Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil

ABSTRACT Objective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding. Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs. Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management. Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.摘要 研究目的 阐述基于快速响应团队的出血管理与处置护理方案的实施路径。 研究方法 本研究设计并开发了一款名为“出血应急预案（Hemorrhage Code，简称Code H）”的医院级临床预案。一方面，多学科团队可为重症出血患者提供全面、快速且高效的护理服务；另一方面，医院药房专职人员可主动筛查出血高风险人群，提前阻断出血事件的发生。此外，本院多个科室及医护人员均接受了针对性岗位培训，明确各岗位权责，以此为医疗与护理团队提供全方位支撑。 研究结果 该预案实施后，因出血管理失误引发的灾难性事件数量显著降低。 研究结论 Code H是基于价值医疗与精准医学的实践范例：其不仅为临床引入了床旁检测（point-of-care testing）技术，提供多学科综合护理服务，同时优化了本院的患者安全保障体系与临床护理流程。此外，该预案可有效降低医院及医护人员面临的医疗纠纷风险，同时实现医疗资源合理化配置，为医院管理者与支付方带来切实收益。