Estudio SUHCAT (2): mapa funcional de los servicios de urgencias hospitalarios de Cataluña / SUHCAT study, part 2: a map of the functional characteristics of hospital emergency services in Catalonia

RESUMEN

Objetivo: Describir las características organizativas y funcionales de los servicios de urgencias hospitalarios (SUH) de Cataluña y la de los médicos y enfermeros que trabajan en ellos. Método: Los responsables de 79 de los 82 SUH de Cataluña (96%) respondieron a preguntas referentes a organización y estructura directiva y ejecutiva del SUH, sistema de triaje, relación con los sistemas de emergencias médicas (SEM), volumen y características contractuales y demográficas de los médicos y enfermeros, así como de organización de su trabajo. Se estimaron los puestos de trabajo a tiempo completo para médicos y enfermeros existentes en los SUH en función de las horas totales anuales contratadas. Se analizaron las respuestas según la actividad del SUH (alta, media o baja), el uso del hospital (privado o público) y la complejidad del hospital público (alta tecnología o alta resolución, referencia, comarcal). Resultados: El 69,6% se organiza como servicio y el 53,2% tiene un jefe de servicio. El 68,4% organiza la asistencia en diferentes circuitos, preferentemente basados en un modelo mixto (triaje y especialidad). El 77,2% dispone de un sistema estructurado de triaje, casi siempre funcionando permanentemente, y en el 80,3% enfermería es la encargada. El Modelo Andorrano de Triaje es el más extendido, que clasificó como categorías 1, 2, 3, 4 y 5 al 0,7%, 5,5%, 28,2%, 47,9% y 17,8% de los pacientes, respectivamente. La organización de la jornada de los médicos es predominantemente a turnos (53,2%, preferentemente de 12 horas) y mixta (turnos y guardias, 30,4%). En 2012 se contrataron 4.894.264 horas de trabajo médico y 3.836.579 de trabajo enfermero, que suponen, respectivamente, 2.899 y 2.368 puestos de trabajo teóricos a jornada completa. De las horas de trabajo médico, el 50,4% las desarrollan médicos con contratos directamente vinculados a urgencias (73% fijos y 27% no fijos o interinos), el 19,1% médicos de otros (AU)

ABSTRACT

Objective: To describe the organization and functional characteristics of hospital emergency departments (ED) in Catalonia, Spain, as well as to describe the how these departments are staffed with physicians and nurses. Methods: The heads of 79 of the 82 hospital EDs in Catalonia (96%) responded to questions about the management structure of their department, their triage systems, relations with out-of-hospital emergency medical services, volume, contractual arrangements with staff, demographic characteristics of physicians and nurses on staff, and how their work is organized. A theoretical estimate of the number of full-time staff positions for physicians and nurses in each department was based on the total number of contracted hours each year. Statistics were compiled for three levels of ED volume (high, medium, and low), for private and public hospital status, and for level of complexity of public hospitals (technologically well equipped, comprehensive general, other referral, or local). Results: ED were organizationally separate in 69.6% of the hospitals, and 53.2% had their own department head. Organization was based on care pathways in 68.4%; the pathways usually followed a mixed model reflecting triage and specialty. A structured triage system was operating in 77.2% and was in use at all times in nearly all those departments; in 80.3%, nurses were in charge of triage. The Andorran Triage Model was the system most widely used. Triage levels 1 through 5 accounted for 0.7%, 5.5%, 28.2%, 47.9%, and 17.8% of the emergency patients, respectively. Physicians' assignments were organized in shifts (preferably 12 hours) in 53.2% of the EDs or in a combination of shifts and on-call schedules (30.4%). A total of 4 894 264 physician hours and 3 836 579 nurse hours were contracted in 2012; that number would correspond to 2899 full-time staff positions for physicians and 2368 for nurses. Physicians contracted directly by the EDs covered 50.4% of the hours (73% of the contracted physicians had permanent contracts and 27% were on temporary or training contracts); 19.1% of the hours were covered by physicians from other departments and 30.6% were covered by residents. Most of the fully trained physicians were specialists in family and community medicine (24%) and internal medicine (16.6%); 11.3% had not done residency training in a specialty. The EDs were staffed by physicians from Spain (62.8%), from other European Union (EU) countries (2.1%), and from non-EU countries (17.7%). Many of these characteristics were significantly different according to hospital category. Conclusions: In Catalonia differ in their organization and functional characteristics and in staffing characteristics. These EDs generate full-time employment for over 5000 physicians and nurses (AU)