Résumé
Existe hacinamiento de pacientes en los servicios de emergencia de nuestros hospitales públicos; sin embargo, se trata de un problema presente en otros países, cuya mención aparece en la literatura médica foránea como crowding. Se presenta una breve revisión de la literatura médica que trata su aparición en el tiempo. Se exponen causas, consecuencias y alternativas de solución. Ante la carencia de trabajos de investigación nacionales, se tomó como fuente informes de Contraloría General de la República sobre implementación y cumplimiento de las normas técnicas en áreas críticas de 8 hospitales públicos de Lima y Callao el año 2012. Se analizó el informe de Defensoría del Pueblo, inspección de 149 hospitales a nivel nacional el mismo año. Se describe las brechas presentes entre las ofertas de cama y sobredemanda de atenciones en los servicios de emergencia inspeccionados, así como las condiciones en que permanecen los pacientes y trabaja el personal de salud en los servicios de emergencia. Se expone otras situaciones que comprometen el acceso y la atención oportuna de personas que demandan ser atendidos. Se resume las recomendaciones presentadas por ambos entes inspectores en torno a la congestión de pacientes dentro de los servicios de emergencia. El hacinamiento es un grave problema de salud pública. Los principales prestadores públicos de salud tienen que priorizar la realización de estudios al respecto y proponer soluciones, con planes de desarrollo y mejora progresiva en el corto y mediano plazo.
There is overcrowding of patients in the emergency services of our public hospitals. However, it is a problem that occurs in other countries and appears in the foreign medical literature as crowding. A brief review of the literature is presented discussing time of appearance, causes, consequences and possible solutions. Inthe absence of national research, sources used were the Comptroller General of the Republic (Contraloría General de la República) on the implementation of and compliance with technical standards in critical areas of 12 public hospitals in Lima and Callao 2012, and the report of the Office of the Ombudsman (Defensoría del Pueblo) on the nationwide inspection of 149 hospitals nationwide in 2012. The gaps between supply of bedsand care excess demand in the emergency services inspected and conditions for both inpatients stay and health personnel working in the emergency services are described. Other situations that compromise access and timely attention of people are exposed. The recommendations presented by the two inspecting entities on the congestion of patients within the emergency services are summarized. Overcrowding is a serious public health problem. The main public health providers have to prioritize studies on this matter and propose solutions with plans of development and gradual improvement in the short and medium term.
Résumé
Objective·To investigate the effect of population aging on health condition of Emergency Department (ED) visitors, the disease constitution of ED, the pressure of emergency treatment and the emergency department length of stay (EDLOS). Methods·Patient data from ED of a tertiary hospital in Shanghai from Jan. 2014 to Dec. 2016 were collected and retrospectively analyzed, including gender, age, arrival time, diagnosis, EDLOS, outcome, chronic disease, infection or tumor, etc. Statistics was used to determine possible factors associated with prolonged EDLOS. Results·A total of 15429 cases were selected. The number of the elderly patients (≥65 years old) was 8480 (54.96%). The elderly patients' EDLOS was significantly longer than patients younger than 65 years (P=0.000). The incidence of chronic aging diseases was significantly higher in elderly patients (67%) than in who were below 65 years old (52%). Tumor and infection were independent risk factors for EDLOS (P=0.000). The proportion of elderly patients with acute onset and unknown diseases was only 14%. Conclusion·The increasing proportion of elderly patients in ED is the main reason leading to the pressure of emergency treatment. The elderly patients who had chronic diseases prolong the EDLOS and cost the most medical resources of emergency treatment. So the gerontology should be rapidly expanding. Meanwhile, the complex chronic aging diseases, acute onset of chronic disease and varying severity of disease in the elderly patients should be treated by the new stepping mode "Family- Hospitalization-Emergency".
Résumé
Objective·To investigate the effect of population aging on health condition of Emergency Department (ED) visitors, the disease constitution of ED, the pressure of emergency treatment and the emergency department length of stay (EDLOS). Methods·Patient data from ED of a tertiary hospital in Shanghai from Jan. 2014 to Dec. 2016 were collected and retrospectively analyzed, including gender, age, arrival time, diagnosis, EDLOS, outcome, chronic disease, infection or tumor, etc. Statistics was used to determine possible factors associated with prolonged EDLOS. Results·A total of 15429 cases were selected. The number of the elderly patients (≥65 years old) was 8480 (54.96%). The elderly patients' EDLOS was significantly longer than patients younger than 65 years (P=0.000). The incidence of chronic aging diseases was significantly higher in elderly patients (67%) than in who were below 65 years old (52%). Tumor and infection were independent risk factors for EDLOS (P=0.000). The proportion of elderly patients with acute onset and unknown diseases was only 14%. Conclusion·The increasing proportion of elderly patients in ED is the main reason leading to the pressure of emergency treatment. The elderly patients who had chronic diseases prolong the EDLOS and cost the most medical resources of emergency treatment. So the gerontology should be rapidly expanding. Meanwhile, the complex chronic aging diseases, acute onset of chronic disease and varying severity of disease in the elderly patients should be treated by the new stepping mode "Family- Hospitalization-Emergency".