Navegando por Palavras-chave "Triage"

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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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    Classificação de risco no serviço de emergência: associação entre as suas categorias e os desfechos do paciente
    (Universidade Federal de São Paulo (UNIFESP), 2014-05-25) Becker, Juliana Barros [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; http://lattes.cnpq.br/1924137485244907; http://lattes.cnpq.br/7232913011589777; http://lattes.cnpq.br/7975003037777468; Universidade Federal de São Paulo (UNIFESP)
    O problema da superlotação dos serviços de emergência (SE) é uma realidade mundial, principalmente em países em desenvolvimento, traduzindo um baixo desempenho dos sistemas de saúde. Mundialmente há recomendação para a implantação da triagem de pacientes nos Serviços de Emergência com o objetivo de melhorar a assistência prestada. Seguindo estas diretrizes o Hospital Universitário da Universidade Federal de São Paulo (UNIFESP) desenvolveu e implantou um protocolo que utiliza a classificação em cinco níveis de gravidade, este definido pela queixa principal do paciente. O objetivo deste estudo foi avaliar se as categorias do protocolo de classificação de risco (CR) estão associadas à morte, internação hospitalar e alta. Métodos: Estudo observacional, tipo coorte retrospectivo, realizado no SE do Hospital São Paulo (HSP), UNIFESP, com pacientes maiores de 18 anos submetidos ao protocolo de CR no mês de agosto de 2012. Resultados: O maior número de pacientes submetidos ao protocolo de CR do SE foi classificado como baixa prioridade. A proporção de óbitos foi maior no grupo de pacientes classificados como alta prioridade. Os homens apresentaram maior taxa de internação hospitalar e óbito em relação às mulheres (?²=13,58; p=0,0011). Pacientes classificados como alta prioridade apresentaram taxa de internação cinco vezes maior e a taxa de óbitos 10,6 vezes maior em relação aos pacientes classificados como baixa prioridade (?²= 214,99; p <0,0001). Observou-se predominância das especialidades clínicas no grupo de maior prioridade (?²= 48.47; p< 0,0001), uma maior taxa de internação e óbito (?²= 20.04; p <0,0001) e um maior tempo de internação hospitalar (ANOVA F = 13.0; p=0,0004) quando comparados às especialidade cirúrgicas. Conclusão: O grupo de maior prioridade associou-se a maiores taxas de internação e óbitos. O protocolo foi capaz de detectar pacientes com condições mais urgentes e identificar fatores de risco para internação hospitalar e óbito. Os resultados encontrados demonstram que desenvolvimento de protocolos próprios, pode ser uma alternativa a protocolos internacionais em Instituições de Saúde com recursos financeiros limitados.
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    Correlation 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.
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    Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil
    (Conselho Brasileiro de Oftalmologia, 2008-04-01) Escarião, Paulo Henrique Gonçalves; Arantes, Tiago Eugênio Faria De [UNIFESP]; Figueiroa Filho, Natanael Cavalcanti; Urtiga, Ricardo De Deus; Florêncio, Telma Lúcia Tabosa; Arcoverde, Ana Lúcia De Andrade Lima; Fundação Altino Ventura; Hospital de Olhos de Pernambuco; Fundação Altino Ventura Projeto para Prevenção da Cegueira por Retinopatia Diabética; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 ± 12.0 years; mean duration of diabetes 8.1 ± 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2%) patients had diabetic retinophathy, while in group II, 89 (39.4%) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.
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    Estudo 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.
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    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.
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    Ocorrência de alterações de orelha média em recém nascidos que falharam na triagem auditiva neonatal
    (Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Pereira, Priscila Karla Santana [UNIFESP]; Azevedo, Marisa Frasson de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: verificar a ocorrência das alterações auditivas em recém nascidos que participaram do Programa de triagem auditiva neonatal de um Hospital Público (UNIFESP- Brasil) no período de 2005 a 2007 e verificar se os recém nascidos que falharam na triagem auditiva por comprometimento condutivo tem mais episódios de perda condutiva durante os primeiros anos de vida do que aqueles que não falharam. Métodos: 0 estudo foi dividido em duas partes. A primeira parte foi retrospectiva analisando-se 0 diagnóstico audiol6gico de 231 (de mil novecentos e noventa e seis) recém nascidos que falharam na triagem auditiva e sua associação com a idade gestacional, 0 peso ao nascimento e as principais intercorrências neonatais. Na segunda parte compararam-se os 62 recém nascidos que falharam na triagem auditiva por comprometimento condutivo com os 221 recém nascidos que passaram na triagem auditiva. Foi feito 0 acompanhamento por meio de EOAT, imitanciometria e avaliação comportamental. Foram utilizados para analise estatística 0 teste Exato de Fisher e modelos de Regressão Logística. Resultados: A incidência de alterações auditivas na população estudada foi de 11,5%, sendo 8,4% de perda condutiva, 1 % de perda neurossensorial, 2% de alteração central. As crianças que falharam na triagem por alteração condutiva tiveram mais episódios de perda condutiva (estatisticamente significante) durante 0 primeiro ano de vida que as crianças que não falharam. Conclusões: Houve maior ocorrência de perda auditiva condutiva dentre as alterações auditivas estudadas. Os neonatos que falharam na triagem auditiva neonatal no primeiro mês de vida por alteração condutiva tem maior chance de terem perda auditiva condutiva ao longo do primeiro ano de vida.
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    Ocorrência de falhas na triagem auditiva em escolares
    (CEFAC Saúde e Educação, 2012-12-01) Farias, Vanessa Vieira; Camboim, Elizângela Dias [UNIFESP]; Azevedo, Marisa Frasson de [UNIFESP]; Marques, Lauralice Raposo [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas; UNCISAL Faculdade de Fonoaudiologia; Universidade Federal de São Paulo (UNIFESP)
    PURPOSES: to determine the occurrence of failures in the hearing screening in students and compare the results obtained in public schools with the particular ones. METHOD: 90 students enrolled in a public and private school took part in this study. The students were submitted to otoscopy and otoacoustic emissions, checking the influence of gender and education network as for the results of hearing screening. RESULTS: we observed that 62.2% of the students passed the hearing screening and 37.8% failed, and we observed higher failure rate among students from public schools. CONCLUSION: we may conclude that in the studied population, the occurrence of failed hearing screening in school is 37.8% and this was significantly higher in students from public schools.
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    Short Mood and Feelings Questionnaire for screening children and adolescents for plastic surgery: cross-cultural validation study
    (Associacao Paulista Medicina, 2017) Sucupira, Eduardo [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; de Lima, Edson Luiz [UNIFESP]; Dini, Gal Moreira [UNIFESP]; Azevedo de Brito, Maria Jose [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]
    CONTEXT AND OBJECTIVE: Patient-reported outcome measurements assessing the emotional state of children and adolescents who seek plastic surgery are important for determining whether the intervention is indicated or not. The aim of this study was to cross-culturally adapt and validate the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) for Brazilian Portuguese, test its psychometric properties and assess the emotional state of children and adolescents who seek plastic surgery. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic at a public university hospital. METHODS: A total of 124 consecutive patients of both sexes were selected between September 2013 and February 2014. Forty-seven patients participated in the cultural adaptation of the questionnaire. The final version was tested for reliability on 20 patients. Construct validity was tested on 57 patients by correlating the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) with the Strengths and Difficulties Questionnaire and the Rosenberg Self-Esteem scale. RESULTS: The child/adolescent and parent versions of the Short Mood and Feelings Questionnaire showed Cronbach's alpha of 0.768 and 0.874, respectively, and had good inter-rater reliability (intraclass correlation coefficient, ICC = 0.757 and ICC = 0.853, respectively) and intra-rater reliability (ICC = 0.738 and ICC = 0.796, respectively). CONCLUSIONS: The Brazilian-Portuguese version of the Short Mood and Feelings Questionnaire is a reproducible instrument with face, content and construct validity. The mood state and feelings among children and adolescents seeking cosmetic surgery were healthy.
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    A teleophthalmology system for the diagnosis of ocular urgency in remote areas of Brazil
    (Conselho Brasileiro de Oftalmologia, 2014-08-01) Ribeiro, Anna Giselle; Rodrigues, Renan Albert Mendonça [UNIFESP]; Guerreiro, Ana Maria; Regatieri, Caio Vinicius Saito [UNIFESP]; Universidade Federal do Rio Grande do Norte; Massachusetts Institute of Technology; Universidade Federal de São Paulo (UNIFESP); Harvard Medical School (Schepens Eye Research Institute) Department of Ophthalmology
    Purposes: To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient's condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation. Methods: A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of São Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. Results were then compared to the gold standard diagnosis provided at the hospital. Results: The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations. Conclusions: This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.
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    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.