ABSTRACT
OBJECTIVES: The aim was to evaluate the outcomes of patients' treatment classified according to the Manchester Triage System (MTS) in two large hospitals. METHODS: Historical cohort study performed in two hospitals in different countries: one emergency unit of a hospital in Portugal, and another in Brazil. The studied population was composed of all patients attended and triaged by nurses in emergency services using the MTS, based on data obtained through the ALERT® software. The sample in this study was composed of 158 959 triages in Portugal and 155 121 in Brazil. RESULTS: The higher the priority attributed to the patient according to the MTS, the longer the hospital stay and risk of death. For both groups, the higher the risk classification of the patient, the greater the risk of death when compared to the group classified as "green". In Portugal, patients classified in the "red" category according to the MTS had 1 516-fold higher risk of death compared to those classified in the green category, and in Brazil, this risk was 1 177-fold higher. CONCLUSIONS: In both countries, the MTS proved to be a good predictor of length of hospital stay and death.
Subject(s)
Emergency Service, Hospital , Hospital Mortality , Length of Stay/statistics & numerical data , Triage/methods , Adult , Aged , Brazil/epidemiology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Portugal/epidemiology , Retrospective StudiesABSTRACT
Introdução: Dados sobre a gravidade clínica dos pacientes atendidos em instituição hospitalar possibilitam di-recionar a assistência de enfermagem de forma a oferecer um cuidado de maior qualidade. Objetivo: Avaliar a gravidade de pacientes internados em um hospital em relação a alta/transferência ou óbito. Método: Trata-se de uma coorte concorrente com 577 pacientes de um hospital de grande porte do Vale do Jequitinhonha, Minas Gerais, Brasil. Na admissão o paciente foi avaliado e aplicou-se o TISS-28 entre 24 e 48 h para a determinação da gravidade dos pacientes por meio da quantificação das intervenções de enfermagem. A análise foi procedida aplicando os testes Qui-quadrado, Kruskal-Wallis e Mann-Whitney. Resultados: Encontrou-se diferença significativa nas seguintes variáveis: idade, tempo de permanência dos pacientes e pontuação obtida pelo TISS-28 em relação ao desfecho alta/transferência e óbito. O TISS-28 mostrou uma acurácia de 77,9% tanto na Unidade de Terapia Intensiva (UTI) como no Pronto Socorro (PS) para mensurar a gravidade clínica dos pacientes. Nas unidades de clínicas médica e cirúrgica esta foi de 65,0%. Conclusão: O TISS-28 mostrou-se melhor instrumento para mensuração da gravidade do paciente na UTI e no PS em comparação com a daqueles internados nas clínicas.
Background: Collected data on the clinical severity of patients treated in a hospital provides better standards for higher nursing care quality. Objective: To assess the severity of patients admitted to a hospital in relation to discharge/referral or death rates. Methods: A concurrent cohort of 577 patients from a large hospital in the Jequitinhonha Valley, State of Minas Gerais, Brazil. On admission the patient was first assessed and administered the TISS-28 between 24 and 48 h to determine severity by quantifying nursing care interventions. The analysis was carried out applying Chi-square, Kruskal-Wallis and Mann-Whitney tests. Results: A significant difference was found in the following variables: age, length of stay in the hospital and TISS-28 score in relation to the discharge/referral and death rates. The TISS-28 showed an accuracy rate of 77.9% in measuring clinical severity of patients in both the intensive care unit (ICU) and the emergency room (ER). In medical and surgical clinics this was 65.0%. Conclusion: The TISS-28 proved to be a better instrument for measuring the severity of patients in the ICU and ER compared with those hospitalized in clinics.
Introducción: Los datos acerca de la gravedad clínica de los pacientes atendidos en una institución hospitalaria permiten orientar la asistencia de enfermería de manera de ofrecer un cuidado de mayor calidad. Objetivo: Evaluar la gravedad de pacientes internados en un hospital en relación a su alta/transferencia o muerte. Método: Se consideró una cohorte concurrente con 577 pacientes de un hospital grande del Vale do Jequitinhonha, Minas Gerais, Brasil. En la admisión el paciente era evaluado y se le aplicaba el TISS-28 entre 24 y 48 h para la determinación de la gravedad de los pacientes por medio de la cuantificación de las intervenciones de enfermería. Se procedió al análisis aplicando tests de Chi-cuadrado, Kruskal-Wallis y Mann-Whitney. Resultados: Se encontró una diferencia significativa para las siguientes variables: edad, tiempo de permanencia de los pacientes y puntuación obtenida en el TISS-28 en relación con el resultado alta/transferencia y muerte. El TISS-28 mostró una precisión de 77,9%, tanto en la Unidad de Terapia Intensiva (UTI) como en la Sala de Emergencia (ER), para medir la gravedad clínica de los pacientes. En las unidades clínicas médica y quirúrgica la precisión fue de 65%. Conclusión: El TISS-28 mostró ser el mejor instrumento para medir la gravedad de los pacientes en la UTI y ER en comparación con aquellos internados en las clínicas.
