Categorización de las urgencias gineco-obstétricas en un hospital público de Chile / Categorization of the gyneco-obstetric emergencies in a public hospital in Chile

INTRODUCCIÓN: La red de atención de urgencia es fundamental en la salud de cualquier país. En Chile, los servicios de urgencia periódicamente están saturados por usuarios con patologías de carácter leve; lo mismo ocurre en las atenciones de urgencias gineco-obstétricas (UGO) en los centros de mediana y alta complejidad. OBJETIVO: Describir la categorización de las consultas de urgencias gineco-obstétricas en un hospital público de Chile, atendidas durante el año 2018. METODOLOGÍA: Estudio descriptivo y transversal que abarcó 3.077 consultas obtenidas de datos estadísticos anonimizados. RESULTADOS: De las UGO, el 58,3% fueron consultas obstétricas, el 36,9% ginecológicas y 4.8% neonatológicas; el 96% fueron consultantes mujeres; el 80,3% eran adultos y el 11,6% adolescentes; el 92,5% eran usuarios pertenecientes a la comuna de Penco; el mes más consultado fue mayo con 292 atenciones y el 71,5% de las consultas fueron atendidas en horario diurno. Los principales motivos de consulta obstétrica y ginecológica fueron el dolor y el sangramiento genital; en las urgencias neonatológicas, la ictericia fue el principal motivo de consulta. El diagnóstico más frecuente en las consultas obstétricas según clasificación CIE _10 fue la supervisión de embarazo normal, en las ginecológicas fue el dolor abdomino-pélvico y en las consultas neonatológicas, la ictericia; del total de consultas UGO un 91,1% fueron resueltas a nivel local. El 0,1% de las UGO fueron categorizadas como c1 y el 0,3% como c2, siendo la gran mayoría, consultas de baja complejidad. CONCLUSIONES: Existe un gran porcentaje de consultas de baja complejidad que sobrecargan el servicio de urgencia, afectando la calidad de la atención del hospital.

INTRODUCTION: the urgent care network is fundamental in the health of any country. In Chile, the emergency services are periodically saturated with users with mild pathologies; the same occurs in gynecological-obstetric emergency care (UGO) in more complex centers. OBJECTIVE: to describe the categorization of gynecological-obstetric emergency consultations in a public hospital in Chile, attended in 2018. METHODOLOGY: descriptive and cross-sectional study; covered 3,077 queries of anonymized statistical data. RESULTS: of the UGO, 58.3% were obstetric consultations, 36.9% gynecological and 4.8% neonatological; 96% were women; 80.3% were adults and 11.6% adolescents; 92.5% were from Penco; the month most consulted was may with 292 visits and 71.5% of the consultations were during daytime hours. The main reasons for obstetric and gynecological consultation were pain and genital bleeding; in neonatal emergencies, jaundice was the main reason for consultation. The most repeated diagnosis in obstetric consultations was the supervision of normal pregnancy; in gynecological cases, it was abdominal-pelvic pain and in neonatological consultations, jaundice; there was 91.1% local resolution. 0.1% of the UGO were categorized as c1 and 0.3% as c2, the vast majority being low complexity queries. CONCLUSIONS: there is a large percentage of low complexity consultations that overload the emergency service, affecting the quality of hospital care.

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.

Análise dos atendimentos a vítimas de acidente de transporte terrestre realizados em um hospital público de grande porte / Analysis of care provided to land transport accident victims in a large public hospital

O trauma está entre as dez principais causas de óbito no mundo. Dentre os tipos de trauma, os acidentes de transporte terrestre (ATT) são responsáveis pelo impacto no padrão de adoecimento e morte da população, sendo muitas vítimas jovens. Por se tratar de um agravo agudo e potencialmente grave, demanda atendimento imediato e de alta complexidade. Conhecer os resultados dos atendimentos realizados desde a chegada ao pronto-socorro até a alta hospitalar pode contribuir para o serviço repensar fluxos e qualidade da assistência com o intuito de aumentar a resolubilidade e melhorar os desfechos dos atendimentos. O estudo teve por objetivo analisar os atendimentos a vítimas de acidente de transporte terrestre realizados em um hospital público de grande porte. Trata-se de estudo transversal, que analisou 431 pacientes adultos vítimas de ATT, submetidos a classificação de risco (CR) e internados na instituição no ano de 2016. Foram analisadas variáveis sociodemográficas, do acidente, do atendimento no pronto-socorro e desfecho hospitalar. Os resultados foram analisados em dois grupos: 'PS': internados no pronto-socorro e 'UI': internados nas unidades de internação. Os dados foram submetidos à análise descritiva. A comparação dos grupos 'PS' e 'UI' entre as variáveis foi feita pelo teste Mann-Whitney para as variáveis contínuas. As diferenças entre as proporções foram testadas pelo teste Qui-quadrado de Pearson e Teste exato de Fisher. Valores de p<0,05 foram considerados significativos. Predominou o sexo masculino (81,9%), que vive sem companheiro (a) (80,0%) e faixa etária entre 20 a 40 anos (66,6%). O fluxograma mais acessado na CR foi 'Grande Traumatismo' (56,9%) no grupo 'UI' e Quedas (66,7%) no grupo 'PS' (p=0,0022) e o nível de prioridade clínica mais frequente foi laranja/muito urgente (78,4%). Os tempos entre o registro e a CR e duração da CR apresentaram mediana de 2,88 minutos (IQ=1,63-5,32), 1,32 minutos (IQ=1,02-1,77) respectivamente. O motivo de atendimento foi relacionado a acidentes com motocicletas (68,5%) seguido por atropelamentos (13,2%). Quanto ao tipo de lesão, a categoria 'sem lesão aparente' foi mais frequente no grupo 'PS' (56,7%) (p-valor=0,0032). No grupo 'UI' prevaleceu as fraturas abertas (86,7%) (p-valor<0,001) e fraturas de ossos longos (100,0%) (p-valor<0,0001). As regiões corpóreas mais atingidas foram os membros superiores no grupo 'PS' (53,9%) (p-valor<0,001) e inferiores (64,3%) no grupo 'UI' (p-valor=0,004). O tempo de permanência hospitalar apresentou mediana de 1,38 (IQ=0,86-2,36) dias para o grupo 'PS' e 7,15 (IQ=3,5-12,86) dias no grupo 'UI'. A maioria (89,8%) recebeu alta hospitalar. A análise dos atendimentos possibilitou identificar que a instituição cumpre seu papel na Rede de Atenção às Urgências ao realizar o primeiro atendimento aos pacientes vítimas de ATT. A assistência imediata ocorreu em tempo hábil, o que possibilitou atender às necessidades do usuário em âmbito agudo e a terapêutica hospitalar oferecida pode ter contribuído para a sobrevivência desses pacientes.(AU)

Trauma is one of the top ten causes of death in the world. Among the types of trauma, land transport accidents (LTA) impact illness patterns and mortality, mostly of young victims. Trauma is an acute and potentially serious injury, thus demands immediate care and of high complexity. Knowledge about the outcomes of services rendered in emergency care until hospital discharge can contribute to the reassessment of patient turnout and quality of care delivered, which in turn increases resolubility and improvement of healthcare services. The objective of this study was to analyze the care provided to victims of land transport accidents in a large public hospital. This study is a cross-sectional study which analyzed 431 adult LTA victims who underwent risk classification (RC) and hospitalized in 2016. Sociodemographic variables related to accident, emergency room care and hospital outcome were analyzed considering two groups: 'PS': hospitalized in emergency room and 'IU': admitted in hospital. Also, descriptive analysis of the variables was done. The variables of the 'PS' and 'UI' group were compared using the Mann-Whitney test for continuous variables. Differences between proportions were tested by Pearson's Chi-square test and Fisher's exact test. P values <0.05 were considered significant. The subjects were predominantly male (81.9%), lived without a partner (80.0%) and between 20 and 40 years (66.6%). Major trauma accounted for 56.9% of RC in the UI group while falls (66.7%) was the most frequent for the 'PS' group (p = 0.0022). Also, the most common clinical priority level was orange/very urgent (78.4%). The median time between registering, RC and duration of RC was 2.88 minutes (IQ = 1.63-5.32), 1.32 minutes (IQ = 1.02-1.77), respectively. Motorcycle accidents (68.5%) followed by road accidents (13.2%) were the most common reasons for the use of urgent care units Regarding type of injury, the 'no apparent injury' category was more frequent in the 'PS' group (56.7%) (p-value = 0.0032). In the 'UI' group, open fractures (86.7%) (p-value <0.001) and long bone fractures (100.0%) (p-value <0.0001) prevailed. The most affected body regions were the upper limbs in the 'PS' group (53.9%) (p-value <0.001) and lower limb (64.3%) in the 'UI' group (p-value = 0.004). The median duration of hospital stay was 1.38 (IQ = 0.86-2.36) days for the 'PS' group and 7.15 (IQ = 3.5-12.86) days for the 'UI' group. Majority (89.8%) of the patients were discharged. The analysis of the healthcare services provided by the institution indicates its role in offering emergency care services to LTA victims. The immediate assistance offered in a timely manner contributed to meeting the needs of the user in an acute situation; moreover the therapy provided by the hospital may have contributed to the survival of these patients(AU)

Hypertensive crisis: clinical characteristics of patients with hypertensive urgency, emergency and pseudocrisis at a public emergency department / Crise hipertensiva: características clínicas de pacientes com urgência, emergência e pseudocrise hipertensivas em um serviço público de emergência

ABSTRACT Objective: To assess patients with hypertensive crisis, classified as urgency, emergency or pseudocrisis, and identify the associated variables. Methods: We evaluated a total of 508 patients (57% women; 56.3±13.8 years old) with hypertensive crisis (diastolic blood pressure of 120mmHg), aged 18 years or over, seen at the emergency department of a public general hospital. Results: The prevalence of hypertensive crises was 6/1,000; in that, 71.7% presented hypertensive urgency, 19.1% hypertensive emergency, and 9.2% hypertensive pseudocrisis. In the multinominal logistic regression, pseudocrisis and urgency conditions were compared to hypertensive emergency. Therefore, the presence of pain (OR: 55.58; 95%CI: 10.55-292.74) except chest pain and headache, and emotional problems (OR: 17.13; 95%CI: 2.80-104.87) increased the likelihood of hypertensive pseudocrisis. Age >60 years (OR: 0,32; 95%CI: 0.10-0.96) and neurologic problems (OR: 1.5.10-8; 95%CI: 1.5.10-8-1.5.10-8) protected against hypertensive pseudocrisis. The comparison of hypertensive urgency with hypertensive emergency showed that age >60 years (OR: 0.50; 95%CI: 0.27-0.92), neurologic (OR: 0.09; 95%CI: 0.04-0.18) and emotional problems (OR: 0.06; 95%CI: 4.7.10-3-0.79) protected against hypertensive urgency. Moreover, only headache (OR: 14.28; 95%CI: 3.32-61.47) increased the likelihood of hypertensive urgency. Conclusion: Advanced age and neurological problems were associated to hypertensive emergency. Headache was associated with hypertensive urgency. Pain and emotional problems were associated with hypertensive pseudocrisis. Our results can contribute to identifying patients with hypertensive crisis who seek emergency services.

RESUMO Objetivo: Avaliar pacientes com crise hipertensiva, classificada em urgência, emergência ou pseudocrise, e identificar variáveis associadas. Métodos: Foram avaliados 508 pacientes (57% mulheres; 56,3±13,8 anos) com crise hipertensiva (pressão diastólica de 120mmHg), idade maior ou igual a 18 anos, atendidos em um serviço de emergência de um hospital geral público. A crise hipertensiva foi classificada em urgência, emergência ou pseudocrise. Resultados: A prevalência da crise hipertensiva foi 6/1.000, com 71,7% com urgência hipertensiva, 19,1% com emergência hipertensiva e 9,2% com pseudocrise hipertensiva. Na análise de regressão logística multinomial, as condições de pseudocrise e urgência foram comparadas com a emergência hipertensiva. Assim, presença de dor (OR: 55,58; IC95%: 10,55-292,74), exceto precordialgia e cefaleia, e problemas emocionais (OR: 17,13; IC95%: 2,80-104,87) elevaram a chance para pseudocrise hipertensiva. Idade acima de 60 anos (OR: 0,32; IC95%: 0,10-0,96) e problemas neurológicos (OR: 1,5.10-8; IC95%: 1,5.10-8-1,5.10-8) foram protetores para pseudocrise hipertensiva. A urgência hipertensiva comparada com emergência hipertensiva mostrou que idade acima de 60 anos (OR: 0,50; IC95%: 0,27-0,92), problemas neurológicos (OR: 0,09; IC95%: 0,04-0,18) e emocionais (OR: 0,06; IC95%: 4,7.10-3-0,79) foram protetores para urgência hipertensiva, e apenas cefaleia (OR: 14,28; IC95%: 3,32-61,47) elevou a chance para urgência hipertensiva. Conclusão: Idade mais elevada e problemas neurológicos se associaram à emergência hipertensiva. Cefaleia associou-se à urgência hipertensiva. Dor e problemas emocionais se associaram à pseudocrise hipertensiva. Nossos resultados podem contribuir para aprimorar a identificação de pacientes com crise hipertensiva que procuram serviços de emergência.

Triage live lecture versus triage video podcast in pre-hospital students' education

Introduction: Triage is the process of determining the priority of patients' treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students. Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as one month later, post-tests were run for both groups, and the results were analysed using an independent t-test and covariance.R Results : No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately, or one month after training. Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage

Validade e confiabilidade de um novo sistema de classificação de risco para emergências pediátricas: clariped / Validity and reliability of a new triage system for pediatric emergency care: clariped

RESUMO Objetivo: Avaliar a validade e a confiabilidade de um sistema de classificação de risco para emergências pediátricas (CLARIPED) desenvolvido no Brasil. Métodos: Fase de validade: estudo observacional prospectivo em crianças de 0 a 15anos atendidas consecutivamente no serviço de emergência pediátrica (SEP) de um hospital terciário entre 2 e 18de julho de 2013. Avaliou-se a associação dos níveis de urgência com desfechos clínicos (utilização de recursos, taxa de admissão no SEP, taxa de hospitalização e tempo de permanência no SEP); e comparou-se o desempenho do CLARIPED com um padrão de referência. Fase de confiabilidade interobservadores: uma amostra de conveniência de pacientes atendidos entre abril e julho de 2013 foi submetida a duas classificações de risco consecutivas e independentes, e estimou-se o Kappa ponderado quadrático. Resultados: Em 1.416 atendimentos realizados na fase de validade, a distribuição de níveis de urgência foi: 0,0% vermelho/emergência; 5,9% laranja/muito urgente; 40,5% amarelo/urgente; 50,6% verde/pouco urgente; e 3,0% azul/sem urgência. Ospercentuais de pacientes que usaram dois ou mais recursos diminuíram do nível laranja para o amarelo, verde e azul (81, 49, 22 e 2%, respectivamente, p<0,0001), assim como a taxa de admissão no SEP, o tempo de permanência no SEP e a taxa de admissão hospitalar. Asensibilidade para discriminar pacientes muito urgentes foi de 0,89 (intervalo de confiança de 95%- IC95% 0,78-0,95), e a taxa de subtriagem foi de 7,4%. Aconfiabilidade interobservadores em 191 pacientes classificados por duas enfermeiras foi substancial (kw2=0,75; IC95% 0,74-0,79). Conclusões: O sistema CLARIPED mostrou boa validade e substancial confiabilidade para classificação de risco em um serviço de emergência pediátrica.

ABSTRACT Objective: To assess the validity and reliability of a triage system for pediatric emergency care (CLARIPED) developed in Brazil. Methods: Validity phase: prospective observational study with children aged 0 to 15 years who consecutively visited the pediatric emergency department (ED) of a tertiary hospital from July 2 to 18, 2013. We evaluated the association of urgency levels with clinical outcomes (resource utilization, ED admission rate, hospitalization rate, and ED length of stay); and compared the CLARIPED performance to a reference standard. Inter-rater reliability phase: a convenience sample of patients who visited the pediatric ED between April and July 2013 was consecutively and independently double triaged by two nurses, and the quadratic weighted kappa was estimated. Results: In the validity phase, the distribution of urgency levels in 1,416 visits was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5% yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The percentage of patients who used two or more resources decreased from the orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%, respectively, p<0.0001), as did the ED admission rate, ED length of stay, and hospitalization rate. The sensitivity to identify patients with high urgency level was 0.89 (confidence interval of 95% [95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater reliability in 191patients classified by two nurses was substantial (kw2=0.75; 95%CI 0.74-0.79). Conclusions: The CLARIPED system showed good validity and substantial reliability for triage in a pediatric emergency department.

Acolhimento com avaliação e classificação de risco em um pronto socorro: estudo comparativo / Acceptance evaluation and classification of risk in a first aid: comparative study

Introdução: Para garantir um tempo de espera menor aos pacientes com necessidade de atendimento, foi implantado no âmbito do Sistema Único de Saúde, o acolhimento humanizado com classificação de risco. Existem diferentes modelos para realização do acolhimento com avaliação e classificação de risco, mas todos buscam organizar o fluxo de pacientes que procuram os serviços de pronto atendimento, diminuindo os riscos da superlotação. Emerge portanto, o interesse em analisar a classificação realizada no Pronto Socorro de um Hospital de Alta complexidade, comparando dados de atendimentos com as suas próprias diretrizes de classificação de risco. Objetivos: Identificar se a classificação de risco realizada no acolhimento com avaliação e classificação de risco do pronto socorro está de acordo com o protocolo institucional. Casuística e Métodos: Estudo de abordagem quantitativa, retrospectivo, correlacional descritivo e de corte transversal. Foi avaliada uma amostra composta por 386 fichas de atendimentos ocorridos no Pronto Socorro de um Hospital de Alta complexidade no ano de 2016. Os dados foram coletados e analisados para determinar o perfil dos atendimentos. Posteriormente, uma reanálise foi realizada considerando o protocolo institucional de classificação, para verificar o nível de adequabilidade destas classificações de risco pelo coeficiente de Kappa. Resultados: 50,7% das assistências foram realizadas a pessoas do sexo feminino, 45,5% com idades entre 20 e 40 anos, 47,1% dos atendimentos de não urgência, com 25,9% de queixas de dor moderada. A comparação entre a classificação realizada e a reanálise apresentou um coeficiente de Kappa igual à 0,16. Conclusão: Entre o acolhimento com avaliação e classificação de risco realizada no Pronto Socorro e a reanálise com base no protocolo da instituição, ha baixa concordância, o que representa que as triagens não estão sendo realizadas seguindo fielmente o próprio protocolo da instituição.

Introduction: In order to guarantee a shorter waiting time for the patients in need of care, the humanized host with risk classification was implemented within the scope of the Unified Health System. There are different models for the accomplishment of the host with evaluation and classification of risk, but all seek to organize the flow of patients who seek the services of prompt care, reducing the risks of overcrowding. There is therefore an interest in analyzing the screening performed in the Emergency Room of a High Complexity Hospital, comparing care data with its own risk classification guidelines Objectives: Identify if the risk classification performed at the hospital with evaluation and risk classification of the emergency room is in accordance with the institutional protocol. Patients and Methods: Quantitative, retrospective, correlational and cross-sectional descriptive study. The evaluation was performed by 386 records of care taken in the Emergency Room of a High Complexity Hospital in the year 2016. Data were collected and analyzed to determine the profile of the visits. Subsequently, a reanalysis was performed considering the classification institutional status, to verify the level of adequacy of the risk classifications by the Kappa coefficient. Results: 50.7% of the surgeries were performed on female subjects, 45.5% aged 20 and 40 years, 47.1% on non-emergency care, and 25.9% on moderate pain complaints. The comparison between the screening performed and the reanalysis showed a Kappa coefficient equal to 0.16. Conclusion:Between the accomplishment of the host with evaluation and classification of risk performed in the Emergency Room and the reanalysis based on the protocol of the institution, there is low agreement, which means that the screenings are not being carried out faithfully following the institution's own protocol.

Caracterização dos sistemas de referência e contrarreferência em um serviço de fonoaudiologia de alta complexidade na cidade de São Paulo / Effectiveness of referral and counter-referral systems in a high-complexity Speech, Language and Hearing healthcare service in the city of São Paulo

RESUMO Introdução Conhecer o fluxo de referência e contrarreferência de serviços de saúde de alta complexidade é imprescindível para o aperfeiçoamento da assistência fonoaudiológica. Objetivo Analisar o fluxo de pacientes de um serviço de Fonoaudiologia de alta complexidade no Sistema Único de Saúde (SUS). Métodos Estudo descritivo, realizado em serviço de Fonoaudiologia de hospital de alta complexidade. Foram analisados os dados de 373 usuários submetidos à triagem fonoaudiológica (consulta a prontuários). As variáveis analisadas foram: perfil sociodemográfico e fonoaudiológico; origem dos usuários (referência); tempo entre a referência e a realização da triagem; encaminhamentos após a triagem (contrarreferência); tempo entre a conclusão da triagem e o primeiro atendimento fonoaudiológico no serviço de contrarreferência; grau de satisfação com o atendimento fonoaudiológico de contrarreferência. Resultados Predominaram indivíduos com idades entre 0 e 11 anos e 11 meses, do gênero masculino, residentes na cidade de São Paulo, com ensino fundamental incompleto. A hipótese diagnóstica fonoaudiológica de disfonia foi a mais prevalente. A maioria dos usuários foi referenciada pela atenção terciária. A média de tempo de espera para a triagem foi de 56,6 dias (intervalo predominante de 51 a 60 dias). Pouco mais da metade dos sujeitos foi encaminhada para o nível terciário. O tempo de espera pelo atendimento foi maior no nível secundário. A maioria dos usuários referiu como excelente ou bom o grau de satisfação com o atendimento. Conclusão Observou-se alto grau de resolutividade no serviço analisado (atenção terciária) e necessidade de reorganização dos sistemas de referência e contrarreferência na atenção secundária e primária.

ABSTRACT Introduction For optimum quality in Speech, Language and Hearing (SLH) healthcare, it is essential to be aware of the flow of referrals and counter-referrals for high-complexity health services. Purpose To analyze the flow of patients of a high-complexity SLH service in Brazil's Unified Health System (Sistema Único de Saúde - SUS). Methods Descriptive study, made at a Speech, language and hearing (SLH) service of a high complexity hospital. Participants were 373 users who underwent SLH screening (consultation of health records). The variables analyzed were: social-demographic profile; SLH profile; origin of referral of users; time between referral and screening being carried out; referrals after screening (counter-referral); time between conclusion of screening and first SLH consultation in the counter-referred service; and degree of satisfaction with the SLH consultation of the counter-referral. Results The largest group was the age range zero to 11 years 11 months, male, resident in the city of São Paulo, who had not completed primary education. The most prevalent initial diagnosis in SLH terms was dysphonia. The majority of users were referred to tertiary care. The average waiting time for screening was 56.6 days. Just over half the subjects were referred for tertiary care. The waiting time for care was longest at the secondary level. The majority of users stated their degree of satisfaction with the care to be excellent or good. Conclusion A high degree of resolutiveness was observed in the tertiary care service analyzed; and a need was observed in secondary and primary care for reorganization of the systems of referral and counter-referral.

Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework

The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.

Pain in emergency units: correlation with risk classification categories / Dor no serviço de emergência: correlação com as categorias da classificação de risco / Dolor en el servicio de emergencia: correlación con las categorías de clasificación de riesgo

ABSTRACT Objectives: to correlate risk classification categories with the level of pain of patients in an emergency service. Method: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. Results: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). Conclusion: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

RESUMO Objetivos: correlacionar as categorias da classificação de risco com grau de dor dos pacientes em um serviço de emergência. Método: estudo transversal, realizado no Acolhimento com Classificação de Risco com 611 pacientes. As variáveis estudadas foram: idade, sexo, comorbidades, duração da queixa, especialidade médica, sinais e sintomas, desfecho, cor atribuída na classificação de risco e grau da dor. Utilizou-se a Análise de Variância, teste Qui-Quadrado e teste da Razão de Verossimilhança. Resultados: a média de idade foi 42,1 anos (17,8), 59,9% eram mulheres, com classificação de risco verde (58,9%) e amarela (22,7%), e comorbidade prevalente a hipertensão arterial (18,3%). Intensidade de dor mais frequente foi moderada (25,9%). Na categoria vermelha, pacientes apresentaram maior percentual de ausência de dor; na azul, dor leve; e nas categorias verde, amarela e laranja, maior percentual de dor intensa (p<0,0001). Conclusão: dos pacientes que apresentaram dor, a maioria referiu intensidade moderada. Em relação às categorias de risco, a maior parte dos pacientes da categoria vermelha não relatou dor; os que foram classificados como verde, amarela e laranja referiram, na maioria das vezes, dor intensa; já os pacientes da categoria azul mencionaram, predominantemente, dor leve.

RESUMEN Objetivos: correlacionar las categorías de clasificación de riesgo con grado de dolor de los pacientes en un servicio de emergencia. Método: estudio transversal, realizado en la Acogida con Clasificación de Riesgo con 611 pacientes. Las variables estudiadas fueron: edad, sexo, comorbilidades, duración de la queja, especialidad médica, signos y síntomas, resultado, color atribuída a la clasificación de riesgo y grado de dolor. Se utilizaron Análisis de Varianza, Prueba Chi cuadrado y la prueba de Razón de Verosimilitud. Resultados: la edad promedio fue de 42,1 años (17,8), 59.9% eran mujeres, con clasificación de riesgo verde (58,9%) y amarillo (22,7%) y comorbilidad prevalente a hipertensión arterial (18,3%). La intensidad de dolor más frecuente fue moderada (25.9%). En la categoría roja, los pacientes presentaron un mayor porcentaje de ausencia de dolor, en la azul, dolor suave, y en las categorías verde, amarillo y naranja, un porcentaje más alto de dolor severo (p < 0,0001). Conclusión: de los pacientes que presentaron dolor, la mayoría se refiere a intensidad moderada. En relación con las categorías de riesgo, la mayoría de los pacientes de la categoría roja no informó dolor. Quienes fueron clasificados como verde, amarillo y naranja, mencionaron, en su mayoría, dolor intenso. Los pacientes de la categoría azul, reportaron, predominante, dolor leve.

Associação entre sinais vitais e Sistema de Triagem de Manchester: estudo observacional retrospectivo / Association between vital signs and Manchester Triage System: a retrospective observational study / Asociación entre los signos vitales y el Sistema de Triaje de Manchester: estudio observacional retrospectivo

OBJETIVO: avaliar a associação entre os sinais vitais coletados na entrada do paciente ao departamento de emergência e os níveis de risco do Sistema de Triagem de Manchester (STM). MÉTODO: estudo observacional retrospectivo, cuja amostra foi de 154.714 pacientes. O fator de exposição foi os dados dos sinais vitais, e o desfecho primário o nível de risco do STM. Análises estatísticas, descritiva e inferencial, foram conduzidas. RESULTADOS: o dado vital mais avaliado foi a intensidade da dor, e a pressão arterial o menos avaliado. Alterações na frequência cardíaca para mais ou menos dos padrões fisiológicos aumentaram a prioridade clínica dos pacientes. DISCUSSÃO: quanto maior o nível de gravidade do STM, maior a variabilidade da média dos sinais vitais avaliados. CONCLUSÃO: pacientes mais graves tendem a apresentar maior variação nos sinais vitais na admissão ao departamento de emergência.

AIM: to evaluate the association between vital signs collected at the patient's entrance to the emergency department and the risk levels of the Manchester Triage System (MTS). METHOD: this is a retrospective observational study; whose sample was 154,714 patients. The exposure factor was the vital signs data, and the primary endpoint was the level of risk of MTS. Statistical, descriptive and inferential analyzes were conducted. RESULTS: the most evaluated vital data was pain intensity; blood pressure was the least evaluated. Changes in heart rate to more or less of physiological patterns have increased the clinical priority of patients. DISCUSSION: the higher the level of severity of MTS, the greater the variability of the mean of the vital signs evaluated. CONCLUSION: more severe patients tend to present greater variation in terms of vital signs on admission to the emergency department.

OBJETIVO: evaluar la asociación entre los signos vitales recolectados cuando el paciente entra al departamento de emergencia y los niveles de riesgo del Sistema de Triaje de Manchester (STM). MÉTODO: estudio observacional retrospectivo, con una muestra de 154.714 pacientes. El factor de exposición corresponde a los datos de los signos vitales y el desenlace primario al nivel de riesgo del STM. Se realizaron Análisis estadísticos, descriptivo e inferencial. RESULTADOS: el dato vital más evaluado fue la intensidad del dolor, y la presión arterial el menos evaluado. Alteraciones en la frecuencia cardíaca para más o menos de los estándares fisiológicos aumentaron la prioridad clínica de los pacientes. DISCUSIÓN: cuanto mayor el nivel de gravedad del STM, mayor la variabilidad de la media de los signos vitales evaluados. CONCLUSIÓN: pacientes más graves tienden a presentar mayor variación en los signos vitales cuando admitidos en el departamento de emergencia.

Resultados cuantitativos de la implementación de la Escala Canadiense de Triaje y Severidad en el servicio de emergencias de un hospital nacional / Quantitative outcome of the implementation of the Canadian Triage and Severity Scale in the Emergency Department of a national hospital

Resumen:Justificación:la clasificación Canadiense de Triaje y Severidad está siendo utilizada en un número creciente de servicios de emergencias; sin embargo, la bibliografía médica ha evidenciado la problemática de su aplicación. Este estudio pretende analizar el resultado de implementar este sistema de clasificación en el Servicio de Emergencias del Hospital Calderón Guardia, con respecto a la mortalidad y otras variables.Métodos:se realizó un análisis comparativo de variables como fallecimientos, cuantía de consultas diarias, estancia promedio y hora paciente, durante un lapso de 14 semanas, antes y después de implementado el sistema de clasificación.Resultados: se encontró cambios significativos con tendencia a la disminución en la consulta diaria y en los egresos rápidos en menos de 1 hora, mientras que hubo cambios significativos con tendencia al crecimiento en la estancia promedio del paciente en el Servicio, y en la mortalidad general. No se halló cambios significativos con respecto a horas paciente diarios, ni en los fallecimientos durante las primeras 2 horas.Conclusiones:el estudio muestra el impacto de implementar un sistema de clasificación en un servicio de emergencias, asociándose a fenómenos preocupantes como el aumento de la mortalidad y el tiempo de estancia. Además, sugiere la necesidad de un abordaje más complejo de la gestión de los servicios de emergencias.

Abstract:Background:The Canadian Triage and Severity Scale is being used in a growing number of Emergency Departments, however the medical literature shows several problems in its application. This study pretends to analyze the outcome of the implementation of this classification in the Emergency Department of the Hospital "Dr. Rafael Ángel Calderón Guardia" regarding mortality and other variables.Methods:A comparative analysis was done on variables like mortality, daily consults, average stay and daily patient hours during a 14 week period before and after the implementation of the classification.Results:Significant negative trend was found in the case of daily consults and fast discharges of less than one hour, while significant positive trend was found in the average length of patient stay in the department and general mortality. No significant changes were present in the case of daily patient hours and deaths during the first 2 hours.Conclusion:The study shows the impact of the implementation of a classification system in an emergency department, associated with worrisome results like the elevation of mortality and average length of stay. It also suggests the need of a more complex triage approach in the management of an emergency department.

Profile of patients admitted to a triage dermatology clinic at a tertiary hospital in São Paulo, Brazil

Abstract: Background: Knowledge of epidemiological data on skin diseases is important in planning preventive strategies in healthcare services. Objective: To assess data from patients admitted to a triage dermatology clinic. Methods: A retrospective study was performed of patients admitted over a one-year period to the Triage Dermatology Clinic at the Hospital das Clínicas of the University of São Paulo Medical School. Data were obtained from record books. The variables analyzed were: patient age, gender, dermatologic disease (initial diagnosis), origin (from where the patient was referred) and destination (where the patient was referred to). Results: A total of 16,399 patients and 17,454 diseases were identified for analysis. The most frequent skin disorders were eczema (18%), cutaneous infections (13.1%), erythematous squamous diseases (6.8%) and malignant cutaneous neoplasms (6.1%). Atopic dermatitis was the most common disease in children. Acne was more common among children and adults, as were viral warts. Basal cell carcinoma and squamous cell carcinoma were more common in the elderly. Contact dermatitis and acne predominated in women. The most frequent origins were: the primary/secondary health system (26.6%), other outpatient specialties (25.5%), emergency care (14.9%); while the destinations were: discharged (27.5%), follow-up in our Dermatology Division (24.1%), return (14.1%) and the primary/secondary health system (20.7%). Conclusion: Understanding the incidence of skin diseases is fundamental in making decisions regarding resource allocation for clinical care and research. Thus, we believe our findings can contribute to improving public health policies.

Evaluación de la categorización de las urgencias gineco-obstétricas en un hospital del sur de Chile / Evaluation of the categorization of gynecological-obstetric emergencies in a hospital in southern Chile

OBJETIVO: Caracterizar las consultas de urgencias gineco-obstétricas de un Hospital del sur de Chile en el año 2013. MÉTODOS: Estudio descriptivo de corte transversal retrospectivo. Se analizaron los registros de la urgencia gineco-obstétrica (UGO) durante el primer semestre del 2013 que ascendieron a 4.898 consultas. RESULTADOS: Un 85% (n=4.155) de las consultas atendidas en UGO fueron pacientes que concurrieron directamente desde su domicilio. El 67,9% (n=3.495) de las atenciones en la UGO se otorgaron en horario diurno promediando 815 consultas por mes. Los principales motivos de consulta fueron otras patologías asociadas al embarazo tales como enfermedades respiratorias agudas, transgresión alimentaria, alergias, hiperémesis gravídica, molestias mecánicas (19,5%, n=897), el trabajo de parto y el parto (7,4%, n=342) y la vulvovaginitis (6,5%, n=302). El 65% (n=2.835) del total de las urgencias gineco-obstétricas con datos completos fueron bien categorizadas según el protocolo de priorización del hospital de estudio. Un 96,6% (n=167) de las pacientes no requirió trasladó a un centro hospitalario de mayor complejidad. CONCLUSIONES: Existe una sobre-utilización de la red de urgencia gineco-obstétrica por parte de las usuarias, colapsando el nivel terciario de atención con patologías que podrían ser resueltas en el nivel primario. Desde la matro-nería se debería liderar la instauración de un instrumento específico de TRIAGE gineco-obstétrico, como también la educación a la comunidad sobre uso adecuado de la red asistencial de nuestro país.

OBJETIVE: To characterize obstetric and gynecological consultations at the emergency department of a hospital in southern Chile in 2013. METHODS: Cross-sectional descriptive retrospective study. Obstetric and gynecological emergency department records (OGE) were analyzed during the first half of 2013 which amounted to 4,898. RESULTS: 85% (n=4155) of the consultations assisted at OGE were patients who attended directly from home. 67.9% (n=3,495) of attentions at the OGE were developed in daytime averaging 815 visits per month. The main reasons of consultation were other diseases of pregnancy such as acute respiratory diseases, food transgression, allergies, hyperemesis gravidarum, mechanical discomforts (19.5%, n=897), labor and delivery (7.4%, n=342) and vulvovaginitis (6.5%, n=302). 65% (n=2835) of all gynecological obstetric emergencies with complete data were well categorized according to protocol prioritization studied hospital. A 96.6% of the patients did not require transfer to a high complexity hospital.CONCLUSIONS: There is an over-utilization of the obstetric and gynecological emergency network by users, collapsing the tertiary level of care with diseases that could be resolved at the primary level. The midwifery should lead the creation of a specific instrument TRIAGE obstetrics and gynecology, as well as community education on proper use of the healthcare network in our country.

Chief Complaints of Elderly Individuals on Presentation to Emergency Department: A Retrospective Analysis of South Korean National Data 2014

PURPOSE: We aimed to assess the chief complaints (CCs) of elderly individuals on presentation to the emergency department (ED) according to gender, age, and disease-related and injury-related visits. METHODS: The 2014 registry database of the National Emergency Department Information System in South Korea, which included data on 908,761 ED visits by individuals aged 65 years and over, was reviewed. RESULTS: We found that 80.7% ED visits were related to disease, whereas the remaining visits were related to injury. The most common CCs presented by elderly male and female individuals with disease-related visits were dyspnea and dizziness, respectively. The 10 most common CCs accounted for 45.5% and 49.2% of the total disease-related visits for male and female individuals, respectively. The most common CC in male and female individuals with injury-related visits was headache and hip pain, respectively. The CC rank showed minimal variance among the different age groups, but a difference was observed between male and female individuals. The most common mechanism of injury in elderly male and female individuals was slipping, wherein females showed a higher occurrence rate than their male counterparts. CONCLUSIONS: These findings can be used to establish an ED training curriculum for nursing students and ED nurses, particularly for ED triage in the elderly.

Triage at the Emergency Department: association between triage levels and patient outcome / Cribado en el Servicio de Emergencia: asociación entre sus categorías y los resultados del paciente / Triagem no Serviço de Emergência: associação entre as suas categorias e os desfechos do paciente

AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP).METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05).RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001).CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

ResumenOBJETIVOIdentificar la asociación entre variables sociodemográficas, clínicas y categorías de cribado con resultados del protocolo desarrollado en el Hospital São Paulo (HSP). MÉTODOEstudio de cohorte retrospectivo llevado a cabo con pacientes mayores de 18 años sometidos al protocolo de cribado en agosto de 2012. Se utilizó la regresión logística para asociar las categorías de riesgo a los resultados (p-valor≤0,05).RESULTADOSHombres con edad más avanzada y atendidos por las especialidades clínicas presentaron mayores índices de estancia hospitalaria y defunción. Pacientes con alta prioridad presentaron índice de estancia hospitalaria y defunción cinco y 10,6 veces mayor, respectivamente (p<0,0001).CONCLUSIÓNEl grupo de mayor prioridad se asoció con mayores índices de estancia hospitalaria y defunciones. El protocolo fue capaz de detectar a pacientes con condiciones más urgentes e identificar factores de riesgo para estancia hospitalaria y defunción.

ResumoOBJETIVOIdentificar a associação entre variáveis sociodemográficas, clínicas e categorias de triagem com desfechos do protocolo desenvolvido no Hospital São Paulo (HSP).MÉTODOEstudo de coorte retrospectivo realizado com pacientes maiores de 18 anos submetidos ao protocolo de triagem em agosto de 2012. Utilizou-se regressão logística para associar as categorias de risco aos desfechos (p-valor≤0,05).RESULTADOSHomens com idade mais avançada e atendidos pelas especialidades clínicas apresentaram maiores taxas de internação e óbito. Pacientes com alta prioridade apresentaram taxa de internação e óbitos cinco e 10,6 vezes maior, respectivamente (p<0,0001).CONCLUSÃOO grupo de maior prioridade associou-se a maiores taxas de internação e óbitos. O protocolo foi capaz de detectar pacientes com condições mais urgentes e identificar fatores de risco para internação hospitalar e óbito.

Nursing staff sizing in the emergency room of a university hospital / Dimensionamiento de enfermería en servicio de urgencias de un hospital escuela / Dimensionamento de enfermagem em sala de emergência de um hospital-escola

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed. .

OBJETIVO Verificar la adecuación de los recursos humanos de enfermería en el servicio de urgencias de un hospital universitario y evaluar la asociación entre las categorías de la clasificación de riesgo con el Sistema de Clasificación de los Pacientes de Fugulin. MÉTODO Se llevó a cabo la clasificación de los pacientes ingresados en servicio de urgencias durante 30 días consecutivos, aplicándose la metodología propuesta por Gaidzinski para el cálculo de dimensionamiento de enfermería. RESULTADOS El cálculo determinó la necesidad de tres enfermeras y cuatro técnicos/auxiliares de enfermería cada turno de 6 horas. Sin embargo, estaban disponibles solo una enfermera y cuatro técnicos/auxiliares por turno. No hubo correlación entre clasificación del riesgo y clasificación de cuidado por el Sistema de Clasificación de los Pacientes. CONCLUSIÓN Se identificó un déficit en el cuadro de profesionales en el servicio de urgencias. La especificidad de esa unidad dificultó el dimensionamiento. Se deben llevar a cabo nuevos estudios a fin de hallarse la mejor estrategia para hacerlo. .

OBJETIVO Verificar a adequação dos recursos humanos de enfermagem no serviço de emergência de um hospital universitário e avaliar a associação entre as categorias da classificação de risco com o Sistema de Classificação dos Pacientes de Fugulin. MÉTODO Foi realizada a classificação dos pacientes internados na sala de emergência durante 30 dias consecutivos, aplicando-se a metodologia proposta por Gaidzinski para o cálculo de dimensionamento de enfermagem. RESULTADOS O cálculo determinou a necessidade de três enfermeiras e quatro técnicos/auxiliares de enfermagem a cada turno de 6 horas. No entanto, estavam disponíveis apenas uma enfermeira e quatro técnicos/auxiliares por plantão. Não houve correlação entre classificação do risco e classificação de cuidado pelo Sistema de Classificação dos Pacientes. CONCLUSÃO Foi identificado défice no quadro de profissionais na sala de emergência. A especificidade dessa unidade dificultou o dimensionamento. Para se encontrar a melhor estratégia para fazê-lo, novos estudos devem ser realizados. .

Valor de predição do Sistema de Triagem de Manchester: avaliação dos desfechos clínicos de pacientes / Valor predictivo del Sistema Triage Manchester: la evaluación de los resultados clínicos de los pacientes / Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes

Objetivo: analisar o valor de predição do Sistema de Triagem de Manchester em relação à evolução clínica de pacientes. Métodos: estudo observacional prospectivo com 577 pacientes admitidos no Pronto Socorro e submetidos à classificação de risco. Foi utilizado o Therapeutic Intervention Scoring System - 28 (TISS-28) para mensurar a gravidade dos pacientes (desfecho primário) e os desfechos secundários: alta/transferência, óbito e tempo de permanência hospitalar. Análise descritiva e univariada foram conduzidas. Resultados: pacientes classificados na cor vermelha têm 10,7 vezes mais chance de ter pontuação acima de 14 no TISS-28 em relação aos demais. Pacientes classificados como vermelho têm 5,9 vezes mais chance de evolução para óbito quando comparados aos demais. Pacientes de alta prioridade de atendimento têm chance 1,5 vezes maior de ficar internado mais de 5 dias do que os de baixa prioridade. Conclusão: o STM se mostrou um bom preditor para os desfechos clínicos. .

Objetivo: analizar el valor predictivo del Sistema Triage Manchester en relación con la evolución clínica de los pacientes. Métodos: estudio prospectivo observacional de 577 pacientes ingresados en la sala de emergencia y sometido a la clasificación de riesgo. El Sistema de Puntaje-28 (TISS-28) Intervención Terapêutica se utilizó para medir la gravedad de los pacientes (resultado primario) y los resultados secundarios: alta / transferencia, la muerte, y la duración de la estancia hospitalaria. Se realizaron análisis descriptivos y univariados. Resultados: los pacientes clasificados como rojo son 10,7 veces más propensos a tener puntuaciones por encima de 14 en el TISS-28 en relación con los demás. Los pacientes clasificados como rojos tienen 5.9 veces más probabilidad de progresión a muerte en comparación con los demás. Los pacientes de un servicio de alta prioridad son 1,5 veces más propensos a ser hospitalizados durante cinco días que baja prioridad. Conclusión: STM resultó ser un buen predictor de los resultados clínicos. .

Objective: to analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients. Methods: prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted. Results: patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority. Conclusions: STM proved a good predictor of clinical outcomes. .

Advanced units: quality measures in urgency and emergency care / Unidades avançadas: medidas de qualidade no atendimento de urgência e emergência

Objective : To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. Methods : We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time. Results : The rate of death in the emergency care unit was zero. Five of the 22 patients classified as Emergency Severity Index 1 (22.7%) arrived presenting cardiac arrest. All were treated with cardiopulmonary resuscitation and reestablishment of vital functions. The average length of stay of patients in the unit was 3 hours, 33 minutes, and 7 seconds. The rate of unscheduled return visits at the emergency care unit of the Ibirapuera unit was 13.64%. Rate of complaints was 2.8/1,000 patients seen during the period Conclusion . : The model of urgency and emergency care in advanced units provides an efficient and efficaious service to patients. Both critically ill patients and those considered less complex can receive proper treatment for their needs. .

Objetivo : Avaliar, por meio de indicadores assistenciais, a qualidade do atendimento prestado aos pacientes considerados de urgência e emergência em uma Unidade Avançada de Pronto Atendimento. Métodos : Foram analisados os dados de relatórios gerenciais das 64.891 consultas (passagens) realizadas na Unidade de Pronto Atendimento da Unidade Ibirapuera do Hospital Israelita Albert Einstein no período de 1o de junho de 2012 até 31 de maio de 2013. Os indicadores propostos para a avaliação do atendimento foram: taxa de óbito no pronto atendimento; tempo médio de permanência dos pacientes dentro da unidade; taxa de consulta de retorno não programado; taxa de internação dos pacientes com triagem 1 segundo o Índice de Severidade de Emergência; taxa de atendimento médico não finalizado; taxa de reclamações; e tempo porta-eletrocardiograma. Resultados A taxa de óbito no pronto atendimento foi zero. Cinco dos 22 pacientes triados como 1 segundo o Índice de Severidade de Emergência (22,7%) chegaram em situação de parada cardiorrespiratória. Todos foram submetidos ao tratamento de reanimação cardiopulmonar com o reestabelecimento de suas funções vitais. O tempo médio de permanência dos pacientes dentro da unidade foi de 3 horas, 33 minutos e 7 segundos. A taxa de retornos em consulta médica não programados no Pronto Atendimento da Unidade Ibirapuera foi de 13,64%. Foi observada taxa de reclamações de 2,8/1.000 atendimentos realizados (183 reclamações) no período analisado. Conclusão O modelo de atendimento de urgência e emergência de unidades avançadas ...

Assessment of knowledge and skills of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania

Introduction:The triage nurse in the emergency centre (EC) is the first person that a patient encounters and the triage nurses' knowledge has been cited as an influential factor in triage decision-making. The purpose was to assess the triaging knowledge and skills of nurses working in the ECs in Dar es Salaam; Tanzania.Methods:Both descriptive cross-sectional and observational study designs were used and data was collected using a structured questionnaire; an observation checklist and a triage equipment audit record. The study population was all nurses (enrolled and registered) working within the EC of the national hospital and three municipal district hospitals in Dar es Salaam. Descriptive statistical data analysis was carried out using SPSS 13.0.Results:Thirty three percent (20/60) of the respondents were not knowledgeable about triage. Thirteen percent of the respondents reported that although they had attended workshops; there had been a lack of information on how to triage patients. More than half (52) of the respondents were not able to allocate the patient to the appropriate triage category. Fifty eight percent (35/60) of the respondents had no knowledge on waiting time limits for the triaged categories. Among the four hospitals observed; only one had nurses specifically allocated for patients' triage. The respiratory rate of patients was not assessed by 84 of the triage nurses observed. No pain assessment was done by any of the triage nurses observed. Only one out of four ECs assessed had triage guidelines and triage assessment forms.Discussion:Nurses who participated in this study demonstrated significant deficits in knowledge and skills regarding patients' triaging in the EC. To correct these deficits; immediate in-service training/education workshops should be carried out; followed by continuous professional development on a regular basis; including refresher training; supportive supervision and clinical skills sessions