Navegando por Palavras-chave "Serviços Médicos De Emergência"

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    Avaliação da classificação de risco em um serviço de emergência da Bahia
    (Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Jesus, Ana Paula Santos De [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Universidade Federal de São Paulo
    Objectives: To associate the risk classification categories with demographic profile, clinical aspects, comorbidities, times of care and patient outcomes in the emergency department, to assess the Manchester Screening System. Methods: Cross-sectional, analytical study. Patients aged 18 years or older were included in relation to the urgency of care under the Manchester Protocol in an emergency department. For statistical processing and analysis, the Statistical Package for Social Science (SPSS), version 23 was used. Descriptive analysis was performed using the calculations of mean, standard deviation, median, minimum and maximum. For categorical variables, frequency and percentage were calculated. Chi-square test, Student's t test, analysis of variance and generalized linear model were used, with a significance level of 5%. Comorbid load was calculated using the Charlson comorbidity index. Results: Data from 3,624 medical records were analyzed. Age ranged from 18 to 114 years, with a mean of 48.4 ± 18.7 years. There was a predominance of females (51.8%), brown skin (94.4%; n = 2,751), those from the household (88.1%), those classified in the yellow risk category (31.5%) and those with outcome of hospital discharge (42.9%). White individuals were older, and men had a higher percentage of red risk when compared to women (p = 0.0018). Patients classified in the high priority categories (red and orange) had a higher frequency of comorbidities, altered vital signs, cardiac complaints, external causes, two or more tests performed and death. The average waiting time to start the risk classification and the duration of the classification were longer than recommended, except the red category. The average waiting time for medical care in the red and orange categories was significantly longer than estimated. The death outcome was associated with the red category, which had shorter average waiting times for care and reduced stay in the emergency department. The average score on the age-adjusted comorbidity index was higher in patients in the red and white categories, with vascular and endocrine complaints, and those who underwent cranial tomography, with a high risk of mortality (p <0.0001). Hospital admission, transfer and death were associated with higher mean comorbidity scores (p <0.0001). Conclusion: The use of the Manchester Triage System was essential to prioritize severe cases, adequate use of diagnostic resources and the identification of a higher risk for hospitalization and death. There was a difference between the average waiting time for medical care and that recommended by the protocol. Despite the prioritization of urgent cases, improvements must be implemented to organize the flow of care, aiming at reducing waiting times, especially in high priority categories. The evaluation of comorbid load can be used to establish the clinical priority, defined by the Manchester Protocol, when it is desired to identify patients with the highest chances of progressing to death.
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    Pacientes com lesões traumáticas decorrentes de acidentes de trânsito: análise do tempo de permanência na sala de emergência
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Aguiar, Katiuscia Larsen De Abreu [UNIFESP]; Whitaker, Iveth Yamaguchi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To characterize patients with traumatic injuries due to traffic accidents admitted to emergency room (ER), analyze the length of ER stay up to the referral to operating room, intensive care unit (ICU), or hospital wards, and verify the association of length of ER stay with age, gender, type of traffic accident, day period of incident, type of prehospital care (PHC), amount of computed tomography (CT) scan undertaken, time up to cranial CT, number of specialists, injury and trauma severity, length of hospital and ICU stay, complications, type of hospital discharge, recovery after hospital discharge, and readmission. Method: Prospective cohort study for the follow-up of patients with traumatic injuries due to traffic accidents, since their admission into the ER up six months after hospital discharge. Data from patients admitted to ER due to traffic accidents aged more 14 years old in 2015 were included in the sample. Kruskal-Wallis, Chi-square, or likelihood-ratio tests were used to observe the association between length of ER stay and study variables, considering a 5% significance level and a 95% confidence interval. Results: The sample included 327 patients of which 82% were men, mean age was 34 years, primarily (58.7%) affected by motorcycle accidents, 97.2% suffered minor, moderate, and serious injuries. The length of ER stay mean was 4.8 hours. The longest length of ER stay was associated with the time for undertaking cranial CT scan (p=0.0039), trauma severity (anatomical p=0.0056 and physiological p=0.0141), and complications (p=0.0241). Among those who stayed in the ER for up to two hours, the highest percentage (37.1%) was referred to the green sector (p<0.0001), and was associated with motorcycle accidents (p=0.0147) and basic support (p=0.0478). Conclusion: The length of ER stay of patients with traffic accident injuries was 4,8 hours in average. It was associated with factors indicating trauma severity. Severe patients were observed in longer ER time intervals than those with lesser severity. Considering the high demand of patients in emergency department and for the therapeutic and monitoring needs of critically ill patients to be met at a time and place appropriate to their conditions, the organization of hospitalized patient flow should be part of health public service management agenda.