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- ItemSomente MetadadadosAvaliação 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 PauloObjectives: 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.
- ItemSomente MetadadadosCorrelation between classification in risk categories and clinical aspects and outcomes(Wiley, 2016) Oliveira, Gabriella Novelli [UNIFESP]; Vancini-Campanharo, Cassia Regina [UNIFESP]; Lopes, Maria Carolina Barbosa Teixeira [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Okuno, Meiry Fernanda Pinto [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]Objective: to correlate classification in risk categories with the clinical profiles, outcomes and origins of patients. Method: analytical cross-sectional study conducted with 697 medical forms of adult patients. The variables included: age, sex, origin, signs and symptoms, exams, personal antecedents, classification in risk categories, medical specialties, and outcome. The Chi-square and likelihood ratio tests were used to associate classifications in risk categories with origin, signs and symptoms, exams, personal antecedents, medical specialty, and outcome. Results: most patients were women with an average age of 44.5 years. Pain and dyspnea were the symptoms most frequently reported while hypertension and diabetes mellitus were the most common comorbidities. Classifications in the green and yellow categories were the most frequent and hospital discharge the most common outcome. Patients classified in the red category presented the highest percentage of ambulance origin due to surgical reasons. Those classified in the orange and red categories also presented the highest percentage of hospitalization and death. Conclusion: correlation between clinical aspects and outcomes indicate there is a relationship between the complexity of components in the categories with greater severity, evidenced by the highest percentage of hospitalization and death.
- ItemSomente MetadadadosEstudo Comparativo No Manejo Da Dor De Pacientes Classificados Como Urgência Relativa Atendidos Em Um Pronto Atendimento De Excelência(Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Santos, Marcia Boessio Dos [UNIFESP]; Bohomol, Elena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Long waiting times at emergency services (ES) increase dissatisfaction and suffering among patients in pain. In these situations, pain management and best practices in nursing are key to ensuring quality care and pain control. Objective: To evaluate the implementation of the Guideline for Antipyretic and Analgesic Administration at Triage (GAAAT) among relatively urgent cases admitted to an ES, based on the indicators arrival-to-discharge time, pain reduction, and user satisfaction. Method: This comparative, prospective cohort study included patients who accepted or declined GAAAT at an ES in the city of São Paulo. All subjects, aged 18 or older, presented with pain and were triaged as relatively urgent cases. The GAAAT and non-GAAAT groups were characterized in terms of arrival-to-discharge time, pain scores at different timepoints, and degree of satisfaction. Results: Of the 185 patients, 55 accepted and 130 declined GAAAT. The most frequent features were female gender, age 31-40 years, higher education, no ES visit during the previous 12 months, and referral to specialized care following triage, albeit without statistical significance. A significant difference (p = 0.004) between groups was observed in analgesic intake before arrival to the ES. No significant difference between the groups was found for mean triage time, medical care, post-triage observation, and subsequent ES stay. However, waiting time until medical care delivery was statistically significant, proving longer for GAAAT-managed than for GAAAT-declining patients (p = 0.03). Significant differences between groups were also observed regarding pain score assigned at triage (p = 0.0001); pain reduction (relative to admission) among those who accepted GAAAT (p = 0.01); fewer analgesics (single dose and type) given during post-triage observation in the GAAAT group (p = 0.01); and pain reduction at discharge (relative to admission) for GAAAT-managed patients (p = 0.02). Pain management proved satisfactory for both groups, but room for improvement was evident. The main reason for declining GAAAT was a preference for medical care, revealing lack of knowledge among users about the strength of protocols. The principal reason for accepting GAAAT was the prospect of pain improvement. Conclusions: No statistical differences were observed in arrival-to-discharge times or patient satisfaction, but pain was better mitigated in the GAAAT group. Nurses should identify patients presenting with pain and take action to manage this symptom during triage, as well as orient drug therapy through continuous evaluation, informed by guidelines validated by the multidisciplinary team. Implementing guidelines designed for the Brazilian healthcare service setting, particularly with support from public policies and professional boards, should result in greater satisfaction among users, irrespective of the principal symptom presented at admission.
- ItemAcesso aberto (Open Access)Nursing care based on risk assessment and classification: agreement between nurses and the institutional protocol(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2013-04-01) Oliveira, Gabriella Novelli; Vancini-Campanharo, Cássia Regina; Okuno, Meiry Fernanda Pinto; Batista, Ruth Ester Assayag [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: to verify the degree of agreement between the levels of priority given by baccalaureate nurses in care based on risk assessment and classification and the institutional protocol, and also among peers. METHOD: descriptive study, using a questionnaire with thirty fictitious clinical cases based on the institutional protocol, which is considered the gold standard, answered by twenty baccalaureate nurses. RESULTS: the agreement analysis through the Kappa Coefficient concluded that the agreement between baccalaureate nurses and the institutional protocol in relation to prioritizing the levels of severity was moderate. When the agreement among peers was evaluated, it was low, as represented by the colorimetric density in shades of light gray. CONCLUSION: in Brazil, some institutions have developed their own protocol, which makes it necessary to develop tools in order to evaluate the accuracy of professionals in relation to the protocols, highlighting the need for capable people to perform this activity, thus contributing to patient safety.
- ItemSomente MetadadadosPacientes 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.
- ItemAcesso aberto (Open Access)Professional nursing practice in critical units: assessment of work environment characteristics(Univ Sao Paulo, Escola De Enfermagem De Ribeirao Preto, 2017) Maurício, Luiz Felipe Sales [UNIFESP]; Okuno, Meiry Fernanda Pinto [UNIFESP]; Campanharo, Cássia Regina Vancini [UNIFESP]; Lopes, Maria Carolina Barbosa Teixeira [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]Objective: assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units. Method: cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture. Results: average age was 31.6 +/- 3.9 years
- ItemAcesso aberto (Open Access)Triagem e intervenção breve em pacientes alcoolizados atendidos na emergência: perspectivas e desafios(Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2007-08-01) Segatto, Maria Luiza; Pinsky, Ilana [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Rezende, Fabiana Faria; Vilela, Thaís Dos Reis; Universidade Federal de Uberlândia Programa de Atenção à Pessoa com Dependência Química; Universidade Federal de São Paulo (UNIFESP)The purpose of this article was to present the general principles, concepts, and main elements of brief intervention, with a literature review on its use for alcoholic patients treated at emergency rooms. It also presents the applicability of screening as a first step to the brief intervention process and the use of validated standard instruments that allow useful information for consistent feedback. Finally, it highlights the challenges associated with screening in emergency rooms due to insufficient time, inadequate professional training, fear of annoying the patient, and common beliefs that alcoholics do not respond to such interventions. Meanwhile, it emphasizes the relevancy of brief emergency intervention, which is both feasible and efficient, and the need for research to define the relevant adjustments by professionals and the health care system.