The emergency room--analysis and evaluation of an organizational model.

ABSTRACT

INTRODUCTION AND AIMS: The purpose of the emergency room is to treat critically ill patients and to prevent cardiac arrest in patients presenting with signs of physiological instability. This study has two main aims: 1) to describe the organizational model of the emergency room of Hospital Pedro Hispano based on 'chain of survival' principles; 2) to report an outcome analysis after the first year's operation with this organizational model. METHODS: Patients arriving at the emergency department of Hospital Pedro Hispano are processed by the Manchester Triage System. Patients presenting in a critical condition are coded red and immediately admitted to the emergency room. Patients classified as less critical but whose condition may worsen, with signs of physiological instability, are also admitted to the emergency room. This reflects the operating principles of the emergency room based on the prevention of cardiac arrest. All patients admitted to the emergency room have an emergency room chart, on which this study is based. RESULTS: Between May 1 2005 and April 30 2006, 1014 patients were admitted to the emergency room. Sixty-five percent of them were aged over 60 years. Altered consciousness was the most frequent reason for admission (17%), followed by respiratory failure (13%) and tachycardia (11%). Fifty-one patients (5%) were admitted after cardiac arrest. Sixty-six patients (7%) died in the emergency room, 57% of whom were admitted following cardiac arrest and 17% after shock of any etiology. A further 189 patients died during the course of their hospital stay after being discharged from the emergency room to other wards, which represents an overall mortality of 25%. CONCLUSION: Prevention and treatment of causes of cardiac arrest were the main reason for admission to the emergency room (altered consciousness, respiratory failure and tachycardia). Cardiac arrest was not among the main reasons for admission. However, when it occurs it has very high mortality; in the present study it was responsible for 5% of admissions and 53% of mortality. This organizational model may contribute to better use of resources as it enables re-orientation of patients to appropriate levels of care.