La densidad horaria de pacientes acumulados como indicador de saturación en urgencias / The hourly accumulated patient density as an indicator of Emergency Clinic saturation

Objetivo: Definir y estudiar el comportamiento de un indicador sensible a la acumulación de pacientes en Urgencias, la densidad horaria de pacientes acumulados (DHPA), que indica el número de pacientes que en una hora determinada están pendientes de alta. Método: Con la hora de admisión y de alta, se ha cuantificando la contribución a la (DHPA) de todos los pacientes pediátricos que transitaron por urgencias en el último cuatrimestre del 2002. Se ha realizado un estudio descriptivo retrospectivo, diferenciando entre septiembre-octubre, período con demanda considerada habitual, y noviembre-diciembre con demanda epidémica. Resultados: En el periodo no epidémico no se llegó ningún día a la cifra de referencia de 80 visitas, mientras que en el periodo epidémico se superó esta cifra el 18% de los días. La DHPA a la llegada de un paciente fue superior en los que decidieron marcharse sin ser visitados (mediana 12). Con el criterio de una DHPA 12, se detectaron 10 días (16,4%) con saturaciones del período no epidémico y, 39 días (63,9%) del epidémico. Conclusiones: Este indicador detecta periodos puntuales de acumulación no evidenciados por el análisis del número de urgencias y puede ayudar en la mejora de la asignación de recursos y la mejora de la calidad (AU)

Aim: To define and study the behaviour of a sensitive indicator or patient accumulation in the Outpatient Emergency Clinic, the “hourly accumulated patient density” (HAPD), which indicates the number of patients who, within a given hour, are still pending discharge. Method: Considering the hour of admission and the hour of discharge, the contribution to the HAPD of all paediatric patients attending the Outpatient Emergency Clinic during the last four months in the year 2002 has been calculated. A retrospective descriptive study was carried out differentiating the september-october period, considered as a “normal demand” one, and the novemeber-december one, considered as an “epidemic demand” period. Results: The 80-visit level was nott achieved in any single day of the non-epidemic-demand period, but was exceeded in 18% of the days in the epidemic demand one. The HAPD on arrival of a patient was highest among those who decided to leave without consultation (median, 12). With the HAPD >= 12 criterion, ten days with saturations (16.4%) were detected in the non-epidemic-demand period, versus 39 days (63.9%) in the epidemic-demand one. Conclusions: This indicator detects discrete accumulation periods which are not evidenced by the “number of emergency attendances” analysis, and may help in the improvement of resources assignation and general quality improvement (AU)

Clinical profiles in fibromyalgia patients of the community mental health center: a predictive index of psychopathological severity.

INTRODUCTION: In recent years we have seen an increasing demand for mental health care in patients with fibromyalgia and psychiatric symptoms, although it is not clear if the symptoms are primary or secondary to the presence of the syndrome. This fact has led mental health providers to think that there would be some psychological factors influencing the vulnerability of suffering this painful syndrome, because its etiology is quite non-specific. Bradley et al. (1978) identified different psychopathological profiles within chronic pain syndromes with the MMPI, which were subsequently adapted by Yunus et al. (1991) for fibromyalgia. This present work studied the clinical profile in patients with fibromyalgia. SAMPLE: 75 patients with fibromyalgia from the community mental health center and 55 healthy subjects. Tools: STAI-E/R, BDI, MMPI-2, MMPI-2 personality disorders, MMPI-2 PSY-5. STATISTICAL ANALYSIS: descriptive statistics and mean comparison (Student's t test). Confirmatory cluster analysis. Discriminative analysis of subgroups. RESULTS: Two different patterns were obtained: group A (32 %) with a typical chronic pain profile (CP) and group B (68 %) with a psychological maladjustment profile (PM). With the discriminative analysis, we obtained the coefficients of the discriminative canonical functions that maximize the differences between both groups. CONCLUSIONS: We confirmed Bradley's classification, obtaining two different psychopathological patterns in the fibromyalgia syndrome sample we studied. We obtained an index of psychopathological profile in fibromyalgia, which would form a new scale, from MMPI-2 for discriminating psychopathological severity in fibromyalgia.

Perfiles clínicos en pacientes con fibromialgia que acuden a un centro de salud mental: obtención de un índice predictivo de gravedad psicopatológica / Clinical profiles in fibromyalgia patients of the community mental health center: a predictive index of psychopathological severity

Introducción. En los últimos años se ha visto incrementada la demanda asistencial en salud mental de pacientes que presentan fibromialgia y sintomatología psiquiátrica, y no queda claro en la mayoría de los casos si esta patología es primaria o secundaria a la aparición del síndrome. Esto ha hecho plantearse a los profesionales de la salud mental la influencia de distintos factores psicológicos de vulnerabilidad a padecer este síndrome doloroso dada la inespecificidad a nivel etiológico. Bradley et al. (1978) identificaron a través del MMPI distintos perfiles psicopatológicos dentro de síndromes con dolor crónico que posteriormente fueron adaptados por Yunus et al. (1991) para la fibromialgia. En el presente trabajo se estudian los perfiles clínicos en pacientes con fibromialgia. Método. Muestra: 75 pacientes derivados al centro de salud mental que presentan fibromialgia; 55 sujetos control sanos. Instrumentos: STAI-E/R; BDI, MMPI-2, MMPI-2 trastornos de la personalidad, MMPI-2 PSY-5. Análisis estadísticos: estadísticos descriptivos y comparación de medias (t de Student). Análisis de clúster confirmatorio. Análisis discriminante de los subgrupos. Resultados. Se obtienen dos patrones diferenciales: grupo A (32 %) con un perfil típico del dolor crónico (DC) y grupo B (68 %) con un perfil de desajuste psicológico (DP). Mediante el análisis discriminante obtuvimos los coeficientes de las funciones canónicas discriminantes que maximizan las diferencias entre los dos grupos. Conclusiones. Se confirma la clasificación de Bradley obteniendo dos patrones psicopatológicos diferenciales en la muestra de síndrome de fibromialgia estudiada. Se obtiene un índice de perfil psicopatológico en fibromialgia que configura una nueva escala a partir del MMPI-2, que discrimina gravedad psicopatológica en la fibromialgia

Introduction. In recent years we have seen an increasing demand for mental health care in patients with fibromyalgia and psychiatric symptoms, although it is not clear if the symptoms are primary or secondary to the presence of the syndrome. This fact has led mental health providers to think that there would be some psychological factors influencing the vulnerability of suffering this painful syndrome, because its etiology is quite non-specific. Bradley et al. (1978) identified different psychopathological profiles within chronic pain syndromes with the MMPI, which were subsequently adapted by Yunus et al. (1991) for fibromyalgia. This present work studied the clinical profile in patients with fibromyalgia. Method. Sample: 75 patients with fibromyalgia from the community mental health center and 55 healthy subjects. Tools: STAI-E/R, BDI, MMPI-2, MMPI-2 personality disorders, MMPI-2 PSY-5. Statistical analysis: descriptive statistics and mean comparison (Student's t test). Confirmatory cluster analysis. Discriminative analysis of subgroups. Results. Two different patterns were obtained: group A (32 %) with a typical chronic pain profile (CP) and group B (68 %) with a psychological maladjustment profile (PM). With the discriminative analysis, we obtained the coefficients of the discriminative canonical functions that maximize the differences between both groups. Conclusions. We confirmed Bradley's classification, obtaining two different psychopathological patterns in the fibromyalgia syndrome sample we studied. We obtained an index of psychopathological profile in fibromyalgia, which would form a new scale, from MMPI-2 for discriminating psychopathological severity in fibromyalgia