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Efeitos da sobrelotação dos serviços de urgência nos resultados das pessoas internadas : Uma revisão sistemática de etiologia e risco
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Abstract(s)
Objetivo: Determinar os efeitos da sobrelotação do serviço de urgência (SU) nos
resultados dos doentes internados: mortalidade, tempo de permanência (TP) no hospital,
tempo para antibiótico, tempo para trombólise e tempo para analgésico.
Métodos: Revisão sistemática de etiologia e risco, incluindo pessoas adultas, com 18
anos ou mais, admitidos em SU, que foram expostos a sobrelotação. A estratégia de pesquisa
foi realizada na MedicLatina, CINAHL Complete, MEDLINE Complete, Cochrane Central
Register of Controlled Trials, SciELO, Banco de teses da CAPES, RCAAP e OpenGrey. A
avaliação do risco de viés, a extração de dados e a síntese foram realizadas por dois revisores
de forma independente.
Resultados: Dos 3500 registos, 30 artigos cumpriram os critérios de inclusão. Os
resultados dos estudos mostram que a sobrelotação dos SU contribui para um aumento da
mortalidade, um maior TP hospitalar e atrasos na administração de antibióticos e analgésicos.
Não foram encontradas evidências de que a sobrelotação influencie o tempo de trombólise.
No entanto, sete dos estudos incluídos concluíram que a sobrelotação não estava associada
a um aumento da mortalidade.
Conclusões: A sobrelotação dos SU tem um impacto negativo nos resultados dos
doentes internados, destacando-se a sua influência na qualidade dos cuidados prestados
neste contexto. Em investigações futuras, é importante compreender quais os fatores que
contribuem para a sobrelotação, de modo a criar estratégias para ultrapassar este problema
de saúde pública.
Palavras-chave: Cuidados críticos, Aglomeração, Serviços médicos de emergência,
Avaliação de resultados, Segurança do paciente
ABSTRACT Objective: To determine the effects of emergency department (ED) overcrowding on the following outcomes of admitted patients: mortality, length-of-stay (LOS), time to antibiotic, time to thrombolysis and time to analgesic. Methods: Systematic review of aetiology and risk including adult patients, aged 18 years or more, admitted to ED settings who were exposed to overcrowding. Search strategy ran in MedicLatina, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, SciELO, Banco de teses da CAPES, RCAAP and OpenGrey. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Results: Out of 3500 records, 30 of those fulfilled the inclusion criteria. The results of the studies show that overcrowding in ED contributes to an increase in mortality, longer LOS and delays in the administration of antibiotics and analgesics. No evidence was found that overcrowding influences time to thrombolysis. However, seven of the included studies concluded that overcrowding was not associated with increased mortality. Conclusions: ED overcrowding has a negative impact on outcomes of admitted patients, highlighting its influence on the quality of care provided in ED settings. In future research, it is important to understand which factors contribute to overcrowding to create strategies to overcome this public health problem. Keywords: Critical care; Crowding; Emergency medical services; Outcome assessment; Patient safety.
ABSTRACT Objective: To determine the effects of emergency department (ED) overcrowding on the following outcomes of admitted patients: mortality, length-of-stay (LOS), time to antibiotic, time to thrombolysis and time to analgesic. Methods: Systematic review of aetiology and risk including adult patients, aged 18 years or more, admitted to ED settings who were exposed to overcrowding. Search strategy ran in MedicLatina, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, SciELO, Banco de teses da CAPES, RCAAP and OpenGrey. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Results: Out of 3500 records, 30 of those fulfilled the inclusion criteria. The results of the studies show that overcrowding in ED contributes to an increase in mortality, longer LOS and delays in the administration of antibiotics and analgesics. No evidence was found that overcrowding influences time to thrombolysis. However, seven of the included studies concluded that overcrowding was not associated with increased mortality. Conclusions: ED overcrowding has a negative impact on outcomes of admitted patients, highlighting its influence on the quality of care provided in ED settings. In future research, it is important to understand which factors contribute to overcrowding to create strategies to overcome this public health problem. Keywords: Critical care; Crowding; Emergency medical services; Outcome assessment; Patient safety.
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Keywords
Aglomeração Avaliação de resultados em cuidados de saúde Competência profissional Cuidados críticos Doença crítica Enfermagem médico cirúrgica Revisão sistemática Segurança do doente Serviço de urgência hospitalar Critical care Critical illness Crowding Emergency service hospital Medical surgical nursing Outcome assessment health care Patient safety Professional competence Systematic review
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