Medición del subtriaje como indicador de calidad y seguridad en un servicio de urgencias / Undertriage as quality of care parameter in an emergency department
Rev. méd. Chile
;
148(5): 602-610, mayo 2020. tab, graf
Artigo
em Espanhol
| LILACS
| ID: biblio-1139344
ABSTRACT
Background: Undertriage or the underestimation of the urgency of the condition of a person arriving in an emergency department (ED) represents a measure of quality care. Aim: To estimate the prevalence of undertriage in a high complexity hospital of Argentina; to describe characteristics and mortality of these patients. Material and Methods: All consultations admitted to the ED during 2014 were analyzed. Those assigned to a lower level of admission risk (classified as Emergency Severity Index -ESI- 3 to 5) but required hospitalization in intensive care units (ICU) as the first hospitalization place were considered as an undertriage. A random sample of correctly categorized admissions (ESI 1 or 2), who were subsequently hospitalized in the ICU, was selected as a comparison group. Results: The global undertriage prevalence was 0.30% (316/104,832). Among patients admitted to the ICU, the prevalence was 21% (316/1,461; 95% confidence intervals (CI) 19-24). The 316 patients whose severity was underestimated had a median age of 73 years, and admitted between 7 a.m. and 9 p.m. in a greater proportion. Overall hospital mortality was 8.9% (95% CI 6.78-11.38), and all deaths occurred after the patient was transferred from the emergency room. There were no differences in mortality between patients with correct triage or undertriage (11 and 7% respectively, p = 0.09). No differences were observed either in the total number of critical interventions during care in the first 24 hours. Significant differences were observed in requirements for mechanical ventilation (11 and 4% respectively, p = 0.01), orotracheal intubation (10 and 5% respectively p = 0.01) and non-invasive ventilation (8 and 4% respectively, p = 0.05). Conclusions: Undertriage rate in this series was low, but it can be improved.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Qualidade da Assistência à Saúde
/
Triagem
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Fatores de risco
Limite:
Idoso
/
Humanos
País/Região como assunto:
América do Sul
/
Argentina
Idioma:
Espanhol
Revista:
Rev. méd. Chile
Assunto da revista:
Medicina
Ano de publicação:
2020
Tipo de documento:
Artigo
País de afiliação:
Argentina
Instituição/País de afiliação:
Central de Emergencias de Adultos/AR
/
Hospital Italiano de Buenos Aires/AR
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