Análisis del uso de la ecografía a pie de cama en los servicios de urgencias hospitalarios de Cataluña. Estudio ECURCAT / Analysis of the use of point-of-care ultrasonography in Emergency Departments in public hospitals in Catalonia. ECURCAT Study

Fundamento: El objetivo de este estudio es conocer el grado de implantación, las características y la formación de la ecografía a pie de cama, realizada por médicos de urgencias (MU), en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Método: Estudio descriptivo basado en una encuesta realizada a los responsables de los SUH públicos de Cataluña y estructurada en tres bloques: dificultad de implementación de la técnica y motivos percibidos en dicha dificultad, aparataje disponible en urgencias y su uso, y formación de los MU. Resultados: Contestaron la encuesta el 96,3% de los SUH públicos. En el 63,5% los MU realizan ecografía a pie de cama. El 86,5% manifestaron un elevado grado de dificultad para implementar la ecografía y el 78,8% disponen de ecógrafo propio. El uso más frecuente es la exploración abdominal (87,9%), torácica (72,7%) o vascular periférica (69,7%). Es escasa la presencia de protocolos y registros de la actividad. La formación no es uniforme entre médicos de plantilla y de guardia. No se encontraron diferencias significativas en función del tipo de hospital, del grado de actividad o de la presencia de radiólogo las 24 horas del día, excepto para el protocolo FAST, más empleado en hospitales comarcales que en el resto (89,5% vs. 42,9%; p=0,007). Conclusiones: La ecografía a pie de cama hecha por MU se usa en más de la mitad de los SUH públicos catalanes. Es necesario que el uso de la ecografía en el SUH se extienda, sea más reglado, registrado de manera adecuada y que participen de él todos los médicos que trabajan en urgencias

Background: The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia. Methods: Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians. Results: The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-ofcare ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007). Conclusions. Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department

[Analysis of the use of point-of-care ultrasonography in Emergency Departments in public hospitals in Catalonia. ECURCAT Study]. / Análisis del uso de la ecografía a pie de cama en los servicios de urgencias hospitalarios de Cataluña. Estudio ECURCAT.

BACKGROUND: The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia. METHODS: Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians. RESULTS: The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-of-care ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007). CONCLUSIONS: Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department.

Ventilación no invasiva en los servicios de urgencias hospitalarios públicos de Cataluña. Estudio VENUR-CAT / Non-invasive ventilation in emergency departments in public hospitals in Catalonia. The VENUR-CAT study

OBJETIVOS: Conocer la implantación y características de la ventilación no invasiva (VNI) en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Analizar si hay diferencias en función de la tipología, del grado de actividad y de la existencia de una unidad de cuidados intensivos (UCI) en el hospital. DISEÑO: Estudio descriptivo, sin intervención, realizado mediante una encuesta estructurada en 3bloques: 1) profesionales y formación; 2) aparataje utilizado y 3) escenarios clínicos y uso de la VNI. Ámbito: Responsables de los SUH públicos de Cataluña. RESULTADOS: Contestaron 52 de 54 SUH públicos (96,3%): 51 realizan VNI, iniciada mayoritariamente por el médico de urgencias (78,5%). El 66,7% mantiene al paciente en urgencias hasta su retirada y en el 43,1% la estancia suele superar las 24 h. El 39,2% de los SUH tienen un protocolo propio, el 35,3% consensuado con otros servicios (más en hospitales no comarcales, p = 0,012, y con UCI, p = 0,014) y el 25,5% no tiene. El 43,1% registran la actividad. El aprendizaje constituye la mayor dificultad para la implantación, pero el 19,6% no contempla la formación reglada regular. En caso de necesitar soporte, el principal médico de referencia es el especialista de Medicina Intensiva (35,3%, más en hospitales no comarcales, p = 0,012, y con UCI, p = 0,002). CONCLUSIONES: La VNI la realizan en la mayoría de los SUH los médicos de urgencias. Las áreas de mejora detectadas incluyen el drenaje de pacientes una vez iniciada la VNI, la potenciación de protocolos, el registro de actividad y la formación de los profesionales

OBJECTIVES: To know the implementation and characteristics of non-invasive ventilation (NIV) in the Emergency Departments (EDs) of public hospitals in Catalonia (Spain) and analyze possible differences based on the typology, degree of activity and the availability of an Intensive Care Unit (ICU) in the hospital. DESIGN: A non-interventional, descriptive study was carried out, using a structured questionnaire divided into 3sections: 1) professional experience and training; 2) devices used; and 3) clinical scenarios and the use of NIV. SETTING: Persons responsible for public EDs in Catalonia. RESULTS: Fifty-two of the 54 public EDs in Catalonia responded (96.3%). Fifty-one perform NIV, which is mainly initiated by emergency care physicians (78.5%); 66.7% maintain the patient in the ED until discharge; and in 43.1% of the cases the length of stay is>24h. Of the EDs, 39.2% have their own protocol, 35.3% of which are established by consensus with other departments (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.014]), while 25.5% have no protocol, and 43.1% register the activity. Training represents the greatest difficulty for the implementation of NIV, but 19.6% do not provide specific training. When support is needed, the main physician of reference is the intensivist (35.3%) (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.002]). CONCLUSIONS: In most EDs in Catalonia, NIV is performed by emergency care physicians. Areas needing improvement include drainage of patients once NIV has been started, the promotion of protocols, registry of activity, and training of the healthcare professionals

Non-invasive ventilation in emergency departments in public hospitals in Catalonia. The VENUR-CAT study. / Ventilación no invasiva en los servicios de urgencias hospitalarios públicos de Cataluña. Estudio VENUR-CAT.

OBJECTIVES: To know the implementation and characteristics of non-invasive ventilation (NIV) in the Emergency Departments (EDs) of public hospitals in Catalonia (Spain) and analyze possible differences based on the typology, degree of activity and the availability of an Intensive Care Unit (ICU) in the hospital. DESIGN: A non-interventional, descriptive study was carried out, using a structured questionnaire divided into 3sections: 1) professional experience and training; 2) devices used; and 3) clinical scenarios and the use of NIV. SETTING: Persons responsible for public EDs in Catalonia. RESULTS: Fifty-two of the 54 public EDs in Catalonia responded (96.3%). Fifty-one perform NIV, which is mainly initiated by emergency care physicians (78.5%); 66.7% maintain the patient in the ED until discharge; and in 43.1% of the cases the length of stay is>24h. Of the EDs, 39.2% have their own protocol, 35.3% of which are established by consensus with other departments (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.014]), while 25.5% have no protocol, and 43.1% register the activity. Training represents the greatest difficulty for the implementation of NIV, but 19.6% do not provide specific training. When support is needed, the main physician of reference is the intensivist (35.3%) (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.002]). CONCLUSIONS: In most EDs in Catalonia, NIV is performed by emergency care physicians. Areas needing improvement include drainage of patients once NIV has been started, the promotion of protocols, registry of activity, and training of the healthcare professionals.