Features of the triggering of the yellow code and factors associated with the occurrence of adverse events.

OBJECTIVE: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. METHODS: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. RESULTS: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). CONCLUSIONS: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

Features of the triggering of the yellow code and factors associated with the occurrence of adverse events / Características de la activación del código amarillo y factores relacionados a la ocurrencia de eventos adversos / Características do acionamento do código amarelo e fatores associados à ocorrência de eventos adversos

ABSTRACT Objective: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. Methods: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. Results: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). Conclusions: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

RESUMEN Objetivo: analizar características de la activación del código amarillo en unidades de internación e identificar factores relacionados a ocurrencia de eventos adversos después de la atención del Equipo de Respuesta Rápida. Métodos: estudio transversal con análisis retrospectivo de prontuarios de adultos internados en enfermerías de Clínica Médica o Quirúrgica de hospital universitario de São Paulo. Resultados: entre 91 pacientes, los signos más frecuentes de las activaciones (n=107) fueron saturación periférica de oxígeno inferior a 90% (40,2%) y hipotensión arterial (30,8%). Cuanto a factores relacionados, identificado que cada minuto de atención del Equipo de Respuesta Rápida en enfermerías aumentó en 1,2% la chance de ocurrencia de eventos adversos (24 admisiones no planeadas en Unidad de Cuidado Intensivo y un paro cardíaco) en la amuestra (p=0,014). Conclusiones: caída de saturación de oxígeno e hipotensión arterial fueron los principales motivos de activación, y tiempo de ateción fue relacionado a ocurrencia de eventos adversos.

RESUMO Objetivo: analisar as características do acionamento do código amarelo em unidades de internação e identificar os fatores associados à ocorrência de eventos adversos após o atendimento do Time de Resposta Rápida. Métodos: estudo transversal com análise retrospectiva de prontuários de adultos internados em enfermarias de Clínica Médica ou Cirúrgica de hospital universitário de São Paulo. Resultados: entre os 91 pacientes, os sinais mais frequentes dos acionamentos (n=107) foram saturação periférica de oxigênio inferior a 90% (40,2%) e hipotensão arterial (30,8%). Quanto aos fatores associados, identificou-se que cada minuto de atendimento do Time de Resposta Rápida nas enfermarias aumentou em 1,2% a chance de ocorrência de eventos adversos (24 internações não planejadas em Unidade de Terapia Intensiva e uma parada cardiorrespiratória) na amostra (p=0,014). Conclusões: queda da saturação de oxigênio e hipotensão arterial foram os principais motivos de acionamento, e o tempo de atendimento foi associado à ocorrência de eventos adversos.

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room.

OBJECTIVE: To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room. METHODS: This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression. RESULTS: In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase. CONCLUSION: The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

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.

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room / Efecto del national early warning score en el monitoreo de los signos vitales de los pacientes en urgencias / Efeito do national early warning score no monitoramento dos sinais vitais de pacientes no pronto-socorro

ABSTRACT Objective: To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room. Methods: This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression. Results: In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase. Conclusion: The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

RESUMEN Objetivo: Verificar el efecto del uso del sistema National Early Warning Score (NEWS) sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado a pacientes en urgencias. Método: Estudio casi experimental, de tipo antes y después, realizado con 280 pacientes adultos seleccionados por conveniencia en un servicio de urgencias. Con el uso de la regresión lineal se analizó el efecto del NEWS sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el sistema. Resultados: En la fase Pre-NEWS se analizaron 143 pacientes (edad media ± desviación estándar: 54,4 ± 20,5; sexo masculino: 56,6%) y, en la fase Post-NEWS, 137 pacientes (edad media ± desviación estándar: 55,5 ± 20,8; sexo masculino: 50,4%). El 92,6% de los registros de signos vitales después de la adopción de este instrumento presentaron cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el NEWS. Este cumplimiento fue mayor en la fase Post-NEWS con un 9% (p < 0,001). Conclusion: El uso del sistema NEWS tuvo un incremento del cumplimiento de los intervalos de monitoreo de los signos vitales conforme a lo recomendado, pero este cumplimiento disminuyó cuando el puntaje NEWS apuntó a un intervalo más corto en el monitoreo de los signos vitales.

RESUMO Objetivo: Verificar o efeito do uso do sistema National Early Warning Score (NEWS) na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado em pacientes no pronto-socorro. Método: Estudo quasi-experimental, do tipo antes e depois, realizado em um pronto-socorro com 280 pacientes adultos selecionados por conveniência. O efeito do NEWS na conformidade do intervalo de monitoramento dos sinais vitais com o recomendado pelo sistema foi analisado por regressão linear. Resultados: Na fase Pré-NEWS, foram analisados 143 pacientes (idade média ± desvio-padrão: 54,4 ± 20,5; sexo masculino: 56,6%) e, na fase Pós-NEWS, 137 pacientes (idade média ± desvio-padrão: 55,5 ± 20,8; sexo masculino: 50,4%). Houve conformidade do intervalo de monitoramento dos sinais vitais com o recomendo pelo NEWS em 92,6% dos registros de sinais vitais após adoção desse instrumento. Essa conformidade foi maior na fase Pós-NEWS em 9% (p < 0,001). Conclusão: O uso do sistema NEWS aumentou a conformidade dos intervalos de monitorização dos sinais vitais com o recomendado, porém essa conformidade diminuiu quando o escore NEWS apontou para intervalo menor no monitoramento dos sinais vitais.

Alteração de sinais vitais e desfecho clínico de pacientes admitidos em unidade de emergência / Alteraciones de los signos vitales y resultado clínico de pacientes admitidos en una unidad de emergencias / Alteration in vital signs and clinical outcome of patients admitted to an emergency unit

Objetivo: descrever as características dos registros de enfermagem, incluindo os sinais vitais, e comparar o desfecho clínico dos pacientes segundo a presença de alteração dos sinais vitais no ambiente de emergência. Método: estudo transversal, com análise retrospectiva de prontuários de pacientes adultos admitidos em maio/2018 em um Pronto-Socorro de São Paulo. Os dados dos registros de enfermagem coletados foram inseridos no sistema REDCap® e análises descritivas e inferenciais foram realizadas. Resultados: dos 194 prontuários (54,1% masculino, idade média 59,7 anos) a queixa de entrada, comorbidades e primeiras condutas realizadas na emergência foram os registros de enfermagem mais anotados. Frequências cardíaca e respiratória e pressão arterial foram os sinais vitais mais alterados e associados ao óbito. Conclusão: a clareza e a frequência dos registros de enfermagem, assim como a correta interpretação dos sinais vitais, são componentes essenciais para a segurança do cuidado prestado ao paciente na emergência.

Objective: to describe the characteristics of the nursing records, including the vital signs, and to compare the patient's clinical outcome according to the presence of alterations in the vital signs in the emergency setting. Method: a cross-sectional study, with retrospective analysis of patient records of adult individuals admitted in May 2018 in an Emergency Room of São Paulo. The data collected from the nursing records were inserted in the REDCap® system and descriptive and inferential analyses were carried out. Results: of the 194 patient records (54.1% male, mean age of 59.7 years old), the complaints at admission, comorbidities and first care measures carried out in the emergency room were the most written down records. Heart and respiratory rates and blood pressure were the most altered and death-associated vital signs. Conclusion: the clarity and frequency of the nursing records, as well as the correct interpretation of the vital signs, are essential components for the safety of the care provided to the emergency patient.

Objetivo: describir las características de los registros de Enfermería, incluidos los signos vitales, y comparar el resultado clínico de los pacientes según la presencia de alteraciones de los signos vitales en el entorno del servicio de emergencia. Método: estudio transversal, con análisis retrospectivo de historias clínicas de pacientes adultos admitidos en mayo de 2018 en una Unidad de Emergencias de San Pablo. Los datos de los registros recolectados se cargaron al sistema REDCap® y se realizaron análisis descriptivos e inferenciales. Resultados: en 194 historias clínicas (54,1% de pacientes masculinos con media de 59,7 años), el motivo de consulta inicial, las comorbilidades y las primeras acciones realizadas en el área de emergencias fueron los registros de enfermería más anotados. La frecuencia cardíaca, el ritmo respiratorio y la presión arterial fueron los signos vitales que presentaron mayores alteraciones y estuvieron más relacionados con un resultado final de fallecimiento. Conclusión: la claridad y la frecuencia de los registros de Enfermería, al igual que la correcta interpretación de los signos vitales, son componentes esenciales para la seguridad en la atención que se brinda a los pacientes en el área de Emergencias.

Pain in emergency units: correlation with risk classification categories.

OBJECTIVES: to correlate risk classification categories with the level of pain of patients in an emergency service. METHOD: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. RESULTS: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). CONCLUSION: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

Pain in emergency units: correlation with risk classification categories / Dor no serviço de emergência: correlação com as categorias da classificação de risco / Dolor en el servicio de emergencia: correlación con las categorías de clasificación de riesgo

ABSTRACT Objectives: to correlate risk classification categories with the level of pain of patients in an emergency service. Method: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. Results: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). Conclusion: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

RESUMO Objetivos: correlacionar as categorias da classificação de risco com grau de dor dos pacientes em um serviço de emergência. Método: estudo transversal, realizado no Acolhimento com Classificação de Risco com 611 pacientes. As variáveis estudadas foram: idade, sexo, comorbidades, duração da queixa, especialidade médica, sinais e sintomas, desfecho, cor atribuída na classificação de risco e grau da dor. Utilizou-se a Análise de Variância, teste Qui-Quadrado e teste da Razão de Verossimilhança. Resultados: a média de idade foi 42,1 anos (17,8), 59,9% eram mulheres, com classificação de risco verde (58,9%) e amarela (22,7%), e comorbidade prevalente a hipertensão arterial (18,3%). Intensidade de dor mais frequente foi moderada (25,9%). Na categoria vermelha, pacientes apresentaram maior percentual de ausência de dor; na azul, dor leve; e nas categorias verde, amarela e laranja, maior percentual de dor intensa (p<0,0001). Conclusão: dos pacientes que apresentaram dor, a maioria referiu intensidade moderada. Em relação às categorias de risco, a maior parte dos pacientes da categoria vermelha não relatou dor; os que foram classificados como verde, amarela e laranja referiram, na maioria das vezes, dor intensa; já os pacientes da categoria azul mencionaram, predominantemente, dor leve.

RESUMEN Objetivos: correlacionar las categorías de clasificación de riesgo con grado de dolor de los pacientes en un servicio de emergencia. Método: estudio transversal, realizado en la Acogida con Clasificación de Riesgo con 611 pacientes. Las variables estudiadas fueron: edad, sexo, comorbilidades, duración de la queja, especialidad médica, signos y síntomas, resultado, color atribuída a la clasificación de riesgo y grado de dolor. Se utilizaron Análisis de Varianza, Prueba Chi cuadrado y la prueba de Razón de Verosimilitud. Resultados: la edad promedio fue de 42,1 años (17,8), 59.9% eran mujeres, con clasificación de riesgo verde (58,9%) y amarillo (22,7%) y comorbilidad prevalente a hipertensión arterial (18,3%). La intensidad de dolor más frecuente fue moderada (25.9%). En la categoría roja, los pacientes presentaron un mayor porcentaje de ausencia de dolor, en la azul, dolor suave, y en las categorías verde, amarillo y naranja, un porcentaje más alto de dolor severo (p < 0,0001). Conclusión: de los pacientes que presentaron dolor, la mayoría se refiere a intensidad moderada. En relación con las categorías de riesgo, la mayoría de los pacientes de la categoría roja no informó dolor. Quienes fueron clasificados como verde, amarillo y naranja, mencionaron, en su mayoría, dolor intenso. Los pacientes de la categoría azul, reportaron, predominante, dolor leve.

Correlation between classification in risk categories and clinical aspects and outcomes.

Objective: to correlate classification in risk categories with the clinical profiles, outcomes and origins of patients. Method: analytical cross-sectional study conducted with 697 medical forms of adult patients. The variables included: age, sex, origin, signs and symptoms, exams, personal antecedents, classification in risk categories, medical specialties, and outcome. The Chi-square and likelihood ratio tests were used to associate classifications in risk categories with origin, signs and symptoms, exams, personal antecedents, medical specialty, and outcome. Results: most patients were women with an average age of 44.5 years. Pain and dyspnea were the symptoms most frequently reported while hypertension and diabetes mellitus were the most common comorbidities. Classifications in the green and yellow categories were the most frequent and hospital discharge the most common outcome. Patients classified in the red category presented the highest percentage of ambulance origin due to surgical reasons. Those classified in the orange and red categories also presented the highest percentage of hospitalization and death. Conclusion: correlation between clinical aspects and outcomes indicate there is a relationship between the complexity of components in the categories with greater severity, evidenced by the highest percentage of hospitalization and death.

Avaliação e classificação de risco: tempo de espera dos usuários de baixa gravidade / Evaluación y clasificación de riesgo: tiempo de espera de usuarios de gravedad baja / Assessment and triage: waiting time of low severity users

Objetivo: identificar se o tempo transcorrido entre a classificação de risco e o atendimento médico para os pacientes de menor gravidade estava de acordo com o protocolo institucional. Método: estudo transversal descritivo. Realizado no Serviço de Emergência de um hospital público, universitário e de alta complexidade no período de março a junho de 2012. A amostra constituiu de 172 pacientes, com idade a partir dos 12 anos, classificados nascores: amarela, verde e azul, segundo o protocolo da instituição. Resultados: de acordo com o protocolo institucional 66% dos pacientes foram classificados na cor verde. Observou-se que o tempo médio de espera, dado em minutos, estava dentro do preconizado nas três cores de classificação: amarela 40,68, verde 53,76 e azul 69,06. Conclusão: o tempo médio de espera para o atendimento médico não ultrapassou aquele preconizado pelo protocolo do serviço de emergência em nenhuma das cores de classificação.

Aim: to identify if the time between the risk assessment and medical care for less severe patient was in accordance with institutional protocol. Method: cross-sectional descriptive study performed in the emergency department of a scholastic public hospital of high complexity, from March to June 2012. The sample consisted of 172 patients, aged starting from 12 years, ranked in colors: yellow, green and blue, according to protocol of theinstitution. Results: according to the institutional protocol 66.00% of patients were classified in the color green. It was observed that the average waiting time, measure in minutes, was within the recommended rating of the three colors: Yellow 40.68, green and blue 53.76 and 69.06. Conclusion: the average waiting time for medical care did not exceed that recommended by the emergency service protocol in any of the classification of colors.

Objetivo: identificar si el tiempo entre la evaluación del riesgo y la atención médica para el paciente menor de edad está en conformidad con el protocolo institucional. Método: estudio descriptivo transversal. Realizado en el servicio de urgencias de un hospital público, universitario y de alta complejidad, de marzo a junio de 2012. La muestra consistió en 172 pacientes, con edades de 12 años, clasificado en los colores: amarillo, verde y azul, según el protocolo de la institución. Resultados: de acuerdo con el protocolo institucional 66.00% de los pacientes fueron clasificados en el color verde. Se observó que el tiempo medio de espera, en minutos, estaba dentro de laclasificación recomendada de los tres colores: amarillo 40.68, verde y azul 53.76 y 69.06.Conclusión: el tiempo medio de espera para la atención médica no superó la recomendada por el protocolo de servicio de emergencia según la clasificación de los colores.

Correlation between classification in risk categories and clinical aspects and outcomes / Correlação das categorias de classificação de risco com aspectos clínicos e desfechos / Correlación de las categorías de clasificación de riesgo con aspectos clínicos y resultados

ABSTRACT Objective: to correlate classification in risk categories with the clinical profiles, outcomes and origins of patients. Method: analytical cross-sectional study conducted with 697 medical forms of adult patients. The variables included: age, sex, origin, signs and symptoms, exams, personal antecedents, classification in risk categories, medical specialties, and outcome. The Chi-square and likelihood ratio tests were used to associate classifications in risk categories with origin, signs and symptoms, exams, personal antecedents, medical specialty, and outcome. Results: most patients were women with an average age of 44.5 years. Pain and dyspnea were the symptoms most frequently reported while hypertension and diabetes mellitus were the most common comorbidities. Classifications in the green and yellow categories were the most frequent and hospital discharge the most common outcome. Patients classified in the red category presented the highest percentage of ambulance origin due to surgical reasons. Those classified in the orange and red categories also presented the highest percentage of hospitalization and death. Conclusion: correlation between clinical aspects and outcomes indicate there is a relationship between the complexity of components in the categories with greater severity, evidenced by the highest percentage of hospitalization and death.

RESUMO Objetivo: correlacionar as categorias de classificação de risco com perfil clínico, desfechos e procedência. Método: estudo transversal analítico realizado com 697 fichas de atendimento de pacientes adultos. Variáveis estudadas: idade, sexo, procedência, sinais e sintomas, exames, antecedentes pessoais, categorias da classificação de risco, especialidade médica de atendimento e desfecho. Para associar as categorias de classificação de risco com procedência, sinais e sintomas, exames, antecedentes pessoais, especialidade médica e desfecho, utilizaram-se o teste qui-quadrado e a razão de verossimilhança. Resultados: pacientes do sexo feminino foram a maioria e com média de idade 44,5 anos. Dor e dispneia foram os sintomas mais relatados e hipertensão arterial e diabetes mellitus foram as comorbidades. As categorias de classificação verde e amarela foram as mais frequentes, e a alta hospitalar foi o desfecho mais observado. Pacientes classificados na categoria vermelha apresentaram maior porcentual de procedência de ambulância, por motivos cirúrgicos. Os classificados nas categorias laranja e vermelha apresentaram maior porcentual de internação e óbito. Conclusão: a correlação entre os aspectos clínicos e desfechos permitiu inferir que existe uma relação entre a complexidade dos componentes estudados nas categorias de maior gravidade, evidenciado pelo maior porcentual de internação e óbito.

RESUMEN Objetivo: correlacionar las categorías de clasificación de riesgo con perfil clínico, resultados y procedencia. Método: estudio transversal analítico, realizado con 697 fichas de atención de pacientes adultos. Variables estudiadas: edad, sexo, procedencia, señales y síntomas, exámenes, antecedentes personales, categorías de la clasificación de riesgo, especialidad médica de atención y resultado. Para asociar las categorías de clasificación de riesgo con procedencia, señales y síntomas, exámenes, antecedentes personales, especialidad médica y resultado, se utilizaron el test chi-cuadrado y la razón de verosimilitud. Resultados: pacientes del sexo femenino fueron la mayoría, con promedio de edad 44,5 años. El dolor y disnea fueron los síntomas más relatados e la hipertensión arterial y diabetes mellitus fueron las comorbilidades. Las categorías de clasificación verde y amarillo fueron las más frecuentes, y el alta hospitalaria fue el resultado más observado. Pacientes clasificados en la categoría roja presentaron mayor porcentaje de procedencia por ambulancia, por motivos quirúrgicos. Los clasificados en las categorías naranja y roja presentaron mayor porcentaje de internación y muerte. Conclusión: la correlación entre los aspectos clínicos y resultados permitió inferir que existe una relación entre la complejidad de los componentes estudiados en las categorías de mayor gravedad, evidenciado por el mayor porcentaje de internación y muerte.

Systemic Arterial Hypertension in the Emergency Service: medication adherence and understanding of this disease.

OBJECTIVE: To identify the epidemiological profile of hypertension patients, how much they understand about the disease and the rate of adherence to treatment by these patients who had been hospitalized in the Brazilian emergency service. METHODS: This cross-sectional study was performed with 116 patients, both male and female and aged over 18 years, who had been hospitalized in the Emergency Service of a University Hospital between March and June, 2013. The studied variables were data referring to socio-demographics, comorbidities, physical activity and knowledge regarding the disease. Patient adherence to treatment and the identification of the barriers were respectively evaluated using the Morisky test and the Brief Medication Questionnaire. RESULTS: Most of the patients involved in this study were women (55%), with white skin color (55%), married (51%), retirees or pensioners (64%) and with a low educational level (58%). Adherence to treatment, in most cases (55%), was moderate and the most prevalent adherence barrier was recall (67%). When medication was acquired at no cost to the patient, there was greater adherence to treatment. CONCLUSION: This study's patients had a moderate understanding about the disease. The high correlation between the number of drugs used and the recall barrier suggests that monotherapy is an option that can facilitate treatment adherence and reduce how often the patients forget to take their medication.

Systemic Arterial Hypertension in the Emergency Service: medication adherence and understanding of this disease / Hipertensão Arterial Sistêmica no Serviço de Emergência: adesão medicamentosa e conhecimento da doença / Hipertensión Arterial Sistémica en el Servicio de Emergencia: adherencia al tratamiento medicamentoso y conocimiento de la enfermedad

Objective: to identify the epidemiological profile of hypertension patients, how much they understand about the disease and the rate of adherence to treatment by these patients who had been hospitalized in the Brazilian emergency service. Methods: this cross-sectional study was performed with 116 patients, both male and female and aged over 18 years, who had been hospitalized in the Emergency Service of a University Hospital between March and June, 2013. The studied variables were data referring to socio-demographics, comorbidities, physical activity and knowledge regarding the disease. Patient adherence to treatment and the identification of the barriers were respectively evaluated using the Morisky test and the Brief Medication Questionnaire. Results: most of the patients involved in this study were women (55%), with white skin color (55%), married (51%), retirees or pensioners (64%) and with a low educational level (58%). Adherence to treatment, in most cases (55%), was moderate and the most prevalent adherence barrier was recall (67%). When medication was acquired at no cost to the patient, there was greater adherence to treatment. Conclusion: this study's patients had a moderate understanding about the disease. The high correlation between the number of drugs used and the recall barrier suggests that monotherapy is an option that can facilitate treatment adherence and reduce how often the patients forget to take their medication.

Objetivo: identificar o perfil epidemiológico, o conhecimento sobre a doença e a taxa de adesão ao tratamento de pacientes com hipertensão arterial sistêmica, internados no serviço de emergência. Métodos: estudo transversal, realizado com 116 pacientes internados no Serviço de Emergência de um Hospital Universitário, de ambos os gêneros e idade superior a 18 anos, no período de março a junho 2013. As variáveis pesquisadas foram os dados sociodemográficos, comorbidades, atividade física e conhecimento sobre a doença. A adesão do paciente ao tratamento e a identificação das barreiras foi avaliada pelo teste de Morisky e Brief Medical Questionnaire, respectivamente. Resultados: a maioria dos pacientes era de mulheres (55%), cor da pele branca (55%), casados (51%), aposentados ou pensionistas (64%) e com baixa escolaridade (58%). A adesão ao tratamento, na maioria das vezes (55%), foi moderada e a barreira de adesão mais prevalente foi a de recordação (67%). Quando a aquisição de medicamento era integral, houve maior adesão ao tratamento. Conclusão: os pacientes deste estudo apresentaram moderado conhecimento sobre a doença. A alta correlação entre o número de fármacos utilizados e a barreira de recordação sugere que a monoterapia seja uma opção para facilitar a adesão ao tratamento, para diminuir a taxa de esquecimento.

Objetivo: identificar el perfil epidemiológico, el conocimiento sobre la enfermedad y la tasa de adherencia al tratamiento de pacientes con hipertensión arterial sistémica ingresados en el servicio de emergencia. Métodos: estudio transversal, realizado con 116 pacientes ingresados en el Servicio de Emergencia de un Hospital Universitario, de ambos géneros y edad superior a 18 años, en el periodo de marzo a junio de 2013. Las variables estudiadas fueron los datos sociodemográficos, la comorbilidad, la actividad física y el conocimiento sobre la enfermedad. La adherencia del paciente al tratamiento y la identificación de las barreras fueron evaluadas por la prueba de Morisky y el Brief Medical Questionnaire, respectivamente. Resultados: la mayoría de los pacientes eran mujeres (55%), color de piel blanca (55%), casadas (51%), jubiladas o pensionistas (64%) y con baja escolaridad (58%). La adherencia al tratamiento, en la mayor parte de las veces (55%), fue moderada y la barrera de adherencia más prevalente fue el olvido (67%). Cuando la adquisición del medicamento era integral, hubo mayor adherencia al tratamiento. Conclusión: los pacientes de este estudio presentaron moderado conocimiento sobre la enfermedad. La alta correlación entre el número de fármacos utilizados y la barrera del olvido sugiere la monoterapia como opción para facilitar la adherencia al tratamiento y disminuir la tasa de olvido.

Nursing care based on risk assessment and classification: agreement between nurses and the institutional protocol.

OBJECTIVE: to verify the degree of agreement between the levels of priority given by baccalaureate nurses in care based on risk assessment and classification and the institutional protocol, and also among peers. METHOD: descriptive study, using a questionnaire with thirty fictitious clinical cases based on the institutional protocol, which is considered the gold standard, answered by twenty baccalaureate nurses. RESULTS: the agreement analysis through the Kappa Coefficient concluded that the agreement between baccalaureate nurses and the institutional protocol in relation to prioritizing the levels of severity was moderate. When the agreement among peers was evaluated, it was low, as represented by the colorimetric density in shades of light gray. CONCLUSION: in Brazil, some institutions have developed their own protocol, which makes it necessary to develop tools in order to evaluate the accuracy of professionals in relation to the protocols, highlighting the need for capable people to perform this activity, thus contributing to patient safety.

Nursing care based on risk assessment and classification: agreement between nurses and the institutional protocol / Acolhimento com avaliação e classificação de risco: concordância entre os enfermeiros e o protocolo institucional / Acogimiento con evaluación y clasificación de riesgo: concordancia entre los enfermeros y el protocolo institucional

OBJECTIVE: to verify the degree of agreement between the levels of priority given by baccalaureate nurses in care based on risk assessment and classification and the institutional protocol, and also among peers. METHOD: descriptive study, using a questionnaire with thirty fictitious clinical cases based on the institutional protocol, which is considered the gold standard, answered by twenty baccalaureate nurses. RESULTS: the agreement analysis through the Kappa Coefficient concluded that the agreement between baccalaureate nurses and the institutional protocol in relation to prioritizing the levels of severity was moderate. When the agreement among peers was evaluated, it was low, as represented by the colorimetric density in shades of light gray. CONCLUSION: in Brazil, some institutions have developed their own protocol, which makes it necessary to develop tools in order to evaluate the accuracy of professionals in relation to the protocols, highlighting the need for capable people to perform this activity, thus contributing to patient safety. .

OBJETIVO: verificar o grau de concordância entre os níveis de prioridade atribuídos no acolhimento com avaliação e classificação de risco, realizado pelos enfermeiros, em relação ao protocolo institucional e entre os pares. MÉTODO: trata-se de estudo descritivo, utilizando um questionário com trinta casos clínicos fictícios com base no protocolo institucional, considerado padrão-ouro, respondido por vinte enfermeiros. RESULTADOS: pela análise de concordância pelo coeficiente Kappa, concluiu-se que a concordância entre a priorização dos níveis de gravidade entre os enfermeiros e o protocolo institucional foi moderada. Quando avaliada a concordância entre os pares, essa foi baixa, representada pela densidade colorimétrica nas tonalidades de cinza claro. CONCLUSÃO: no Brasil, algumas instituições desenvolveram protocolos próprios, o que torna fundamental o desenvolvimento de ferramentas para avaliar a acurácia dos profissionais em relação aos protocolos, evidenciando as necessidades de capacitação para essa atividade, contribuindo para a segurança do paciente. .

OBJETIVO: verificar el grado de concordancia entre los niveles de prioridad atribuidos en el acogimiento con evaluación y clasificación de riesgo cuando efectuado por los enfermeros, en comparación con el protocolo institucional y entre los pares. MÉTODO: estudio descriptivo, utilizando un cuestionario con treinta casos clínicos ficticios, basado en el protocolo institucional, considerado la regla de oro, respondido por veinte enfermeros. RESULTADOS: el análisis de concordancia a través del Coeficiente Kappa concluyó que la concordancia entre la priorización de los niveles de gravedad entre los enfermeros y el protocolo institucional fue moderada. La concordancia entre los pares fue baja, representada por la densidad colorimétrica en las tonalidades de gris claro. CONCLUSIÓN: en Brasil, algunas instituciones desarrollaron protocolos propios, lo que hace fundamental el desarrollo de herramientas para evaluar la precisión de los profesionales respecto a los protocolos, evidenciando las necesidades de capacitación para esta actividad, contribuyendo a la seguridad del paciente. .

Profile of the Population Cared for in a Referral Emergency Unit / Perfil da população atendida em uma unidade de emergência referenciada / Perfil de la población atendida en una unidad de emergencia de referencia

Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the service’s care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.

O conhecimento das características da população que frequenta um serviço de emergência constitui ferramenta de planejamento de ações em saúde. O objetivo deste estudo foi identificar o perfil sociodemográfico e as principais queixas da população adulta, atendida na unidade de emergência referenciada (UER). O método usado foi o descritivo/retrospectivo, desenvolvido na UER de um hospital de ensino no interior do Estado de São Paulo. A amostra ficou constituída pelos boletins de atendimento (BAU), referentes ao período de janeiro a dezembro/2008. O instrumento utilizado foi estruturado com base nos dados do BAU.. Os resultados mostraram que a procura espontânea foi feita por mulheres jovens (14 aos 54 anos) dos bairros próximos à UER, durante a semana e no horário das sete às dezenove horas. As queixas mais frequentes foram: cefaleia, lombalgia, dores (abdominal, torácica). Conclui-se que o perfil da amostra foi, na maioria, composta por adulto jovem, idade produtiva, sexo feminino, demanda espontânea e no período diurno em dias úteis. Os atendimentos apontaram para queixas de baixa complexidade.

El objetivo del estudio fue identificar el perfil sociodemográfico y las principales quejas de la población adulta atendida en la Unidad de Emergencia de Referencia (UER). El conocimiento de las características de la población que frecuenta un servicio de emergencia constituye una herramienta de planificación de las acciones en salud. Se trata de un estudio descriptivo/retrospectivo desarrollado en la UER de un hospital de enseñanza en el interior del estado de Sao Paulo. La muestra fue constituida por los boletines de atención(BAU) del período de enero a diciembre de 2.008. El instrumento utilizado fue estructurado con base en los datos del BAU. La búsqueda espontánea fue hecha por mujeres jóvenes (14 a 54 años) de los barrios próximos a la UER durante la semana y en el horario de las siete a las diecinueve horas. Las quejas más frecuentes fueron: cefalea, lumbago, dolores (abdominal, torácica). Se concluye que el perfil de la muestra fue en su mayoría adulto y joven, en edad productiva, de sexo femenino, con demanda espontánea y en el período diurno en días útiles. Las atenciones apuntaron para quejas de baja complejidad.