Rehabilitación propioceptiva del síndrome de hombro doloroso / Proprioceptive rehabilitation of painful shoulder syndrome / Reabilitação proprioceptiva da síndrome do ombro doloroso

El hombro es una de las regiones anatómicas de mayor movilidad en la vida cotidiana, siendo una de las causas de consulta más frecuentes en el área de fisioterapia para su rehabilitación, pues la primera línea de acción es el tratamiento conservador del hombro; por ello, es de suma importancia conocer y evaluar el complejo articular del hombro, así como también de la región cervicotorácica, con los resultados de la valoración establecer una estrategia de tratamiento que pueden ir desde la terapia manual, el masaje terapéutico, cambios de temperatura hasta el empleo de otros agentes físicos. Paciente femenino de 42 años, con ocupación de asistente odontológica; no reporta discapacidad previa. Como antecedente médico se presenta accidente de tránsito en motocicleta sin producir fractura de hueso ni luxación, ocurrido ocho años antes de la consulta en fisiatría, la paciente tiene afectado el desarrollo de las actividades de la vida cotidiana. Recibió serie de tratamientos durante 10 sesiones, en las cuales se aplican agentes físicos, dado que anteriormente recibió tratamiento farmacológico sin resultados favorables. Se aplica protocolo de rehabilitación fundamentado en las técnicas de propiocepción y al finalizar la terapia la paciente reporta dolor leve, y mejora en la realización de actividades de la vida diaria.

The shoulder is one of the anatomical regions of greater mobility in daily life, being one of the most frequent causes of consultation in the area of physiotherapy for rehabilitation, since the first line of action is the conservative treatment of the shoulder; therefore, it is of utmost importance to know and evaluate the articular complex of the shoulder, as well as the cervicothoracic region, with the results of the assessment to establish a treatment strategy that can range from manual therapy, therapeutic massage, temperature changes to the use of other physical agents. Female patient, 42 years old, with occupation as a dental assistant; she reports no previous disability. As medical history, she had a traffic accident on a motorcycle without bone fracture or dislocation, which occurred eight years before the physiatry consultation, the patient has affected the development of activities of daily living. She received a series of treatments during 10 sessions, in which physical agents are applied, since she had previously received pharmacological treatment without favorable results. Rehabilitation protocol based on proprioception techniques is applied and at the end of therapy the patient reports mild pain and improvement in the performance of activities of daily living.

O ombro é uma das regiões anatômicas de maior mobilidade na vida diária, sendo uma das causas mais freqüentes de consulta na área de fisioterapia para reabilitação, pois a primeira linha de ação é o tratamento conservador do ombro; portanto, é extremamente importante conhecer e avaliar o complexo articular do ombro, bem como a região cervicotorácica, com os resultados da avaliação para estabelecer uma estratégia de tratamento que pode variar desde a terapia manual, massagem terapêutica, mudanças de temperatura até o uso de outros agentes físicos. Paciente do sexo feminino, 42 anos de idade, trabalhando como assistente odontológica; nenhuma deficiência anterior foi relatada. O histórico médico inclui um acidente de trânsito em uma motocicleta sem fratura ou deslocamento ósseo, que ocorreu oito anos antes da consulta ao fisiatra; as atividades de vida diária do paciente são afetadas. Ela recebeu uma série de tratamentos durante 10 sessões, nas quais foram aplicados agentes físicos, já que ela havia recebido anteriormente tratamento farmacológico sem resultados favoráveis. Um protocolo de reabilitação baseado em técnicas de propriocepção foi aplicado e ao final da terapia o paciente relatou dor leve e melhora no desempenho das atividades da vida diária.

Aplicativo móvel Nursing Alert® para apoio ao enfermeiro na identificação da deterioração clínica do paciente / Nursing Alert® mobile app to support nurses in identifying patient clinical deterioration / Aplicación móvil Nursing Alert® para apoyo al enfermero en la identificación del deterioro clínico del paciente

Objetivo: descrever o desenvolvimento de um aplicativo móvel híbrido multiplataforma para auxiliar o enfermeiro na sistematização de sua assistência diante do risco de deterioração clínica do paciente internado no espaço hospitalar. Método: estudo descritivo para elaboração de aplicativo móvel híbrido multiplataforma baseado no processo de engenharia de software Rational Unified Process, por meio das fases de concepção, elaboração e construção. Resultados: o nome e a logo do aplicativo Nursing Alert ® associa-o à sua função como aplicativo móvel, versão para Android® e iOS® e registrado no Instituto Nacional de Propriedade Industrial. O enfermeiro, usuário-alvo, necessita inserir o seu registro profissional e as informações referentes ao paciente a ser analisado. Não necessita de rede de internet após o seu download. Conclusão: o aplicativo móvel Nursing Alert pode ser uma ferramenta dinâmica e precisa para auxiliar o enfermeiro em seu julgamento clínico e definição de prioridades para seus pacientes.

Objective: to describe the development of a hybrid, cross-platform, mobile application to assist nurses in systematizing their care in view of the risk of clinical deterioration of hospital patients. Method: descriptive study of the development of a hybrid, cross-platform, mobile application, through the conception, elaboration and construction phases of the Rational Unified Process of software engineering. Results: the name and logo of the Nursing Alert® application associate it with its function as an Android® and iOS® version mobile application registered with Brazil's National Industrial Property Institute. The target users, nurses, need to enter their professional registration number and patient vital signs information. Once downloaded, no Internet access is required. Conclusion: the Nursing Alert® mobile app can be an accurate, dynamic tool to assist nurses in their clinical judgment and priority setting for their patients.

Objetivo: describir el desarrollo de una aplicación móvil híbrida multiplataforma para ayudar al enfermero en la sistematización de su asistencia frente al riesgo de deterioro clínico del paciente internado en el ámbito hospitalario. Método: estudio descriptivo para la elaboración de una aplicación móvil híbrida multiplataforma basada en el proceso de ingeniería de software Rational Unified Process, a través de las etapas de concepción, elaboración y construcción. Resultados: el nombre y el logo de la aplicación Nursing Alert® la asocia a su función como aplicación móvil, versión para Android® e iOS® y patentada en el Instituto Nacional de Propiedad Industrial. El enfermero, usuario objetivo, debe ingresar su matrícula profesional y las informaciones del paciente a ser analizado. No hace falta conexión de Internet una vez hecha la descarga. Conclusión: la aplicación móvil Nursing Alert® puede ser una herramienta dinámica y de precisión para ayudar al enfermero en su juicio clínico y en la definición de prioridades para sus pacientes.

Challenges at the front: experiences of professionals in admitting patients to the intensive care unit during the covid-19 pandemic / Desafíos delanteros: experiencias de profesionales en el ingreso de pacientes en la unidad de cuidados intensivos en la pandemia del covid-19 / Desafios do front: experiências de profissionais na admissão de pacientes em unidade de terapia intensiva na pandemia da covid-19

ABSTRACT Objective: to know the perspectives, practices and challenges in decision-making for admitting patients into the Intensive Care Unit during the Covid-19 pandemic. Methods: a qualitative study developed in two public hospitals in Maranhão, Brazil, from November/2020 to January/2021. Data collection took place through individual interviews guided by a script. A total of 22 professionals participated in the study: nurses and doctors who worked in the Intensive Care Unit and Bed Regulation in the first wave of the pandemic. Content Analysis was used in the thematic mode, with support from the Qualitative Data Analysis software program for data categorization. The theory of Responsibility for Reasonableness guided the study. Results: two main categories emerged: "The context of the decision-making process - the paradox of celestial discharges" and "Decision-making for admission". In the scenario of high demand, a lack of beds, and the uncertainties of the "new disease", deciding who would occupy the bed was arduous and conflicting. Clinical and non-clinical criteria such as severity, chance of survival, distance to be covered and transport conditions were considered. It was found that the ambivalence of feelings attributed to death and care at that moment of the pandemic marked the social and technical environment of intensive care. Conclusions: the complexity of the decision-making process for admission to an intensive care unit was evidenced, demonstrating the importance of analyzing the allocation of critical resources in pandemic scenarios. Knowing the perspectives of professionals and their reflections on the experiences in that period can help in planning the allocation of health resources in future emergency scenarios.

RESUMEN Objetivo: conocer perspectivas, prácticas y desafíos en la toma de decisiones para el ingreso de pacientes a camas en Unidades de Cuidados Intensivos en la pandemia de COVID-19. Métodos: un estudio cualitativo, desarrollado en dos hospitales públicos de Maranhão, Brasil, de noviembre/2020 a enero/2021. La recolección de datos se realizó a través de entrevistas individuales guiadas por un guión. Un total de 22 profesionales participaron en el estudio: enfermeros y médicos que actuaban en la Unidad de Cuidados Intensivos y Regulación de Camas en la primera ola de la pandemia. Se utilizó el Análisis de Contenido en la modalidad temática, con apoyo del Software de Análisis Cualitativo de Datos para la categorización de los datos. La teoría de la Responsabilidad por la Razonabilidad guió el estudio. Resultados: surgieron dos categorías principales: "El contexto del proceso de toma de decisiones - la paradoja de los altos celestes" y "Toma de decisiones para la admisión". En el escenario de alta demanda, escasez de camas e incertidumbres de la "nueva enfermedad", decidir quién ocuparía la cama fue arduo y conflictivo. Se consideraron criterios clínicos y no clínicos, como gravedad, probabilidad de supervivencia, distancia a recorrer y condiciones de transporte. Se constató que la ambivalencia de los sentimientos atribuidos a la muerte y al cuidado, en ese momento de la pandemia, marcaron el ambiente social y técnico de la terapia intensiva. Conclusiones: se evidenció la complejidad del proceso de toma de decisiones para el ingreso a una unidad de cuidados intensivos, demostrando la importancia de analizar la asignación de recursos críticos en escenarios de pandemia. Conocer las perspectivas de los profesionales y sus reflexiones sobre las experiencias en ese período puede ayudar en la planificación de la asignación de recursos de salud en futuros escenarios de emergencia.

RESUMO Objetivo: conhecer perspectivas, práticas e desafios na tomada de decisão para admissão de pacientes em leitos de Unidades de Terapia Intensiva na pandemia da Covid-19. Métodos: estudo qualitativo, desenvolvido em dois hospitais públicos do Maranhão, Brasil, de novembro/2020 a janeiro/2021. A coleta de dados ocorreu por meio de entrevistas individuais guiadas por roteiro. Participaram do estudo 22 profissionais: enfermeiros e médicos que atuaram em Unidade de Terapia Intensiva e Regulação de Leitos na primeira onda da pandemia. Empregou-se a Análise de Conteúdo na modalidade temática, com apoio do Qualitative Data Analysis Software para categorização dos dados. A teoria da Responsabilidade pela Razoabilidade norteou o estudo. Resultados: emergiram duas categorias principais: "Contexto do processo decisório - o paradoxo das altas celestiais" e "Tomada de decisão para admissão". No cenário de alta demanda, insuficiência de leitos e de incertezas da "nova doença", decidir quem ocuparia o leito era árduo e conflitante. Critérios clínicos e não clínicos, como gravidade, chance de sobrevivência, distância a ser percorrida e condições do transporte foram considerados. Constatou-se que a ambivalência de sentimentos atribuídos à morte e ao cuidado, naquele momento da pandemia, marcaram o ambiente social e técnico da terapia intensiva. Conclusões: evidenciou-se a complexidade do processo decisório para admissão em unidade de terapia intensiva, demonstrando a importância de analisar a alocação de recursos críticos em cenários pandêmicos. Conhecer as perspectivas dos profissionais e as reflexões deles sobre as experiências naquele período podem auxiliar no planejamento de alocação de recursos de saúde em cenários emergenciais futuros.

Calidad de la gestión del ingreso hospitalario en los servicios de medicina interna / Quality of the hospital admission management in the Internal Medicine Services

La calidad de la gestión y adecuación del ingreso de los pacientes en los servicios de medicina interna es un tema relevante en el ámbito sanitario, dado que resulta un indicador del equilibrio existente entre la atención primaria de salud, el servicio de urgencia hospitalaria y la funcionalidad del propio servicio de medicina interna. Sin embargo, en este equilibrio se presentan irregularidades debido a determinadas problemáticas vinculadas a un insuficiente nivel teórico de los prestadores y a carencias en las habilidades prácticas y organizativas para ejecutar la hospitalización. En este artículo se abordan algunas de estas deficiencias que dañan la calidad de la gestión del ingreso en dicho servicio, y que requieren la proyección de una estrategia sustentada en un modelo formativo sociohumanista y asistencial, a fin de lograr avances significativos en el contexto hospitalario.

The quality of management and adaptation of admission of patients to the internal medicine services is a relevant topic in the health environment, as it is an indicator of the existing balance between primary health care, the emergency hospital service and the functioning of the internal medicine service itself. However, there are irregularities in this balance due to certain problems linked to a scarce theoretical level of the providers and to scarcities in the practical and organizational skills to carry out hospitalization. Some of the deficiencies damaging the quality of management during admission in this service, which require the projection of a strategy based on a health, formative, and social-humanistic model are presented in this work, with the aim of achieving significant advances in the hospital context.

Processo de enfermagem no ambiente hospitalar: potencialidades, fragilidades e estratégias vivenciadas por enfermeiros / Proceso de enfermería en el entorno hospitalario: potencialidades, fragilidades y estrategias experimentadas por los enfermeros / Nursing process in the hospital environment: potentialities, fragilities and strategies experienced by nurses

Objetivo: Descrever as potencialidades e fragilidades vivenciadas por enfermeiros, atuantes no contexto hospitalar acerca do Processo de Enfermagem, bem como as estratégias para auxiliar nesse contexto. Método: Pesquisa exploratória, descritiva, de abordagem qualitativa, realizada com 15 enfermeiros atuantes em um hospital público municipal, localizado no Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um questionário semiestruturado, os quais foram submetidos à análise textual discursiva. Resultados: Geraram uma categoria central - vivências de enfermeiros, atuantes no contexto hospitalar acerca do Processo de Enfermagem; e oito categorias, das quais, três referentes a unidade de base - potencialidades vivenciadas por enfermeiros acerca do Processo de Enfermagem; três, referentes a unidade - fragilidades vivenciadas por enfermeiros acerca do Processo de Enfermagem; e duas, sobre a unidade - Estratégias sugeridas para auxiliar na realização do Processo de Enfermagem. Conclusão: A compreensão das potencialidades e fragilidades é fundamental para o planejamento de estratégias para auxiliar no processo de enfermagem(AU)

Objective: To describe the strengths and weaknesses experienced by nurses, working in the hospital context about the Nursing Process, as well as the strategies to assist in this context. Method: Exploratory, descriptive research with a qualitative approach, conducted with 15 nurses working in a municipal public hospital, located in Rio Grande do Sul, Brazil. Data were collected through a semi-structured questionnaire, which were subjected to discursive textual analysis. Results: It generated a central category - nurses' experiences, working in the hospital context about the Nursing Process; and nine categories, of which, three referring to the basic unit - potentialities experienced by nurses about the Nursing Process; three, referring to the unit - weaknesses experienced by nurses about the Nursing Process; and two, on the unit - Strategies suggested to assist in the realization of the Nursing Process. Conclusion: Understanding the strengths and weaknesses is essential for planning strategies to assist in the nursing process(AU)

Objetivo: Describir las fortalezas y debilidades vividas por los enfermeros, trabajando en el contexto hospitalario sobre el Proceso de Enfermería, así como las estrategias para ayudar en este contexto. Método: Investigación exploratoria descriptiva con enfoque cualitativo, realizada con 15 enfermeros que laboran en un hospital público municipal, situado en Rio Grande do Sul, Brasil. Los datos fueron recolectados a través de un cuestionario semiestructurado, los cuales fueron sometidos a análisis discursivo textual. Resultados: Generó una categoría central - experiencias de enfermeros, trabajando en el contexto hospitalario sobre el Proceso de Enfermería; y nueve categorías, de las cuales tres se refieren a la unidad básica - potencialidades vividas por los enfermeros sobre el Proceso de Enfermería; tres, referido a la unidad - debilidades experimentadas por los enfermeros sobre el Proceso de Enfermería; y dos, en la unidad - Estrategias sugeridas para ayudar en la realización del Proceso de Enfermería. Conclusión: Comprender las fortalezas y debilidades es fundamental para planificar estrategias que ayuden en el proceso de enfermería(AU)

Practical exploration of one-stop admission service in a general hospital / 中华医院管理杂志

The authors introduced the construction of one-stop admission service in a large general hospital.Measures were carried out by implementing the measures of one window handling of admission business, building one-stop pre-hospital preparation center, optimizing the operational pattern of pre-hospital examination, strictly controlling the hospitalization time of surgical patients, optimizing the information system according to admission criteria, providing personalized services for clinic and implementing quality monitoring.It effectively improved the pre-hospital examination rate, shortened the waiting time and the average length of stay of the patients undergoing elective surgery, and increased the satisfaction of pre-hospital patients.

Utilidad de una escala de alerta temprana como predictor precoz de deterioro clínico en niños internados / Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children

Introducción. La detección temprana del deterioro clínico en pacientes internados posibilita mejorar la calidad de atención médica. Las escalas Pediatric Early Warning Score (PEWS) predicen este deterioro dentro de las primeras 24 h de aplicadas. Estudios previos avalan estas herramientas.Objetivo. Evaluar la utilidad de la escala B-PEWS(Brighton PEWS) para predecir el deterioro clínico en niños internados, en un hospital pediátrico de la Ciudad de Buenos Aires.Población y métodos. Diseño de corte transversal. Incluyó todas las historias clínicas de pacientes de 1 mes a 18 años hospitalizados en áreas de hospitalización indiferenciada, desde el 1 de marzo al 31 de agosto de 2018. Variable de predicción: valor de B-PEWS (≤ 3 y ≥ 4 puntos). Variable de resultado: deterioro clínico dentro de las 24 horas. Análisis de variables categóricas mediante prueba de chi2 y cálculo de valores de clivaje. Como medida de asociación, se usó riesgo relativo. Se realizó análisis de curva ROCy análisis de punto óptimo mediante índice de Youden, tomando la escala de manera continua.Resultados. Se analizaron 518 historias clínicas. Cuarenta pacientes presentaron deterioro clínico; 37 con B-PEWS ≥ 4, y 3 con B-PEWS ≤ 3 (RR 56,36; IC 95 %: 17,76-178,89; p < 0,01). Sensibilidad: el 92,5 %; especificidad: el 88,3 %; valor predictivo positivo: el 39,8 %; negativo: el 99,3 %; razón de verosimilitud positiva: 7,91; razón de verosimilitud negativa: 0,08. AUC: 0,94 (IC 95 %: 0,89-0,98).Conclusión. La escala B-PEWS demostró ser útil para predecir el deterioro clínico en niños hospitalizados

Introduction. The early detection of clinical deterioration in hospitalized patients helps to improve the quality of care. The pediatric early warning score (PEWS) system predicts such deterioration in the first 24 hours of administration. Prior studies support the use of these tools.Objective. To assess the usefulness of the Brighton PEWS (B-PEWS) for the prediction of clinical deterioration among hospitalized children at a children's hospital in the Autonomous City of Buenos Aires.Population and methods. Cross-sectional study. The medical records of all patients aged 1 month to 18 years admitted to any hospitalization ward between March 1st and August 31st, 2018 were included. Predictive outcome measure: B-PEWS score (≤ 3 and ≥ 4 points). Outcome variable: clinical deterioration in the first 24 hours. Categorical outcome measures were analyzed with the χ² test and screening values were estimated. The relative risk was used as a measure of association. A ROC curve analysis and an optimal cut-point analysis according to the Youden index were done considering the score in a continuous manner.Results. A total of 518 medical records were reviewed. Forty patients had clinical deterioration; the B-PEWS score was ≥ 4 in 37 patients and ≤ 3 in 3 (relative risk: 56.36; 95 % confidence interval: 17.76-178.89; p < 0.01). Sensitivity: 92.5 %; specificity: 88.3 %; positive predictive value: 39.8 %; negative predictive value: 99.3 %; positive likelihood ratio: 7.91; negative likelihood ratio: 0.08. AUC:0.94 (95 % confidence interval: 0.89-0.98).Conclusion. The B-PEWS demonstrated to be useful to predict clinical deterioration in hospitalized children.

Resultados adversos de admissões tardias à unidade de terapia intensiva a partir do pronto-socorro / Adverse outcomes of delayed intensive care unit

RESUMO Objetivo: Verificar o impacto da transferência tardia do pronto-socorro para a unidade de terapia intensiva no tempo de permanência na unidade e na ocorrência de óbitos. Métodos: Este estudo de coorte prospectiva foi conduzido em um hospital acadêmico terciário, com obtenção dos dados de 1.913 pacientes admitidos ao pronto-socorro com solicitação documentada de admissão à unidade de terapia intensiva. Os pacientes admitidos diretamente para a unidade de terapia intensiva médico-cirúrgica (n = 209) foram categorizados em tercis segundo o tempo de espera para admissão à unidade de terapia intensiva (Grupo 1: menos de 637 minutos; Grupo 2: entre 637 e 1.602 minutos, e Grupo 3: acima de 1.602 minutos). Os pacientes que permaneceram na unidade de terapia intensiva por mais de 3,2 dias (tempo mediano de tempo de permanência na unidade de terapia intensiva para todos os pacientes) foram considerados como tempo prolongado de permanência na unidade de terapia intensiva. Resultados: Foram tratados no pronto-socorro durante o período do estudo 6.176 pacientes, dentre os quais 1.913 (31%) necessitaram de um leito na unidade de terapia intensiva. O tempo mediano de permanência no pronto-socorro foi de 17 horas (9 - 33 horas). Hospitalização por infecção/sepse foi preditor independente para tempo prolongado de permanência na unidade (RC: 2,75; IC95% 1,38 - 5,48, p = 0,004), porém o tempo de espera para admissão à unidade de terapia intensiva não. A taxa de mortalidade foi mais elevada no Grupo 3 (38%) do que no Grupo 1 (31%), porém a diferença não foi estatisticamente significante. Conclusão: A admissão tardia à unidade de terapia intensiva a partir do pronto-socorro não resultou em aumento do tempo de permanência ou da mortalidade na unidade de terapia intensiva.

ABSTRACT Objective: To examine the impact of delayed transfer from the emergency room into the intensive care unit on the length of intensive care unit stay and death. Methods: This prospective, cohort study performed in a tertiary academic hospital obtained data from 1913 patients admitted to the emergency room with a documented request for admission into the intensive care unit. The patients admitted directly into the medical-surgical intensive care unit (n = 209) were categorized into tertiles according to their waiting time for intensive care unit admission (Group 1: < 637 min, Group 2: 637 to 1602 min, and Group 3: > 1602 min). Patients who stayed in the intensive care unit for longer than 3.2 days (median time of intensive care unit length of stay of all patients) were considered as having a prolonged intensive care unit stay. Results: A total of 6,176 patients were treated in the emergency room during the study period, among whom 1,913 (31%) required a bed in the intensive care unit. The median length of stay in the emergency room was 17 hours [9 to 33 hours]. Hospitalization for infection/sepsis was an independent predictor of prolonged intensive care unit stay (OR 2.75 95%CI 1.38 - 5.48, p = 0.004), but waiting time for intensive care unit admission was not. The mortality rate was higher in Group 3 (38%) than in Group 1 (31%) but the difference was not statistically significant. Conclusion: Delayed admission into the intensive care unit from the emergency room did not result in an increased intensive care unit stay or mortality.

Characteristics of primary care and rates of pediatric hospitalizations in Brazil

ABSTRACT OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03) CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.

Transformar el ingreso hospitalario en un momento de cuidado de enfermería / Transforming the hospital admission process into an opportunity for nursing care

Describir el proceso de transformación del ingreso hospitalario para convertirlo en un momento de cuidado de enfermería en el que se logra mejorar la adaptación de quienes son atendidos. Metodología: investigación metodológica en enfermería realizada en seis fases entre el 2017 y el 2018: diagnóstico de la experiencia de los pacientes y sus cuidadores familiares durante el ingreso a hospitalización; revisión de las buenas prácticas mundiales de ingreso hospitalario; definición de un protocolo de enfermería para orientar el ingreso hospitalario con base en la mejor evidencia disponible y pautas para establecer un vínculo de cuidado enfermera-paciente y cuidador familiar; diseño y ajuste de instrumentos y estrategias para apoyar la implementación del protocolo; afinamiento del protocolo y las herramientas de apoyo mediante revisión de expertos; y prueba piloto en el servicio durante nueve meses. Resultados: la transformación del ingreso hospitalario exige tanto la búsqueda de una evidencia que lo respalde, como los lineamientos de humanización plasmados en una guía práctica. La adherencia de enfermería a las guías se asoció con una mejor percepción del servicio por parte del paciente y su cuidador convirtiendo este procedimiento en un momento de cuidado. Conclusiones: la transformación del procedimiento de ingreso al servicio de hospitalización del paciente y su cuidador familiar para convertirlo en un momento de cuidado de enfermería mejora la experiencia de las personas implicadas y su percepción sobre el servicio que ofrece la institución.

This research seeks to describe the process of transforming hospital admissions into a moment of nursing care that improves the adaptation of patients and their caregivers. Methodology: This is a Nursing Methodology Research that was conducted between 2017 and 2018. The study included six phases: diagnosis of the experience of patients and their family caregivers during admission to hospitalization; review of the best hospital admission practices worldwide; definition of both, a nursing protocol to guide hospital admission based on the best available evidence, and guidelines to establish a caring relationship between the nurse, the patient, and the family caregiver; design and adjustment of instruments and strategies to support the implementation of the protocol; adjustment of the proposed protocol and supporting tools through expert review; and a pilot test in use for 9 months9 months. Results: The transformation of the hospital admission requires nurses to search for evidence and humanization strategies, embodied in a practical guide that supports the admission process. There is a direct connection between the adherence of nurses to the guidelines and a better perception from patients and caregivers of the received service. This implies the admission process may become a caring opportunity. Conclusions: The transformation of hospital admission process into a moment of nursing care for patients and family caregivers improves the experience of the people involved and their perception of the institutional service quality.

Analysis of triage and care for women victims of road accidents / Análisis del triagen y de los atendimentos a mujeres víctimas de accidentes de tránsito / Análise da triagem e dos atendimentos a mulheres vítimas de acidentes de trânsito

ABSTRACT Objective: to analyze the care flow for women victims of Road Traffic Accidents (RTA). Method: a descriptive study with 782 women victims of RAT, classified by the Manchester Triage System (MTS) between 2015 and 2016. The sociodemographic profile and the time between the stages of care were analyzed, as well as care place and outcomes. Results: of the women in the study, 65.47% were young adults, 80.44% lived without a partner and 62.28% lived in the city of Belo Horizonte. Regarding the time between recording and risk classification, the mean was 7.7 minutes (SD: 9.9). The prevalent flowchart was "Great Trauma" (62.92%). 53.07% had "Red/Orange" priority level and the most prevalent outcome was "Discharge after consultation/medication". Conclusion: the study shows that the hospital partially fulfills the times recommended by the MTS. Analyzing the flow of women victims of RAT contributed to optimize the quality and efficiency of care.

RESUMEN Objetivo: analizar el flujo de atención de mujeres víctimas de Accidentes de Transporte Terrestre (ATT). Método: estudio descriptivo, con 782 mujeres víctimas de ATT, clasificadas por el Sistema de Triaje de Manchester (STM), entre 2015 y 2016. Se analizó el perfil sociodemográfico y el tiempo entre las etapas de la atención, así como el local de atención y desenlace. Resultados: de las mujeres del estudio, el 65,47% eran adultas jóvenes, el 80,44% vivía sin compañero (a) y el 62,28% residían en la ciudad de Belo Horizonte. En cuanto al tiempo entre el registro y la clasificación de riesgo, se presentó promedio de 7,7 minutos (DE: 9,9). El diagrama de flujo prevalente fue "Gran Traumatismo" (62,92%). El 53,07% obtuvo un nivel de prioridad "Rojo/Naranja" y el resultado más prevalente fue "Alta tras consulta/medicación". Conclusión: el estudio evidencia que el hospital cumple parcialmente los tiempos preconizados por el STM. El análisis del flujo de mujeres víctimas de ATT contribuyó a optimizar la calidad y eficiencia de la asistencia.

RESUMO Objetivo: analisar o fluxo do atendimento a mulheres vítimas de Acidentes de Transporte Terrestre (ATT). Método: estudo descritivo, com 782 mulheres vítimas de ATT, classificadas pelo Sistema de Triagem de Manchester (STM), entre 2015 a 2016. Analisou-se o perfil sociodemográfico e o tempo entre as etapas do atendimento, bem como o local de atendimento e desfecho. Resultados: das mulheres do estudo, 65,47% eram adultas jovens, 80,44% viviam sem companheiro(a) e 62,28% residiam em Belo Horizonte. Em relação ao tempo entre o registro e a classificação de risco, apresentou-se média de 7,7 minutos (DP:9,9). O fluxograma prevalente foi "Grande Traumatismo" (62,92%). 53,07% obteve nível de prioridade "Vermelho/Laranja" e o desfecho mais prevalente foi "Alta após consulta/medicação". Conclusão: o estudo evidencia que o hospital cumpre parcialmente os tempos preconizados pelo STM. Analisar o fluxo de mulheres vítimas de ATT contribuiu para otimizar a qualidade e eficiência da assistência.

Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia

ABSTRACT OBJECTIVE To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

Caracterização dos atendimentos de um pronto-socorro público segundo o sistema de triagem de manchester / Characteristics of care of a public emergency room according to the manchester triage system / Caracterización de la atención de pacientes en urgencias y emergencias de um hospital público según el sistema de triaje de manchester

Objetivo: caracterizar os atendimentos de pacientes classificados pelo Sistema de Triagem de Manchester (STM) em um hospital público de grande porte. Metodologia: trata-se de estudo descritivo com abordagem quantitativa que analisou 52.657 atendimentos com classificação de risco realizada à admissão no Pronto-Socorro no ano de 2015. Os dados foram coletados nos prontuários eletrônicos e submetidos à análise descritiva pelo programa Statistical Package for Social Sciences versão 19.0. Resultados e discussão: predominou população do sexo masculino (54,2%), mediana de 33 anos de idade (IQ: 19-51). As faixas etárias mais frequentes foram adultos jovens entre 19 e 29 anos (20,7%) e idosos (16,4%). Os níveis de prioridades clínicas mais frequentes foram urgente/amarelo (45,6%) e pouco urgente/verde (33,4%) e os fluxogramas mais acessados foram problema de extremidades (31,4%) e "mal-estar em adulto (10,1%). O tempo entre o registro e a classificação teve mediana de 6,2 minutos (IQ: 2,8-13). Quanto ao tempo entre a classificação de risco e o primeiro atendimento, a mediana em minutos foi de 20,1 (IQ: 9,3-33,7) para emergência/vermelho, 18,5 (IQ:10,9-33,2) para muito urgente/ laranja, 58,2 (IQ:30,2-111,2) para urgente/amarelo, 92,7 (46,9-177,3) para pouco urgente/verde e 103,4 (IQ:41,5-209,6) para não urgente/azul. Predominou como desfecho a alta após consulta/medicação (61,3%). Conclusão: a reavaliação dos fluxos e processos relacionados à classificação de risco e ao atendimento inicial tem o intuito de melhorar a precisão dos registros e do tempo de primeiro atendimento, o que pode contribuir para uma assistência mais qualificada e resolutiva.(AU)

Objective: to characterize the care of patients classified by the Manchester Triage System (MTS) in a large public hospital. Methodology: it is a descriptive study with a quantitative approach that analyzed 52,657 patients with a risk classification made on admission to the Emergency Room in the year 2015. The data were collected in electronic records and subjected to descriptive analysis by the program Statistical Package for Social Sciences 19.0 version. Results and discussion: predominant male population (54.2%), average age of 33 years (IQ: 19-51). The most frequent age groups were young adults between 19 and 29 years old (20.7%) and elderly (16.4%). The most frequent clinical priority levels were urgent/yellow (45.6%) and less urgent/green (33.4%) and the most visited flowcharts were extremity problems (31.4%) and "adult malaise" (10.1%). The time between recording and classification had an average of 6.2 minutes (IQ: 2.8-13). As for the time between the risk classification and the primary care, the average in minutes was 20.1 (IQ: 9.3-33.7) for emergency/red, 18.5 (IQ: 10.9-33.2) for very urgent/orange, 58.2 (IQ: 30.2-111.2) for urgent/ yellow, 92.7 (46.9-177.3) for less urgent/green and 103.4 (IQ: 41.5-209.6) for non-urgent/ blue. Prevailed as the outcome hospital discharge after consultation/medication (61.3%)...(AU)

Objetivo: caracterizar la atención de pacientes clasificados por el Sistema de Triaje de Manchester (STM) en un gran hospital público. Estudio descriptivo de enfoque cuantitativo que analizó 52.657 procesos de atención de pacientes con clasificación de riesgo en la entrada de urgencias y emergencias en 2015. Método: los datos eran recogidos en expedientes electrónicos y sometidos al análisis descriptivo por el programa Statistical Package for Social Sciences , versión 19.0. Resultados y discusión: predominio de población de sexo masculino (54,2%), promedio de 33 años de edad (IQ: 19-51). Las franjas de edad más frecuentes eran de adultos jóvenes entre 19 y 29 años (20,7%) y de adultos mayores (16,4%). Los niveles de prioridades clínicas más frecuentes eran urgente/amarillo (45,6%) y poco urgente/verde (33,4%) y los diagramas de flujo con más entradas eran problemas de extremidades (31,4%) y malestar en adultos (10,1%). El tiempo promedio entre el registro y la clasificación era de 6,2 minutos (IQ: 2,8-13). El tiempo promedio entre la clasificación de riesgo y la primera atención era de 20,1 minutos (IQ: 9,3-33,7) para emergencias/rojo, 18,5 (IQ:10,9-33,2) para muy urgente/ anaranjado, 58,2 (IQ:30,2-111,2) para urgente/amarillo, 92,7 (46,9-177,3) para poco urgente/verde y 103,4 (IQ:41,5-209,6) para no urgente/azul. El desenlace más frecuente era el alta después de la consulta/medicación (61,3%). Conclusión: la reevaluación de flujos y procesos relacionados con la clasificación de riesgo y la atención inicial buscan mejorar la precisión de los registros y del tiempo de la primera atención, lo cual puede contribuir a la atención más calificada y res...(AU)

Performance of the combined models of Pediatric Risk of Admission scores I and II, and C-reactive protein for prediction of hospitalization in febrile children who visited the emergency department

PURPOSE: To study the performance of the combined models of Pediatric Risk of Admission (PRISA) scores I and II and Creactive protein (CRP) for prediction of hospitalization in febrile children who visited the emergency department.METHODS: We reviewed febrile children aged 4 months-17 years who visited a tertiary hospital emergency department between January and December 2017. White blood cell count, CRP concentration, the PRISA scores, and systemic inflammatory response syndrome score were calculated. We compared areas under the curves (AUCs) of the admission decision support tools for hospitalization using receiver operating characteristic curve analysis.RESULTS: Of 1,032 enrolled children, 423 (41.0%) were hospitalized. CRP and the PRISA scores were significantly higher in the hospitalization group than in the discharge group (all P < 0.001). Among the individual tools, CRP showed the highest AUC (0.69; 95% confidence interval [CI], 0.66–0.72). AUC was 0.71 (95% CI, 0.69–0.74) for the combined model of the PRISA I score and CRP, and 0.71 (95% CI, 0.68–0.74) for that of the PRISA II score and CRP. The AUC of PRISA score I and CRP combined was significantly higher than that of isolated CRP (P = 0.048).CONCLUSION: The combined model of the PRISA I score and CRP may be useful in predicting hospitalization of febrile children in emergency departments.

Critérios de admissão do paciente oncológico em Unidades de Terapia Intensiva de hospitais gerais / Oncology patient admission criteria in Intensive Care Units of general care hospitals

A função da Unidade de Terapia Intensiva é de suporte terapêutico ao paciente. O paciente com câncer muitas vezes necessita de suporte intensivo. Nesse contexto, a gravidade das disfunções orgânicas, o comprometimento da capacidade funcional, o estadiamento do câncer e a aplicação de índices prognósticos são considerados na discussão para admissão na Unidade de Terapia Intensiva. Este artigo tem como objetivo identificar os critérios para admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais, através de uma revisão integrativa, com estudos de 2007 a 2017 disponíveis em versão completa e gratuita nas bases de dados digitais: Biblioteca Virtual em Saúde, Scientific Electronic Library Online e no portal PubMed. Foram encontradas 58 publicações potenciais. Após análise preliminar dos títulos e resumos e aplicação dos critérios de inclusão e exclusão, 23 artigos seguiram para leitura na íntegra, sendo que 10 compuseram a amostra final. Sete estudos (70%) citaram o escore prognóstico APACHE II, quatro (40%) utilizaram Simplified Acute Physiology Score, dois (20%) o Sequential Organ Failure Assessment e seis (60%) utilizaram mais de um instrumento. O câncer é uma doença grave, entretanto a decisão de indicação para tratamento intensivo não deve ser baseada em apenas uma morbidade. Pacientes oncológicos podem ter benefícios ao receberem suporte intensivo. Estudos que determinam critérios objetivos para admissão e avaliam o benefício da admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais devem ser incentivados a fim de melhor definir a utilização adequada dos recursos.

The role of the Intensive Care Unit is to provide therapeutic support for the patient. The cancer patient often needs intensive support. In this context, the severity of organ dysfunctions, the impairment of functional capacity, the stage of cancer and the application of prognostic indexes are factors considered in the discussion for the patient's admission into the Intensive Care Unit. The aim of this study is to identify the criteria for admission of cancer patients into the Intensive Care Unit of general care hospitals, through an integrative review, with studies performed between 2007 and 2017, which are fully available and free for downloading in the following digital databases: Virtual Library on Health, Scientific Electronic Library Online and PubMed. Fifty-eight potential studies were found. After a preliminary analysis of the titles and abstracts and application of the inclusion and exclusion criteria, 23 articles were analyzed, of which 10 composed the final sample. Seven studies (70%) cited the APACHE II prognostic score, four (40%) used the Simplified Acute Physiology Score, two (20%) the Sequential Organ Failure Assessment and six (60%) used more than one instrument. Cancer is a serious disease, but the indication for intensive care should not be based on just one morbidity. Oncology patients may benefit from receiving intensive treatment. Studies that establish objective criteria for admission and evaluate the benefit of admission of cancer patients into Intensive Care Unit of general care hospitals should be encouraged in order to better define the appropriate use of resources.

Internaciones en pacientes con ventilación domiciliaria crónica / Hospital admissions in patients with chronic home ventilation

La ventilación mecánica domiciliaria representa un estándar de cuidados en la insuficiencia de la bomba ventilatoria. El modelo de seguimiento podría modificar la tasa de internaciones. Con la finalidad de estudiar las internaciones en pacientes con ventilación mecánica domiciliaria se diseñó un estudio descriptivo, sobre una base de datos de recolección sistemática. Participaron pacientes con ventilación no invasiva o asistencia respiratoria mecánica invasiva incluidos en forma consecutiva en un programa de hospital de día entre julio 2014 y diciembre 2016. Se analizaron internaciones y modalidad de las mismas, un año antes y después del programa. Participaron 94 pacientes; 52 hombres (55%), edad 64.4 ± 15.9 años; índice de masa corporal medio 28.60 ± 8.46 kg/m². El 50% presentaba obesidad. Recibían ventilación mecánica domiciliaria 80 participantes (85%); no invasiva en 77 casos e invasiva en tres (4%). En un año de seguimiento fueron re-admitidos al hospital 32 pacientes. Existieron diferencias significativas entre la tasa de internación global antes y después del programa (0.68 ± 0.47 vs. 0.42 ± 0.50 internaciones por caso), p 0.044, internaciones en terapia intensiva; 32 vs. 14, p 0.005 y días en UTI (12.9 ± 7.75 vs. 10.57 ± 7.5) p 0.048. La población a la que se ofreció ventilación mecánica domiciliaria presentó una elevada tasa de internaciones que se redujo mediante este modelo de seguimiento.

Home mechanical ventilation represents a standard of care in the insufficiency of the ventilatory pump. The follow-up model could change the hospitalization rate. In order to study hospitalizations in patients with home mechanical ventilation, a descriptive study was designed on a systematic collection database. Participants were patients with non-invasive ventilation or invasive mechanical ventilation consecutively included in a day hospital program between July 2014 and December 2016. Hospitalizations and their modality one year before and after the program were analyzed. Ninety four patients participated; 52 men (55%), age 64.4 ± 15.9 years; mean body mass index; 28.60 ± 8.46 kg/m²; 50% had obesity. Eighty patients (85%) received home mechanical ventilation; non-invasive in 77 cases and invasive in three (4%). Thirty two patients were re-admitted to the hospital in one year of follow-up. There were significant differences between the global admission rate before and after the program (0.68 ± 0.47 vs. 0.42 ± 0.50 hospitalizations per patient) p 0.044, intensive care unit hospitalizations; 32 vs. 14, p 0.005 and days in ICU (12.9 ± 7.75 vs. 10.57 ± 7.5) p 0.048. The population to whom home mechanical ventilation was offered had a high hospitalization rate that was reduced by this follow-up model.

Factor Analysis of Intoxicated Patients Disposition in Pediatric Emergency Department

PURPOSE: This study was conducted to analyze the factors associated with intoxicated patient's disposition in the pediatric emergency department. METHODS: We retrospectively evaluated pediatric intoxicated patients visiting the pediatric emergency department of a hospital between January 1, 2011 and December 31, 2013. Specifically, we analyzed the association between hospitalization recommended rate and the following variables: patient age group, symptoms, intentional poisoning, decontamination and toxic level of substance. RESULTS: We collected data from 345 patients. A high incidence was noted in the 1-4 years of age group and 10-15 years of age group. Unintentional poisoning occurred in 306 patients (88.7%). A total of 115 patients (33.3%) had symptoms when visiting. Forty three patients (12.5%) ingested cleaning substances, which was the most common agent. Potentially-toxic level was the most common level of the substance. The hospitalization recommended rate associated with visits in 2011 was 2.5 times greater than in 2012 and 2013, decontamination was 2.0 times greater than no decontamination, and poisoning with potentially-toxic substances was 2.6 times greater than poisoning with other toxic substances. Additionally, the hospitalization recommended rate associated with symptomatic patients was 2.4 times greater than that of asymptomatic patients and intentional poisoning was 2.4 times greater than unintentional poisoning. CONCLUSION: Patients with decontamination, ingestion of potentially-toxic substances, symptoms and intentional poisoning had increased hospitalization rates. In addition, the hospitalization rate for patients who visited in 2011 was greater than that of patients who visited in 2012 or 2013.

Efectividad de la terapia conductual dialéctica en pacientes con trastorno de personalidad limítrofe en Santiago de Chile / Dialectical behavior therapy effectiveness for borderline disorder personality in Santiago de Chile

Resumen Más de la mitad de los pacientes con trastorno de personalidad limítrofe (TPL) han realizado al menos un intento suicida durante su vida y el 70% ha tenido al menos una hospitalización psiquiátrica. La presente investigación tiene como objetivo evaluar la efectividad de la Terapia Conductual Dialéctica (TCD) en pacientes con trastorno de personalidad limítrofe. Método: A través de un diseño observacional retrospectivo se evaluó el número de intentos suicidas, el número de hospitalizaciones psiquiátricas y el impacto clínico previo al tratamiento con TCD y posterior a éste. Se analizó la información disponible de 144 pacientes de la Unidad de Terapia Conductual Dialéctica del Servicio de Psiquiatría del Hospital del Salvador, de Santiago de Chile, entre los años 2006-2012. Los datos fueron recolectados a través de registros electrónicos, análisis de ficha clínica, mediante el cuestionario OQ-45.2 y contacto telefónico. Resultados: En cuanto a los resultados, a través del método estadístico de Wilcoxon, se demostró una diferencia significativa (p = 0,000) en el número de hospitalizaciones psiquiátricas pre y post tratamiento, una disminución (p = 0,000) del número de intentos suicidas posterior al tratamiento y mejoría en los puntajes del cuestionario OQ-45.2. Conclusión: La TCD fue efectiva en disminuir las 3 variables estudiadas en la población escogida.

More than half of patients diagnosed with borderline personality disorder have made at least one suicide attempt during their lifetime and 70% have been admitted to an inpatient psychiatric unit. This research aims to assess the effectiveness of Dialectical Behavior Therapy (DBT) in patients with borderline personality disorder. Methods: Using a retrospective observational design, the number of suicide attempt and psychiatric hospitalizations was measured pre and post DBT treatment. Data from 144 patients from Dialectical Behavior Therapy Unit at Hospital Salvador in Santiago de Chile was analyzed during 2006 and 2012. The data were gathered from electronic files of clinical records, a OQ-45.2 questionnaire and telephone calls. Results: The Wilcoxon statistical test showed a significant difference (p = 0.000) in the number of psychiatric hospitalizations pre and post-treatment, as well as a reduction (p = 0.000) in the number of post-treatment suicide attempt. Conclusion: The Dialectical Behavior Therapy was effective in the 3 studied events in the selected population.

Impacto pronóstico del momento de ingreso y egreso de la unidad de cuidados intensivos / Prognostic impact of the time of admission and discharge from the intensive care unit

RESUMEN Objetivo: Determinar el impacto en la mortalidad del día y horario de admisión y alta de la unidad de cuidados intensivos. Métodos: Estudio prospectivo observacional, que incluyó pacientes admitidos entre abril y noviembre de 2014 en la unidad de cuidados intensivos del Hospital Maciel de Montevideo. Resultados: Se analizaron 325 pacientes con una edad de 55 (36 - 71) años y un valor SAPS II de 43 (29 - 58) puntos. No se encontraron diferencias en la mortalidad en unidad de cuidados intensivos de los pacientes al comparar el momento de ingreso (35% el fin de semana versus 31% en los días laborales, p = ns) ni el horario de ingreso (nocturnos 35% versus diurnos 31%, p = ns). El momento de egreso se asoció a mayor mortalidad en el hospital (57% en egresos del fin de semana versus 14% en días laborales, p = 0,000). Los factores independientemente asociados a mortalidad hospitalaria luego del alta de unidad de cuidados intensivos fueron la edad mayor de 50 años (OR 2,4; IC95%, 1,1 - 5,4) y el egreso durante el fin de semana (OR 7,7; IC95%, 3,8 - 15,6). Conclusión: Este estudio logró identificar al momento del alta de la unidad de cuidados intensivos como un factor independientemente asociado a mortalidad hospitalaria.

ABSTRACT Objective: To determine the impact of the day and time of admission and discharge from the intensive care unit on mortality. Methods: Prospective observational study that included patients admitted to the intensive care unit of the Hospital Maciel in Montevideo between April and November 2014. Results: We analyzed 325 patients with an average age of 55 (36 - 71) years and a SAPS II value of 43 (29 - 58) points. No differences were found in the mortality of patients in the intensive care unit when time of admission (35% on the weekend versus 31% on weekdays, p = ns) or the hour of entry (35% at night versus 31% in the daytime, p = ns) were compared. The time of discharge was associated with higher hospital mortality rates (57% for weekend discharges versus 14% for weekday discharges, p = 0.000). The factors independently associated with hospital mortality after discharge from the intensive care unit were age > 50 years (OR 2.4, 95%CI, 1.1 - 5.4) and weekend discharge (OR 7.7, 95%CI, 3.8-15.6). Conclusion: This study identified the time of discharge from the intensive care unit as a factor that was independently associated with hospital mortality.