. Generically, the process and outcome should be evaluated annually, and structure at least every 5 years.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Day hospitalization has been a considerable development in recent years in Rheumatology departments, becoming an important part of their daily work and their service portfolio. Although the performance and characteristics of each of the<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> DHU's is highly heterogeneous, the progressive increase in performance and complexity on the appropriate management portfolio transcends, in many cases, the mere organizational formula to become a real model servicing complex rheumatologic patients. Additionally, DHU have become an essential element in clinical research, both due to the need for clinical trials, as well as for the support in data collection and sampling for epidemiological and basic research.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The contribution of this work is novel in that it addresses the development of quality standards, both in structure and operating results for DHU, specifically in the field of Rheumatology. The recent development of these units explains that the standards developed previously collected more specific aspects of our specialty. Publications of other health institutions outside our country thoroughly focused on structural requirements and the benefits of Rheumatology are only mentioned<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> in the updated guidelines of the English National Health System as part of their service portfolio.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Agencies such as the Joint Commission, with recognized expertise in the creation of standards aimed at accreditation, do not provide this type of care provision and only refer to treatment programs as ‘partial’ hospitalization targeting healthcare providers in behavioral disorders (<a id="intr0015" class="elsevierStyleInterRef" href="http://www.jointcommission.org/accreditation/bhc_seeking_accreditation.aspx">http://www.jointcommission.org/accreditation/bhc_seeking_accreditation.aspx</a>).</p><p id="par0140" class="elsevierStylePara elsevierViewall">In rheumatology, we find several studies in Spain that describe the degree of implementation of DHU and their distribution,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and begin to raise the variability in their characteristics and operation.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> In these publications, key issues for the operation of DHU, as well as identifying weaknesses and areas for improvement, and as a need to establish standards for operation on the basis of quality criteria.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> The first approach is based on these criteria in the definition of the process map of Rheumatology DHU and reaches a consensus in a set of quality criteria for strategic key and support processes which are then analyzed in various DHU in a <span class="elsevierStyleItalic">benchmarking</span> process.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The results of this study, in line with other general standards already published by the SER,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> represent a breakthrough because they provide recommendations and specific management tools for use at the local and institutional level.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Regarding the structure standards, the comprehensive description of basic criteria, whether of mono or polyvalent units, has not been the subject of this article and could represent a limitation, but the WG understands that the requirements of human resources and equipment, either themselves or those of an already defined DHU<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7,8</span></a> are widely available in the final extensive report (<a id="intr0020" class="elsevierStyleInterRef" href="http://www.ser.es/investigacion/Proyectos/Icaro/Icaro.php">http://www.ser.es/investigacion/Proyectos/Icaro/Icaro.php</a>). The panel, however, wanted to emphasize some aspects considered crucial such as the definition and dissemination of the portfolio of services, the need for involvement of rheumatologists in the management of DHU, the presence of nurse training and specific training, key documents that should be accessible electronically or necessary for the registration and management of all processes. The protocols, a fundamental and essential part of any health care activity, acquire special relevance in this mode, because they ensure uniformity in very standardized practices and prevent unjustified variability.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In addition to the scarcity of previous publications, regarding the processes and results, one must add the constant change and new opportunities in the use of DHU in Rheumatology. Here, in our country, many of the DHU have become the framework for monitoring and centralized prescription of all biological drugs, either subcutaneous or intravenous. The need for risk management and their rational use and other therapies have contributed to the development of Rheumatology DHU, whose expansion and staffing requirements has driven parallel development of advanced nursing skills in Rheumatology.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> DHU's have emerged as one of the suitable frameworks for the application of these skills, as evidenced by publications and experiences in our country.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Similarly, the development of specific nursing clinics, either in the framework of the DHU or outpatient clinics, is one strategy that has contributed to the efficient management of outpatient rheumatic patients and has led the SER to publish their own quality standards.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Part of these standards collect requirements, nursing skills and competencies that can be applied at DHU's, and underscore their relevance in many key processes: the safe administration of drugs, telephone consultation, patient and caregiver education or their contribution to the monitoring of illness, which facilitates patient management guidelines and recommendations tailored to a more rational and drug use.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The WG also highlighted other irrevocable standards, and the use of standardized work and informed consent procedures, provided these are indicated. The need for a rapid access of new patients to DHU's, which should be no more than 15 days later, was found. However, the consensus of acceptable waiting days is more complicated, because it varies depending on the resources of each center and the relative urgency of the procedure.</p><p id="par0160" class="elsevierStylePara elsevierViewall">One limitation of this study may lie in the limited number of experts who participated. However, the actual study is part of a previous project in which rheumatologists from 21 different hospitals defined quality standards and recommendations, also with methodological support.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Also, in the situational analysis of this proposal, we have taken into account the available data on the current DHU status and different organizational contexts in our country.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The proposed quality standards should form the basis for each service to develop the indicators needed to ensure a good practice, evaluate their activities and identify areas for improvement in the DHU, also incorporating experience. In the current economic climate, generating outcome indicators, electronic records for the prescription, administering, dispensing and monitoring of drugs, with an integrated control panel, is a unique opportunity for efficient management of complex patients.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Since feasibility is not uniform, the document contains, along with essential standards, other proposals that will shape excellence care, as the existence of administrative staff or DHU clinical research, the dissemination of specific research activities as publications or the quality certification of the units. In this context, we believe that the contribution of this study, together with the generation of indicators, can lead to the creation of an individualized quality plan for each of the DHU's, offering multiple opportunities for advancement to the services that use them (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 6</a>).</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Ultimately, rheumatologic DHU's are much more than mere organizational formula to provide an intermediate service between hospitalization and outpatient clinics. In this context, one of the most important contributions to the quality standards that are proposed is to create management tools to ensure consistent, patient-centered, evidence-based and experienced practice and be able to define the indispensable quality requirements for excellence.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical Responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of people and animals</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that this research did not perform experiments on humans or animals.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidentiality of data</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors state that patient data do not appear in this article.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financing</span><p id="par0195" class="elsevierStylePara elsevierViewall">Funded by the Spanish Foundation of Rheumatology (FER) with a grant from Bristol-Myers Squibb (BMS). The company has not participated in the project design and has not been involved in writing the findings or final report of this manuscript.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of Interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">Dr. García-Vicuña has received funding for research and training and fees for consulting and presentations: Roche, BMS, MSD, UCB, Pfizer, Actelion and Hospira.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Dr. Montoro declares conflicts of interest concerning Abbvie, BMS, Glaxo, MSD, Pfizer, Roche, UCB.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Dr. Bustabad has received research funding, consulting and presentation fees from Abbvie, Pfizer, Roche and MSD.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Dr. Centeno Gómez has received grants from Pfizer, payment for lectures from Pfizer, Abbvie, BMS, Roche, MSD and Menarini, Roche advisory payments and MSD, and Pfizer for attending conferences.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Dr. Pérez-Pampín declared conflicts of interest related to BMS, MSD, Pfizer, Roche, UCB.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Dr. Roman Ivorra has received research funding or honoraria for consulting and lectures from Roche, MSD, Pfizer, Abbvie, UCB, GSK, BMS, Actelion, Amgen.</p><p id="par0230" class="elsevierStylePara elsevierViewall">Dr. Balsa has received research funding or honoraria for consulting and lectures from UCB, Pfizer, Roche, BMS, Abbvie, GSK, MSD and AMGEM.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Dr. Loza reports receiving payment for providing professional services from Abbvie, Roche, MSD, BMS.</p><p id="par0240" class="elsevierStylePara elsevierViewall">Drs. Egues Dubuc and Muñoz-Fernández declare no conflict of interest related to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres376325" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec355387" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres376326" "titulo" => array:6 [ 0 => "Resumen" 1 => "Antecedentes" 2 => "Objetivo" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec355386" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Service Portfolio of Day Hospital Units of Rheumatology" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Configuring the Episode in a Day Hospital Unit Rheumatology" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Quality Standards" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Financing" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of Interest" ] 11 => array:2 [ "identificador" => "xack97522" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-05" "fechaAceptado" => "2014-02-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec355387" "palabras" => array:4 [ 0 => "Day care hospital" 1 => "Rheumatology" 2 => "Quality standards" 3 => "Quality management" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec355386" "palabras" => array:4 [ 0 => "Hospital de día" 1 => "Reumatología" 2 => "Estándares de calidad" 3 => "Gestión de la calidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In recent years, the Rheumatology Day-Care Hospital Units (DHUs) have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To develop specific quality standards for Rheumatology DHUs.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Seventeen structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: (1) essential standards to (2) excellent standards, (3) a Rheumatology DHU services portfolio and (4) performance criteria.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En los últimos años, las Unidades de Hospitalización de Día (UHdD) en Reumatología han experimentado un amplio desarrollo. Sin embargo, existe escasa documentación respecto a estándares de calidad, que mayoritariamente se limita a la estructura y no incluye aspectos específicos de la especialidad.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Desarrollar estándares de calidad específicos para las UHdD en Reumatología.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tras una revisión sistemática de la literatura y de documentos relacionados, un grupo de trabajo (GT) de 8 reumatólogos, bajo la supervisión de un metodólogo experto, elaboró una primera propuesta de estándares de calidad. Se realizó una segunda ronda para su revisión y sugerencias por todo el GT. Consensuado el contenido, se realizó un informe final.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se definieron 17 estándares de estructura, 25 de proceso y 10 de resultados, con especial énfasis en aspectos específicos de una UHdD de Reumatología. La propuesta incluye: <span class="elsevierStyleItalic">1)</span> estándares imprescindibles; <span class="elsevierStyleItalic">2)</span> estándares de excelencia; <span class="elsevierStyleItalic">3)</span> cartera de servicios de una UHdD reumatológica, y <span class="elsevierStyleItalic">4)</span> criterios de funcionamiento.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los estándares de calidad propuestos son la base para la elaboración de indicadores y de otras herramientas de gestión para las UHdD reumatológicas que garanticen una práctica homogénea, centrada en el paciente y basada en la evidencia y en la experiencia.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Vicuña R, Montoro M, Egües Dubuc CA, Bustabad Reyes S, Gómez-Centeno A, Muñoz-Fernández S, et al. Estándares de calidad en una Unidad de Hospitalización de Día reumatológica. Propuesta del Grupo de Trabajo de Hospitales de Día de la Sociedad Española de Reumatología. Reumatol Clin. 2014;10:380–388.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>" "etiqueta" => "Annex 1" "titulo" => "Functional Program of Day Hospital Units (DHUs)" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1350 "Ancho" => 1000 "Tamanyo" => 215684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sequence of activities for a Day Hospital Unit in Rheumatology.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">(I) Essential benefits</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>(<span class="elsevierStyleItalic">1) Administration of intravenous treatments</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(a) Biological treatment (infliximab, tocilizumab, rituximab, abatacept, and belimumab) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(b) Cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(c) Bisphosphonates (zoledronic acid and pamidronate) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(d) Corticosteroids bolus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(e) Prostaglandins and analogs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(f) Iron \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(g) Gamma globulins \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(h) Transfusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(i) Antibiotic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(2) Clinical monitoring of patients with rheumatic diseases</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">(II) Optional features</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(1) Diagnostic techniques, including post-procedure care</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(a) Ultrasound-guided puncture \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(b) Bronchoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(c) Or transthoracic FNAB of soft tissue \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(d) Thoracentesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(e) Biopsy (liver, muscle, bone, pleural, renal, etc.) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(2) Therapeutic procedures</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(a) Articular lavage \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(b) Arthrocentesis and infiltrations, including ultrasound-guided \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(3) Education of patients and caregivers</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(4) Other techniques and procedures</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(a) Salivary gland biopsy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(b) Lumbar puncture \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(c) Epidural catheters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(d) Vertebroplasty and kyphoplasty \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(e) Wound care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(f) Subcutaneous infusion pump \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>(g) Care of central venous catheter and subcutaneous reservoir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(5) Clinical research: clinical trials</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(6) Specific undergraduate and graduate training (doctors and nurses)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(7) Emergency or rheumatologic consultations outside normal hours</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571526.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Portfolio of Services of the Day Hospital Rheumatology Unit.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DHUs: Day Hospitalization Units.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clarification/Advice \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Planning agendas and receiving patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The appointment will be made with electronic media, with applications for the registration of the patient's arrivalPatients were scheduled in a personalized way, according to their characteristics and preferences whenever possibleSome appointments are in separate outpatient agendas, for therapeutic control and treatmentsTelephone confirmation of appointment the day before \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood samples \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The indication or confirmation of treatment may require the evaluation of the results of previous clinical analysis. Optionally, the blood sample can be performed the day before or at health centers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consultations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The consultation aims to clinically evaluate the patient for treatment or confirm management and monitoring of patient progress. A single integrated visit is recommended for analysis and medical assessment of the day procedureNursing consultations are recommended with specific training: welcoming patients, informing them about the structure and functioning of the DHU and patient and family education \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prescription \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The prescription process shall be electronic whenever possible. We recommend integrating therapeutic orders, formalizing the procedures associated with the prescription, preparation and administration of treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preparation of treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The preparation should be completed for administration without requiring handling and ensuring the composition and stability, security and the prevention of environmental pollutionThe treatments should be available by the time of the programmed patient allocation.The option of preparing DHU treatments, subject to the availability of resources and proper conditions, may be considered and it is shown that this improves the quality and efficiency of the unit \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The organization of the operation of the unit must conform to the times of administration of each prescription scheme \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuity of care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">We recommend assigning a specific doctor for DHU's, ideally a rheumatologistThere must be a method to treat patients requiring unscheduled care, preventing from coming to the emergency in order to ensure continuity of careIt is advised to have a telephone consultation, ideally managed by the nursing staff, identifying the person to contactThe discharge sheet should contain specific instructions on aftercare for: the patient, the Rheumatology doctor responsible for the patient, the Primary Care doctor and nurse \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571529.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Performance Criteria and Configuration Episode of the Day Hospital Rheumatology Units.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DHU: Day Hospital Unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Standard structure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clarification/Advice \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All rheumatology departments must have or have access to a DHU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If not monographic, at least have access to a multipurpose DHU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adequate physical structure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Main physical areas: reception, DHU positions, the nurses and general support, administrative area and support for staff \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suitable access and location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DHUs should ideally be at street level and always with good wheelchair accessibility conditions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Broad attention hours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If possible daily and morning and afternoon shifts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Privacy during the visit/stay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Individualized consultation for physical examination or other procedures and the possibility of privacy in the room for the delivery of treatment, using curtains, screens, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electronic format that can be used by information systems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Connected to the hospital for the management of patients and agendas, financial and administrative management and general services, electronic prescribing, registry of data collection and monitoring (such as clinical unit and system-evaluation scorecard) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The boxes will be located around direct support spaces in a single, centralized disposition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Air conditioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Logging and defining lines of responsibility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Responsibilities, reporting lines, responsibilities and competencies must be clearly defined \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DHU's must have at least one administrative worker with experience to support those responsible for the unit, managing admissions and waiting lists \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The management of clinical documentation correspond to the admission and clinical documentation unit or equivalent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have a person responsible (ideally a rheumatologist) for management. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It may be the same person as that responsible for the administration of the treatments. That person is responsible for organizing and coordinating unit staff, with appropriate use of resources, program activities, quality assurance and management of waiting list \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The unit must have a physician (rheumatologist) for administration of treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This person will be responsible for patient care (prescription, clinical monitoring), plus monitoring. If the physical presence of the rheumatologist is not possible in the Unit, there should be one located and accessible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The unit must have trained nursing staff in rheumatologic processes and procedures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Even if it is a multipurpose DHU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have a responsible nursing staff \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Its function is to coordinate care planning, scheduling activities of nursing staff and control the availability of material resources \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide a nursing assistant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical or electronic availability of key documents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1) Service Portfolio2) Medical Records3) Informed consents4) Admission program5) Guidelines and/or clinical practice protocols6) Protocols of confidentiality and legal access to patient data7) Standard Working Procedures8) Procedures required in clinical trials8) Reports of medical discharge9) Registration of complaints and suggestions10) Operation Manual11) Hospital Code of Ethics13) Insurance of responsibility14) Plan for self-protection against possible disasters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plan for self-protection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This will establish the organization of human and material resources available to prevent risk of fire or equivalents and immediate intervention to ensure against possible disasters \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571530.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Structure Standards of Day Hospital Rheumatology Units.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CPG: clinical practice guideline; DHU: Day Hospital Unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Quality standards \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clarification/Advice \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quality plan tailored to each DHU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It includes, among others, analysis, archiving, review and updating of consensus, CPG, technical specifications of drugs, protocols, and operating organization and operation of the DHU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Organization and operation manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This must include organizational, resources, physical layout of the DHU, care organization and standards and services portfolios \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ensure optimum cleanliness and hygiene \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cleaning protocol for the dependencies, facilities, equipment and supplies and equipment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide contact and telephone consultation to patients and caregivers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">With identification of the contact person \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Give ID card of the contact person \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have a system of appointments and appointment confirmation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Providing a delay guarantee for access to the DHU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The waiting list for access to the unit should be limited and defined according to each treatment or procedure (e.g. differentiate steroid boluses from Zoledronic acid for osteoporosis) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have a reception procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Information that includes at least a description of the different phases that the patient go through and related special warnings or advice \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide written information about the DHU and all processes related to the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(a) Advance directives on admission and access to the DHU(b) Instructions for patient stays, for caregiver and roommates(c) Instructions for immediate aftercare and post-discharge(d) The probable issues that the patient may present due to medication and the care that should be given(e) Forms of access to continued resources \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient record \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Should include, among others, the identification of hospital or, physician/nurse responsible for the care, post-discharge, patient identification, dates and discharge \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ensure efficient coordination between the pharmacy and DHU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No delay between prescription and administration, with the possibility of preparing drugs in the same DHUThe definitive validation for medication preparation should be made following confirmation of patient care and, once reviewed, show no impediment for administration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Updated protocols (medical, nursing, pharmacy, administrative, management) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Must be accredited with the update date and person responsible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have and use a checklist of tasks to perform \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Includes reception, validation procedure to start medical and nursing care (analytical, clinical evaluation, etc.) during the procedure (infusion tests), monitoring and discharge (report, appointment, etc.). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Have a contingency plan for key processes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In case of fever, adverse events, patients who do not come to appointment, death, etc. Ability to appoint another patient on that day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Activity log and contents coding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electronic format preferred \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer integrated unique visit opportunity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lab analytics, medical assessment, procedure and discharged on the same day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide health education and self-care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Education for self-care, including, among others: healthy lifestyle, recognition of alerts and management for pain and other symptoms, treatment compliance, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dispense appropriate treatment to the patient and their caregivers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perform systematic and periodic evaluation of care received by patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Through surveys of satisfaction, perceived quality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delivery discharge report and treatment plan to the patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always or in special situations: at baseline, changes in medication, last discharge, in case of adverse events, etc. with a detailed specification of the post-discharge care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Promote coordination with primary care professionals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To ensure continuity of care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Undergraduate and graduate DHU training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">For medical students and nursing and rheumatology residents \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide care coordination programs within the center itself \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To identify user needs and guide or provide social resources \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide and promote specific training programs for DHU staff \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At all levels of health workers: medical, nursing, ancillary, administrative, orderlies, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perform specific clinical sessions in Rheumatology DHU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monographic sessions or within the service \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571528.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Standards Processes of the Day Hospital Rheumatology Units.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">MSD: minimum set of databases; ISO: International Standard Organization; DHU: Day Hospital Unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Quality standards \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clarification/Advice \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DHU must have electronic application that allows to obtain (daily, monthly, quarterly or annual) information on the activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Implementation of an appropriate information system to monitor the results of the activity<span class="elsevierStyleHsp" style=""></span>-No. total procedures performed<span class="elsevierStyleHsp" style=""></span>-No. total patients seen<span class="elsevierStyleHsp" style=""></span>-No. total suspended proceedings and causes<span class="elsevierStyleHsp" style=""></span>Total No. of each procedureAverage daily patientsAverage patients per DHU post \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular and systematic evaluation of DHU staff performance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Including all health care staff and those responsible for management and administration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular and systematic evaluation of adherence to protocols \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">For example, by random audit of medical records \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular and systematic evaluation of patient satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">User surveys, to determine the degree of acceptance and satisfaction of the method, and to establish a diagnosis of problems in the development of the service \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Registration of adverse events and incidents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All those that occurred during the procedureLater: at least serious events attributable to the procedure or treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Registration of all DHU discharges \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Encoded by the MSD center or other specific coding \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provide the estimated time and cost for each DHU procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular Economic evaluation of drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minimum: costs; preferred cost/effectiveness or cost/utility. Period: at least annually \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electronic application that allows to obtain (monthly, quarterly or annual) information on results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of patients requiring admissionRate of adverse events during the procedureCrude death rateSpecific outcomes collected per patient by disease: rates of activity, function, quality of life, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">External quality certification \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">For example, ISO 9001-2008 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571527.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Results of Standards in Day Hospital Rheumatology Units.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased portfolio of a Unit of Rheumatology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Setting of excellence for comprehensive care of complex rheumatologic patients in which the most innovative aspects of the specialty are reflected \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Teaching, continuing medical education, continuing professional development \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Research and innovation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leadership as specialty knowledge of rationality and peculiarities of use of biological therapies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rational use of high-cost therapies and commitment to sustainability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Education for self-care and “<span class="elsevierStyleItalic">activation”</span> of patients and caregivers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quality management that allows continuous evaluation to improve and achieve external accreditation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greater involvement in managing tasks in the future for greater independence/self-management Rheumatology services \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571532.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Opportunities Arising From a Quality Plan for Day Hospital Rheumatology Units.</p>" ] ] 7 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Reproduced with permission from the reference Working Group for the preparation of “DHU Standards and Recommendations”.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Ministry of Health, Social Services and Equality.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Demographic analysis of the environment (with particular reference to the population included in the capture area of the unit and the selection criteria of patients) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Study of DHU theoretical demand of treatments, considering the volume of procedures performed. The pervasiveness of the unit in its environment should be taken into account, once it is fully operational \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analysis of the architectural infrastructure where the activities of DHU (definition of new or modification of existing infrastructure) will be developed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analysis of the production capacity, according to varying scenarios efficiency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Study of the need for staff and equipment, based on the demand, the planned activity and portfolio of existing services in the hospital \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Definition of operation with reference to the policy manual, including schematics of movement of patients, staff, family and materials \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Configuration the care circuit (forms of patient access, administrative processing of receipt, transit within DHUs, alternatives to output, etc.), forms of medical care and post-discharge functional relationships with other environment structures (central services, emergency, critical care units, primary care, etc.). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Functional Plan, according to the specific characteristics of its organization \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Economic survey, in which both the amount of the planned investment in infrastructure and equipment as well as the estimated running costs of personnel, supplies and maintenance for the activities and economic and health impact of the operation will be reflected on the institution it depends from. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab571531.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Grupo de Trabajo para la elaboración de “Estándares y recomendaciones de HdD”" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "Ministerio de Sanidad y Consumo, Unidad de Hospital de Día, Estándares y recomendaciones" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitales de día: recomendaciones según consenso nacional SEOM" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 46 | 31 | 77 |
| 2024 September | 52 | 20 | 72 |
| 2024 August | 69 | 26 | 95 |
| 2024 July | 58 | 28 | 86 |
| 2024 June | 84 | 43 | 127 |
| 2024 May | 83 | 40 | 123 |
| 2024 April | 82 | 43 | 125 |
| 2024 March | 95 | 34 | 129 |
| 2024 February | 52 | 38 | 90 |
| 2024 January | 52 | 23 | 75 |
| 2023 December | 38 | 33 | 71 |
| 2023 November | 83 | 40 | 123 |
| 2023 October | 85 | 48 | 133 |
| 2023 September | 132 | 41 | 173 |
| 2023 August | 69 | 12 | 81 |
| 2023 July | 81 | 36 | 117 |
| 2023 June | 68 | 35 | 103 |
| 2023 May | 78 | 41 | 119 |
| 2023 April | 57 | 19 | 76 |
| 2023 March | 88 | 27 | 115 |
| 2023 February | 60 | 31 | 91 |
| 2023 January | 48 | 8 | 56 |
| 2022 December | 68 | 40 | 108 |
| 2022 November | 58 | 26 | 84 |
| 2022 October | 78 | 32 | 110 |
| 2022 September | 66 | 52 | 118 |
| 2022 August | 60 | 46 | 106 |
| 2022 July | 47 | 43 | 90 |
| 2022 June | 35 | 38 | 73 |
| 2022 May | 44 | 39 | 83 |
| 2022 April | 51 | 55 | 106 |
| 2022 March | 54 | 43 | 97 |
| 2022 February | 51 | 32 | 83 |
| 2022 January | 40 | 40 | 80 |
| 2021 December | 35 | 39 | 74 |
| 2021 November | 43 | 40 | 83 |
| 2021 October | 44 | 53 | 97 |
| 2021 September | 54 | 46 | 100 |
| 2021 August | 42 | 46 | 88 |
| 2021 July | 40 | 35 | 75 |
| 2021 June | 48 | 54 | 102 |
| 2021 May | 58 | 39 | 97 |
| 2021 April | 123 | 91 | 214 |
| 2021 March | 55 | 30 | 85 |
| 2021 February | 69 | 34 | 103 |
| 2021 January | 44 | 18 | 62 |
| 2020 December | 54 | 22 | 76 |
| 2020 November | 41 | 33 | 74 |
| 2020 October | 20 | 5 | 25 |
| 2020 September | 42 | 33 | 75 |
| 2020 August | 29 | 16 | 45 |
| 2020 July | 23 | 12 | 35 |
| 2020 June | 43 | 22 | 65 |
| 2020 May | 48 | 13 | 61 |
| 2020 April | 55 | 15 | 70 |
| 2020 March | 19 | 7 | 26 |
| 2019 January | 3 | 0 | 3 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 6 | 24 | 30 |
| 2018 April | 161 | 11 | 172 |
| 2018 March | 117 | 12 | 129 |
| 2018 February | 116 | 4 | 120 |
| 2018 January | 94 | 10 | 104 |
| 2017 December | 85 | 5 | 90 |
| 2017 November | 107 | 9 | 116 |
| 2017 October | 39 | 9 | 48 |
| 2017 September | 40 | 6 | 46 |
| 2017 August | 30 | 10 | 40 |
| 2017 July | 35 | 13 | 48 |
| 2017 June | 60 | 6 | 66 |
| 2017 May | 64 | 10 | 74 |
| 2017 April | 53 | 8 | 61 |
| 2017 March | 49 | 35 | 84 |
| 2017 February | 52 | 5 | 57 |
| 2017 January | 47 | 5 | 52 |
| 2016 December | 104 | 14 | 118 |
| 2016 November | 84 | 15 | 99 |
| 2016 October | 112 | 22 | 134 |
| 2016 September | 130 | 2 | 132 |
| 2016 August | 67 | 5 | 72 |
| 2016 July | 43 | 2 | 45 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 3 | 0 | 3 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 37 | 5 | 42 |
| 2015 June | 96 | 19 | 115 |
| 2015 May | 85 | 20 | 105 |
| 2015 April | 44 | 9 | 53 |
| 2015 March | 75 | 15 | 90 |
| 2015 February | 66 | 10 | 76 |
| 2015 January | 79 | 24 | 103 |
| 2014 December | 68 | 15 | 83 |
| 2014 November | 76 | 22 | 98 |
| 2014 October | 32 | 17 | 49 |
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