COVID-19 infection in nursing staff: A cohort study.

AIM: This study aims to identify the working conditions of Brazilian nursing professionals and the risk factors for these professionals to become infected by coronavirus disease. BACKGROUND: Understanding the factors that affected nursing professionals during the pandemic can support better nursing management. DESIGN: This is a quantitative, cross-sectional survey study. METHODS: Data collection was carried out between February and March 2022 in Brazil. All nursing professionals registered in the national database received by e-mail the study instrument with the data collection variables: professionals' sociodemographic and comorbid, professional and institutional characteristics, and professionals' health conditions and disease-related aspects for COVID-19. RESULTS: Four thousand eight hundred sixty-two nursing professionals reported a lack of personal protective equipment for patient care, and 4424 were infected by coronavirus disease. The risk factors to become infected were having cardiovascular disease, being under 60 years of age, living in the northern region, using public transportation, working in a hospital, an emergency department or reference institution for COVID-19, living with an infected person and lack of respirators or waterproof aprons. CONCLUSION: Multiple risk factors for infection with SARS-CoV-2 were demonstrated for the nursing professionals during the pandemic, highlighting current and future pandemics factors that are modifiable in a worthwhile time frame to minimize nurses' infection risks, such as inadequate working conditions associated with lack of essential personal protective equipment.

Rapid triage performed by nurses: Signs and symptoms associated with identifying critically ill patients in the emergency department.

AIM: Aim of this study is to identify signs and symptoms associated with identifying critically ill patients by rapid triage assessment performed by nurses in an emergency department. BACKGROUND: In some emergency services, the immediate assessment of critically ill patients occurs before opening the hospital formal registration and it is based on the nurse's experience. Studies on the topic are essential to improve this process. DESIGN: This is a cross-sectional, quantitative study. METHODS: This study was conducted in a Brazilian emergency department in 2017. Adult patients who presented potentially life-threatening symptoms underwent rapid triage to determine the medical urgency. Those identified as being critically ill were classified as high priority and streamed to the emergency room. RESULTS: A total of 154 (84.6%) patients were classified as high priority from the total of 182 evaluations. Altered state of consciousness (35.2%) and altered skin perfusion (25.3%) were frequently identified. Signs and symptoms associated with identifying critically ill patients by rapid triage were alterations in ventilation (OR 6.09; p = 0.028), neurological dysfunction (OR 44.96; p < 0.001) and pain (OR 5.80; p = 0.004). CONCLUSION: Nurses should value neurological and ventilation alterations and pain in patients during rapid triage, since these signs and symptoms are associated with high care priority.

Type of admission and nursing workload of critical patients: a cross-sectional study.

BACKGROUND: According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory. AIMS AND OBJECTIVES: To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU. DESIGN: This was a quantitative cross-sectional study comprised of a retrospective analysis of clinical records of critical patients. METHODS: Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level. RESULTS: In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay. CONCLUSIONS: The type of admission was not a predictive factor of the nursing workload required by critical patients. RELEVANCE TO CLINICAL PRACTICE: Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU.

Factors Associated With Interhospital Transfer of Trauma Victims.

This study aimed to identify the factors associated with interhospital transfer of trauma victims treated in the emergency department of a nontertiary hospital. Retrospective analysis of medical records of trauma victims treated from January to July 2014 in the emergency department of a hospital not specialized in trauma care and located in Brazil was undertaken. The inclusion criteria were as follows: being 15 years or older; being a trauma victim; having received prehospital care; and being admitted to the hospital directly from the scene of the accident. Pearson's chi-square, Mann-Whitney U, Fisher's exact tests, and multiple logistic regression were used in the analyses. The sample was made up of 246 patients, mostly men (67.9%) and blunt trauma victims (97.6%). The mean age of the trauma victims was 44.2 (SD = 22.1). Falls were the most frequent external cause (41.1%). Forty patients were transferred to a tertiary care center, mostly for orthopedic treatment (70%). The factors associated with interhospital transfer of victims were severity of the trauma according to the Injury Severity Score ([ISS]; mean ±SD of ISS = 8.1 ± 4.5; odds ratio = 1.14; 95% confidence interval [1.06, 1.24]; p = .001) and extremities/pelvic girdle as the body region most severely injured (mean ±SD of extremities/pelvic girdle Abbreviated Injury Scale score = 2.9 ± 0.5; odds ratio = 3.86; 95% confidence interval [1.71, 8.72; p = .001). Identification of the risk factors for interhospital transfer of trauma victims treated in hospitals without a trauma center provides important information for the creation of referral and counter-referral policies to facilitate the process and ensure definitive early treatment and improved patient survival.

Performance of the rapid triage conducted by nurses at the emergency entrance.

OBJECTIVE: to compare the performance of the rapid triage conducted by nurses at the emergency entrance and of the Manchester Triage System (MTS) in identifying the priority level of care for patients with spontaneous demand and predicting variables related to hospitalization. METHOD: a cross-sectional study carried out in an Emergency Department (ED) of a university hospital in São Paulo. The priority levels established in the rapid triage performed by nurses were high priority (patients of spontaneous demand directed to the emergency room) or low priority (those referred to the institution's usual flow). Diagnostic accuracy measures were calculated to assess the performance of the indexes. RESULTS: of the 173 patients (52.0% female, with mean age of 60.4 ± 21.2 years old) evaluated, it was observed that rapid triage was more inclusive for high priority and had better sensitivity and worse specificity than the MTS. The probability of non-severe patients being admitted to the emergency observation unit was lower due to the rapid triage. For the prediction of the other variables, the systems presented unsatisfactory results. CONCLUSION: the nurses overestimated the classification of patients as high priority, and rapid triage performed better than MTS in predicting admission to the emergency observation unit.

Evaluation of triage quality in the emergency department: a scoping review protocol.

REVIEW OBJECTIVE/QUESTIONS: The objective of this scoping review is to explore the existing literature on the evaluation of the quality of triage for patients of all ages and medical conditions in emergency departments (EDs).The question for this review is: How is triage in the ED evaluated? More specifically, we are interested in answering the following sub-questions.

Performance of the rapid triage conducted by nurses at the emergency entrance / Desempenho da triagem rápida realizada por enfermeiros na porta de emergência / Desempeño del triaje rápido realizado por enfermeros en la puerta de emergencias

Objective: to compare the performance of the rapid triage conducted by nurses at the emergency entrance and of the Manchester Triage System (MTS) in identifying the priority level of care for patients with spontaneous demand and predicting variables related to hospitalization. Method: a cross-sectional study carried out in an Emergency Department (ED) of a university hospital in São Paulo. The priority levels established in the rapid triage performed by nurses were high priority (patients of spontaneous demand directed to the emergency room) or low priority (those referred to the institution's usual flow). Diagnostic accuracy measures were calculated to assess the performance of the indexes. Results: of the 173 patients (52.0% female, with mean age of 60.4 ± 21.2 years old) evaluated, it was observed that rapid triage was more inclusive for high priority and had better sensitivity and worse specificity than the MTS. The probability of non-severe patients being admitted to the emergency observation unit was lower due to the rapid triage. For the prediction of the other variables, the systems presented unsatisfactory results. Conclusion: the nurses overestimated the classification of patients as high priority, and rapid triage performed better than MTS in predicting admission to the emergency observation unit.

Objetivo: comparar o desempenho da triagem rápida realizada pelos enfermeiros na porta de emergência e do Sistema Manchester de Classificação de Risco (SMCR) na identificação do nível de prioridade de atendimento dos pacientes de demanda espontânea e predição de variáveis relacionadas à internação hospitalar. Método: estudo transversal realizado em um Pronto Socorro (PS) de hospital universitário em São Paulo. Os níveis de prioridade estabelecidos na triagem rápida realizada pelos enfermeiros foram alta prioridade (pacientes de demanda espontânea direcionados à sala de emergência) ou baixa prioridade (aqueles encaminhados ao fluxo habitual da instituição). Medidas de acurácia diagnóstica foram calculadas para avaliar o desempenho dos índices. Resultados: dos 173 pacientes (52,0% sexo feminino; idade média 60,4±21,2 anos) avaliados, observou-se que a triagem rápida foi mais inclusiva para alta prioridade e apresentou melhor sensibilidade e pior especificidade do que o SMCR. A probabilidade de pacientes não graves serem admitidos na observação da emergência foi menor pela triagem rápida. Para a predição das outras variáveis, os sistemas apresentaram resultados insatisfatórios. Conclusão: os enfermeiros superestimaram a classificação de pacientes como alta prioridade e a triagem rápida obteve melhor desempenho que o SMCR na predição de admissão na sala de observação do PS.

Objetivo: comparar el desempeño del triaje rápido realizado por el personal de enfermería en la puerta de emergencias y del Manchester Triage System (MTS) al identificar el nivel de prioridad de atención a los pacientes de demanda espontánea y la predicción de las variables relacionadas con la internación. Método: estudio transversal realizado en un Servicio de Emergencias (SE) de un hospital universitario de São Paulo. Los niveles de prioridad establecidos en el triaje rápido realizado por los enfermeros fueron de alta prioridad (pacientes de demanda espontánea dirigidos a la sala de emergencias) o de baja prioridad (los remitidos al flujo habitual de la institución). Se calcularon medidas de exactitud diagnóstica para evaluar el desempeño de los índices. Resultados: de los 173 pacientes (52,0% mujeres; edad promedio 60,4±21,2 años) evaluados, se observó que el triaje rápido fue más inclusivo en casos de alta prioridad y presentó mejor sensibilidad y peor especificidad que el MTS. La probabilidad de que los pacientes no graves fueran admitidos en el área de observación del servicio de emergencias fue menor gracias al procedimiento de triaje rápido. En cuanto a la predicción de las demás variables, los sistemas presentaron resultados no satisfactorios. Conclusión: los enfermeros sobrestimaron la clasificación de los pacientes como alta prioridad y el triaje rápido obtuvo un mejor desempeño que el MTS para predecir el ingreso en la sala de observación del SE.

Desempenho da triagem rápida realizada por enfermeiros na porta de emergência e sinais e sintomas associados à classificação de pacientes graves / Performance of fast triage performed by nurses at emergency door, and signs and symptoms associated with the classification of critical patients

Introdução: A classificação de risco tem importância comprovada na organização dos serviços de emergência, mas algumas questões acerca de sua utilização ainda são apontadas. É comum pacientes chegarem ao serviço de emergência em situações críticas de ameaça à vida e necessitarem de avaliação profissional rápida (neste estudo denominada triagem rápida) ainda na porta de emergência do hospital. Assim, pode-se detectar com rapidez a gravidade do caso, bem como realizar o encaminhamento imediato para o atendimento médico. Objetivo: Analisar aspectos da triagem rápida realizada pelos enfermeiros na identificação de pacientes graves na porta de emergência, provenientes de demanda espontânea. Método: Estudo transversal, prospectivo, desenvolvido no Hospital Universitário da Universidade de São Paulo, entre maio e novembro de 2017. Foi realizada observação direta da triagem rápida. O grau de prioridade estabelecido pelo enfermeiro triador foi categorizado como alta prioridade (pacientes graves direcionados imediatamente à sala de emergência) e baixa prioridade (pacientes não graves encaminhados ao fluxo habitual de classificação de risco). Simultaneamente, os pacientes foram avaliados pela pesquisadora com aplicação do Sistema Manchester de Classificação de Risco (SMCR), dicotomizado em alta prioridade (vermelhos e laranjas) e baixa prioridade (amarelos, verdes e azuis). Sensibilidade, especificidade, acurácia, valores preditivos positivo e negativo, e razão de verossimilhança positiva e negativa foram calculados para avaliar o desempenho dos índices na predição de diferentes variáveis. O teste Mann-Whitney e a regressão logística múltipla foram aplicados, com nível de significância de 5%. Resultados: No total, 173 pacientes (52,0% mulheres; idade média 60,4±21,2 anos) foram avaliados e triados por enfermeiras na emergência. Nove pacientes foram avaliados em duas ocasiões diferentes, caracterizando 182 atendimentos (avaliações). Destes, 56,0% permaneceram em observação no pronto-socorro, 11,0% foram internados em enfermaria, e 5,0% em unidade de terapia intensiva. A taxa de mortalidade foi de 13,2%. A triagem rápida foi mais inclusiva para alta prioridade (n=154; 84,6%) do que o SMCR (n=132; 72,5%). Os sinais e sintomas mais frequentes no grupo da alta prioridade pela triagem rápida foram alterações do nível de consciência (34,6%) e da pele relacionadas ao choque (25,3%). A triagem rápida apresentou melhor sensibilidade e pior especificidade do que o SMCR na análise de quase a totalidade das variáveis (exceto para internação em enfermaria). Ainda, a probabilidade de pacientes não graves serem admitidos na observação do pronto-socorro (variável considerada padrão-ouro no estudo) foi menor pela triagem rápida do que pelo SMCR. Houve diferença significativa (p<0,001) entre os grupos (alta e baixa prioridade atribuída pela triagem rápida) em relação ao número de procedimentos/recursos utilizados. Os fatores associados à classificação de pacientes de alta prioridade pela triagem rápida foram alterações na ventilação (OR de 6,09), disfunção neurológica (OR de 44,96) e presença de dor (OR de 5,80). Conclusão: A triagem rápida obteve melhor desempenho que o SMCR na predição de admissão dos pacientes na observação do pronto-socorro. Os enfermeiros devem valorizar as alterações neurológicas e de ventilação, além da dor dos pacientes durante a triagem rápida, uma vez que estes sinais e sintomas estão associados à gravidade e à alta prioridade de atendimento.

Introduction: Triage plays an important role in the organization of emergency services, but questions about its use are still raised. It is common for patients to get at emergency services in critical life-threatening situations, demanding a fast professional evaluation (in this study, we called fast triage). Thus, we can quickly detect the severity of the case and immediately refer the patient to the medical care. Objective: To analyze aspects of fast triage performed by nurses to identify severe patients from spontaneous demand at the emergency door. Methods: A prospective, cross-sectional study was carried out at the University Hospital of the University of São Paulo, from May 2017 to November 2017. We performed direct observation of the fast triage. The triage nurse established the degree of priority as high priority (severe patients immediately directed to the emergency room) and low priority (non-severe patients referred to the usual triage flow). At the same time, a researcher evaluated the patients considering the Manchester Triage System (MTS), dichotomized in high priority (reds and oranges) and low priority (yellow, green and blue). Sensitivity, specificity, accuracy, positive and negative predictive values and positive and negative likelihood ratio were calculated to evaluate the performance of indices in the prediction of different variables. The Mann-Whitney test and the multiple logistic regression were applied, with a significance level of 5%. Results: A total of 173 patients (52.0% women; mean age 60.4±21.2 years) were evaluated and triaged by nurses in the emergency door. Nine patients were evaluated on two different occasions, characterizing 182 visits (evaluations). Among them, 56.0% were in observation in the emergency department, 11.0% were admitted to the ward, and 5.0% were in the intensive care unit. The mortality rate was 13.2%. The fast triage was more inclusive for high priority (n=154; 84.6%) than MTS (n=132; 72.5%). The most frequent signs and symptoms in the high priority group for fast triage were disorders in the level of consciousness (34.6%) and in the skin related to the shock (25.3%). Fast triage showed better sensitivity and worse specificity than MTS in the analysis of almost all variables (except for admission to the ward). In addition, the probability of non-severe patients being admitted to observation in the emergency department (variable considered standard gold in the study) was lower by fast triage than MTS. There was a significant difference (p<0.001) between the groups (high and low priority by fast triage) in relation to the number of procedures/ resources used. The factors associated with the classification of high priority patients by fast triage were alterations in ventilation (OR 6.09), neurological dysfunction (OR 44.96) and presence of pain (OR 5.80). Conclusion: The fast triage performed better than MTS in prediction of admission of patients in observation in the emergency department. Nurses should value neurological and ventilation disorders, as well as patients pain during fast triage, since these signs and symptoms are associated with the severity and high priority of care.