| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.59 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Enquadramento: A estratificação dos marcadores de risco de clientes admitidos no serviço de urgência assume-se como um instrumento fulcral para a prestação de cuidados de excelência.
Objetivo: Determinar o nível de risco clínico mais prevalente nos clientes com prioridade clinica vermelha, admitidos no serviço de urgência.
Metodologia: Estudo de análise quantitativa e de coorte retrospetivo, envolvendo uma amostra de 427 clientes admitidos no serviço de urgência de um centro hospitalar da região centro de Portugal no ano de 2017, com uma média de idades de 69 anos (±20), sendo a maioria (52.7%) do género masculino. O estudo insere-se no Projeto de investigação “Evidências para Não arriscar Vidas: do pré hospitalar ao serviço de urgência e à alta”, desenvolvido em parceria entre a Escola Superior de Saúde de Viseu e o Centro Hospitalar Tondela-Viseu, autorizado pelo Conselho de Administração e com parecer favorável da Comissão de Ética para a Saúde da instituição selecionada como participante. Os dados foram recolhidos com base na informação administrativa, com registo numa grelha de recolha de dados.
Resultados: Como dados significativos citam-se os seguintes: No período entre as 8h-14h, foram admitidos no serviço de urgência 39.3% dos clientes, foram triados 37.5% e observados pelo médico 36.5%. A maioria dos clientes admitidos (75.4%) tiveram um tempo de triagem de zero minutos. Realizaram exames complementares de diagnóstico 60.5% e a maioria realizou gasimetria (52.1%). Os valores de saturação de oxigénio foram normais em 56.1% e a administração de oxigénio ocorreu em 55%. O estado do cliente manteve-se estável em 34.3%, e 26.7% foram internados no Centro Hospitalar e em 23.9% o desfecho foi o óbito. Em 39.6% dos casos a hora da alta recai entre as 14h-20h. O tempo de permanência no serviço de urgência foi ≤ 120 minutos em 37.0% e 32.0% permaneceram mais de 360 minutos. A realização de manobras de RCP, ocorreu apenas em 8.2%.O nível de risco oscilou entre 0 e 17, a que corresponde um nível de risco médio de 5.39 (4.40), numa escala de 0 a 18, pontuando os homens, em média (M=5.814.71), com maior nível de risco do que as mulheres (M=4.943.99), com diferenças estatísticas (t=2.014;p=0.045).O rácio de chances da ocorrência de manobras de RCP (OR=0.333) faz decrescer para 66.7% o nível de risco quando não são executadas. Por outro lado, os clientes com idade inferior ou igual a 70 anos (OR=0.422), o tempo de permanência no serviço de urgência <= 120 minutos e entre 120 e 240 minutos, e ainda o menor tempo de observação médica (entre 1 a 10 minutos) também fazem decrescer o nível de risco, respetivamente em 57.8% 94.7% 67.7% e 72.9%, enquanto que o tempo de permanência superior a 240 minutos faz aumentar o índice de risco em 152.8%.
Conclusão: A ocorrência de manobras de RCP, a faixa etária e o tempo de permanência no serviço de urgência, encontram-se associadas ao nível de risco nas pessoas que recorrem ao serviço de urgência, constituindo-se como preditivas do risco clínico no SU.
Abstract Background: The stratification of risk markers in the admittance of clients to the ER is a key instrument in providing excellent care. Objective: To determine the most prevalent level of clinical risk in clients with red clinical priority admitted to the ER. Methodology: A quantitative and retrospective cohort study, involving a sample of 427 clients admitted to the ER at a hospital center in the central region of Portugal in the year 2017, with a average age of 69 years (± 20), the majority (52.7%) being of the male gender. The study is part of the research project "Evidências Para Não Arriscar Vidas:do pré-hospitalar ao serviço de urgência e à alta", developed in partnership between the Viseu School of Health and the Tondela-Viseu Hospital Center, authorized by the Council of Administration and with the agreement of the Ethics Committee for Health of the institution selected as a participant. The data was collected on the basis of administrative information, with registration in a data collection grid. Results: Significant data includes the following: In the period between 8:00am and 2:00pm 39.3% of the clients were admitted to the ER, 37.5% were screened and 36.5% were observed by the physician. The majority of clients admitted (75.4%) had a screening time of zero minutes. 60.5% of the patients underwent complementary diagnostic tests and the majority of the patients performed an arterial-blood gas (ABG) test (52.1%). Oxygen saturation values were normal in 56.1% of the clients and oxygen administration occurred in 55% of them. The state of the clients remained stable in 34.3% of the cases, 26.7% of the clients were hospitalized in the Hospital Center and in 23.9% the outcome was death. In 39.6% of the cases the discharge time falls between 2:00pm and 8:00pm. The length of stay in the ER was ≤ 120 minutes in 37.0% of the cases and 32.0% remained for more than 360 minutes. The performance of CPR maneuvers occurred in only 8.2% of the cases. The level of risk ranged from 0 to 17, corresponding to an average risk level of 5.39 (4.40), on a scale of 0 to 18, evaluating men, in average (M=5.814.71), with a higher level of risk than women (M=4.943.99), revealing statistical differences between genders (t=2.014;p=0.045). The risk ratio for the occurrence of CPR maneuvers (OR = 0.333) decreases the level of risk to 66.7% when they are not performed. On the other hand, clients aged less than or equal to 70 years (OR = 0.422), time spent in the emergency room ≤120 minutes and between 120 and 240 minutes, and the shorter medical observation time (between 1 to 10 minutes) also reduce the risk level by 57.8%, 94.7%, 67.7% and 72.9% respectively, while a length of stay of more than 240 minutes increases the risk index by 152.8%. Conclusion: The occurrence of CPR maneuvers, the age group and the length of stay in the ER are associated with the level of risk in people who resort to the ER, acting as predictors of clinical risk in the ER.
Abstract Background: The stratification of risk markers in the admittance of clients to the ER is a key instrument in providing excellent care. Objective: To determine the most prevalent level of clinical risk in clients with red clinical priority admitted to the ER. Methodology: A quantitative and retrospective cohort study, involving a sample of 427 clients admitted to the ER at a hospital center in the central region of Portugal in the year 2017, with a average age of 69 years (± 20), the majority (52.7%) being of the male gender. The study is part of the research project "Evidências Para Não Arriscar Vidas:do pré-hospitalar ao serviço de urgência e à alta", developed in partnership between the Viseu School of Health and the Tondela-Viseu Hospital Center, authorized by the Council of Administration and with the agreement of the Ethics Committee for Health of the institution selected as a participant. The data was collected on the basis of administrative information, with registration in a data collection grid. Results: Significant data includes the following: In the period between 8:00am and 2:00pm 39.3% of the clients were admitted to the ER, 37.5% were screened and 36.5% were observed by the physician. The majority of clients admitted (75.4%) had a screening time of zero minutes. 60.5% of the patients underwent complementary diagnostic tests and the majority of the patients performed an arterial-blood gas (ABG) test (52.1%). Oxygen saturation values were normal in 56.1% of the clients and oxygen administration occurred in 55% of them. The state of the clients remained stable in 34.3% of the cases, 26.7% of the clients were hospitalized in the Hospital Center and in 23.9% the outcome was death. In 39.6% of the cases the discharge time falls between 2:00pm and 8:00pm. The length of stay in the ER was ≤ 120 minutes in 37.0% of the cases and 32.0% remained for more than 360 minutes. The performance of CPR maneuvers occurred in only 8.2% of the cases. The level of risk ranged from 0 to 17, corresponding to an average risk level of 5.39 (4.40), on a scale of 0 to 18, evaluating men, in average (M=5.814.71), with a higher level of risk than women (M=4.943.99), revealing statistical differences between genders (t=2.014;p=0.045). The risk ratio for the occurrence of CPR maneuvers (OR = 0.333) decreases the level of risk to 66.7% when they are not performed. On the other hand, clients aged less than or equal to 70 years (OR = 0.422), time spent in the emergency room ≤120 minutes and between 120 and 240 minutes, and the shorter medical observation time (between 1 to 10 minutes) also reduce the risk level by 57.8%, 94.7%, 67.7% and 72.9% respectively, while a length of stay of more than 240 minutes increases the risk index by 152.8%. Conclusion: The occurrence of CPR maneuvers, the age group and the length of stay in the ER are associated with the level of risk in people who resort to the ER, acting as predictors of clinical risk in the ER.
Description
Keywords
Prioridade clínica Serviço de urgência hospitalar Triagem Risco Emergency service, hospital Risk Triage