RESUMO
The practice of consulting with emergency medical centers without an appointment as an alternative to visiting one's doctor has been steadily increasing in Switzerland. Fully integrated in the Swiss health system and attending without appointment to late hours, these establishments can deal with a wide variety of medical and surgical emergencies. However, considered first recourse medical centers, they apply billing rates based on those of general practitioner offices. With the 2018 overhaul of the Tarmed, the billing of some services provided in an emergency center become intricate, particularly those involving time-consuming care or extended observation.
Le recours à la consultation d'urgence, ou sans rendez-vous, est en constante augmentation dans le paysage médical suisse. Les centres d'urgences sont des partenaires du système de santé qui accueillent sans rendez-vous et sur des horaires étendus des urgences médico-chirurgicales variées. Ils sont affiliés à la médecine de premier recours et la tarification des prestations se base sur celle d'un cabinet de médecine générale. Avec la révision du Tarmed 2018 et ses limitations, la facturation de certaines prestations délivrées dans un centre d'urgences ambulatoires devient problématique, en particulier pour les cas nécessitant des soins longs ou une surveillance prolongée.
Assuntos
Agendamento de Consultas , Emergências , Clínicos Gerais , Humanos , Encaminhamento e Consulta , SuíçaRESUMO
Secondary headaches are rare though potentially severe. A systematic search of red flags helps to suspect headaches of secondary origin that require further urgent investigation. Main red flags are: sudden onset, exceptionally severe headache, new headache in patient over 50, vomiting or syncope, focal neurological sign or neck stiffness, recent trauma, uncommon headache during pregnancy or anticoagulant therapy, suspicion of glaucoma.
Assuntos
Serviço Hospitalar de Emergência , Cefaleia/diagnóstico , Cefaleia/etiologia , Encaminhamento e Consulta/normas , Adulto , Algoritmos , Anticoagulantes/efeitos adversos , Traumatismos Craniocerebrais/complicações , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Cefaleia/complicações , Cefaleia/terapia , Humanos , Meningismo/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Fatores de Risco , Síncope/etiologia , Vômito/etiologiaRESUMO
Primary headaches, whose aetiologies cannot be identified by current diagnostic methods, represent the most frequent headaches and must be distinguished from secondary or symptomatic headaches, e.g. related to traumatic, vascular, inflammatory or neoplastic processes. Only an appropriate treatment will meet the expectations of patients, for who even a mild headache may generate important fears and handicaps. Medical history and physical examination form the basis for targeting the right diagnosis before any biological or radiological testing. The article presents guidelines implemented at the Geneva University Hospitals by the Pain Network of the institution. Therapeutic modalities and recommendations concerning the need for specialized assessments are presented to provide a framework in both emergency situation and long-term care.
