Estudio del tiempo de demora asistencial en urgencias hospitalarias. Estudio multicéntrico en los servicios de urgencias hospitalarias de la Comunidad Valenciana / Multicentre study on waiting time in emergency departments at the Valencian Community

Objetivos: Definir dos indicadores de calidad: demora asistencial y demora diagnóstica, comparar dichas demoras en relación con la gravedad de las patologías, y comprobar si sirven para valorar la calidad asistencial de los diferentes servicios de urgencias hospitalarias (SUH). Método: Estudio observacional, multicéntrico y prospectivo realizado entre diciembre de 2002 y junio de 2003 mediante la recogida de datos semanal, en un día determinado, a los pacientes atendidos de 8 h a 15 h en los SUH. Los episodios se recopilan y gestionan en una base de datos Access, y se procesan con el programa SPSS 11.05. Se miden los diferentes tiempos de demora y se valora la gravedad de la consulta. Se obtienen los siguientes tiempos reales: Tiempo medio de primera asistencia, Tiempo medio de diagnóstico, Tiempo medio de permanencia en Urgencias y Porcentaje de pacientes atendidos por centro; posteriormente los comparamos con los indicadores de calidad establecidos. La muestra n fue de 703 pacientes, correspondiendo: 36,1% al SUH1 (254 pacientes), 30,9% al SUH2 (217), 18,1% al SUH3 (127) y 14,9%(105) al SUH4. Resultados: Tiempo medio de primera asistencia: 27’. Tiempo medio de diagnóstico: 46’. Media de tiempo de permanencia: 74’. Porcentaje según gravedad: Crítico 1%, Grave 7%, Gravedad moderada 42%, Leve 50%. Demora global: 21,6%. Cumplimiento de estándar de oro: 78,4%. Conclusiones: Relacionar demora asistencial con gravedad es un buen método para el control de calidad de los SUH. Hay que tender a cero en la demora de los pacientes U1 y U2. Podemos llegar a un consenso de buena asistencia e incidir en los problemas que derivan en una mayor demora según la gravedad de la patología (AU)

Background: First was to analyse the medical-care and medicaldiagnosis waiting time related to the severity of pathologies in order to measure the medical care quality in different Emergency Departments (ED) and second, comparison between several hospitals. Methods: Observational, multicentred and prospective study carried out during weekdays, from December 2002 to June 2003, including all patients treated from 8 a.m. to 3 p.m. in ED It was funded by a research grant from the Conselleria de Sanidad. The participants were four ED of public hospitals at the Valencian Community. Results: The average time it takes for a patient to walk into E.D until they were visited was 27 minutes; until they were diagnosed was 46 minutes and until they leaved ED. was 74 minutes. Overal waiting-time: 21.6%. Conclusions: Relating waiting time to severity is a good method for quality control in E.D. The trend should be zero waiting time in patients U1 and U2. Analysing the obtained data we could say is possible to reach a consensus on good care practice, and studying each ED it is feasible to correct the problems that cause a major delay depending on the severity of the pathology (AU)

[Urinary infection in patients with short-term bladder catheterization]. / Estudio de la infección urinaria en pacientes con sondaje vesical de corta duración.

BACKGROUND: The aim of the study was to assess the number of urinary tract infections, the time between catheterization and the development of bacteriuria, the route taken by the microorganisms and the clinical relevance of infection in patients with bladder catheterization during a short time. METHODS: 83 patients were evaluated by urine culture from the bladder, urethra, the connection of the catheter and the collecting system, and the collecting bag, on a daily basis during the 5 initial days, with clinical and microbiological follow up to 7 days after the removal of the catheter. RESULTS: 32% of patients developed bacteriuria. The mean interval between catheterization and the development of bacteriuria was 4.1 days. 45% of them were detected within 48 hours after catheter insertion. In 50% the causative organisms were detected in the urethra at least 24 hours previously. In no case the microorganism isolated from the connection between the catheter and the collecting system was subsequently isolated form bladder urine. Bacteriuria disappeared spontaneously in 27% of cases. Antibiotic therapy was necessary in 42%. CONCLUSIONS: In the study population most urinary infections were due to previous urethral colonization and subsequent dragging into the bladder, in many cases at the same time of catheterization. A non-negligible number of bacteriurias disappeared spontaneously.