La saturación de los servicios de urgencias: una llamada a la unidad / Emergency Department Crowding: a call for unity

La saturación de los servicios de urgencias hospitalarios (SUH) es un problema global que afecta a millones de pacientes cada día. Debe considerarse como un problema que afecta a la calidad y la seguridad de los pacientes, y no sólo como un asunto que afecte a la organización. La evidencia sugiere que mientras que hay muchos factores que contribuyen a la saturación de SUH, los médicos de urgencias deben adoptar una definición que se base en la calidad. La definición debe incluir las dimensiones adoptadas por el Institute of Medicine y seguir las guías recomendadas. Asimismo los urgenciólogos deben argumentar que erradicar la saturación de los SUH debe alcanzar el mismo nivel de importancia que eliminar errores quirúrgicos, disminuir el número de infecciones nosocomiales y otros objetivos destacados. Los urgenciólogos deben defender que los estándares reguladores nacionales dirigidos al paciente sean implantados y tenidos en cuenta por los hospitales. El tiempo ha venido a demostrar que los factores asociados con la saturación de urgencias no están dentro del control de los médicos de urgencias durante sus actividades diarias. Mientras que aportar recursos a nuestros SUH puede ser de ayuda, pedir o demandar un incremento de la productividad de los urgenciólogos y de los SUH no corregirá este problema. Aunque que hay múltiples razones que explican la saturación de los SUH, éstas no se encuentran en la entrada de pacientes o en los procesos internos de los servicios de urgencias. Las razones (..) (AU)

ED crowding is a global issue. It impact on millions of patient every day. Crowding must be seen as patient safety and quality issue and not just as an operational issue. The evidence suggests that, while there are many factors contributing to ED crowding, emergency physicians must adopt a definition that centers on quality. The definition must include the dimensions adopted by the Institute of Medicine and follow the guidelines discussed above. Likewise emergency physicians must argue that ED crowding must rise to the same level of importance as eliminating wrong site surgery, decreasing hospital acquired infections and the other goals listed in table 1. Emergency physicians must argue that national and regulatory standards addressing patient be implemented and adhered to by hospitals. The time has come to accept that the factors associated with crowding are not within the control of emergency physicians during their day to day activities. While adding resources to our emergency departments may be helpful, asking or demanding increased productivity form EPs and ED staff will not correct this problem. While multi-factorial the reason for ED crowding are not found in the influx of patients or the internal processes of the ED. The reasons are in the output; they are found within the processes of the organizations emergency departments support. Staffing critical care beds, allocating general acutecare beds for ED patients and transporting these patients to those beds are the essential components to solving this global crisis. ED crowding has been present for over twenty years. The time has come for a unity of purpose, definition, research, solution and adherence following established guidelines for the delivery of quality care (AU)

TPH-contaminated Mexican refinery soil: health risk assessment and the first year of changes.

The soil of a coastal Mexican refinery is quite contaminated, especially by hydrocarbons, with detected concentrations up to 130000 mg kg(-1) as TPHs (total petroleum hydrocarbons). The main sources of contamination are pipelines, valves, and old storage tanks, besides the land disposal of untreated hydrocarbon sediments derived from the cleaning of storage tanks. A health risk assessment (HRA) was carried out in order to measure the risk hazard indexes and clean-up standards for the refinery soil. HRA suggested the following actions to be taken: benzene concentrations must be reduced in eight of the 16 studied refinery zones to 0.0074-0.0078 mg kg(-1). Also, vanadium concentration must be reduced in two zones up to a concentration of 100 mg kg(-1). In only one of all of the studied zones, benzo(a)pyrene concentration must be reduced to 0.1 mg kg(-1). After 1 yr, TPHs showed a diminution of about 52%. Even though TPHs concentrations were variable, during 1999 the average concentrations were as much as 15.5 times the goal concentration. For year 2000, TPHs concentrations were only 7.4-fold the proposed value. For the 1999-2000 period, PAHs (polycyclic aromatic hydrocarbons) concentrations decreased by 82%. Some PAHs with 2, 3, 4, and 5 aromatic rings were removed up to 100% values.