Field trauma triage criteria associated with need for dedicated trauma center care: a single-center retrospective cohort study.

INTRODUCTION: Direct transport from the scene of injury to a trauma centre reduces saves lives. In Ontario, paramedics use the field trauma triage standard (FTTS) to determine if a patient meets trauma bypass criteria. Recent studies have questioned the efficacy of the FTTS in identifying severely injured patients. The objective of this study was to determine the predictive performance of the FTTS on the need for trauma center care in patients who were transported to a trauma center. METHODS: This was a single-center health records study of patients transported by ambulance directly to a level 1 trauma center. Hospital based trauma center need and injury severity score-based need were defined. Bivariate associations with one or more FTTS criteria were tested using the Wilcoxon two-sample test for continuous variables, and the Chi-square or Fisher's exact test for categorical indicators. The sensitivity and specificity of each category of the FTTS were calculated. RESULTS: There were 1427 patients included in the study, with 76% men, mean age of 40, and 76% had a blunt mechanism. The overall sensitivity and specificity of the FTTS was 90.9% and 20.8% for hospital-based need and 91.6% and 20.3 for injury severity need. The most sensitive variable for hospital-based need was physiologic criteria (53.7). Mechanism of injury was the most sensitive criteria for injury severity need (54.8). Physiological criteria had the highest association with hospital-based and injury severity need (adjusted odds ratios 7.5 [95% CI 5.8-9.8] and 5.1 [95% CI 3.9-6.7]). CONCLUSIONS: The FTTS has fair performance in identifying the need for hospital-based and injury severity need. Systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (motor) less than 6, and falls greater than 6 m were most predictive of trauma center need. Improving prehospital trauma triage is critical to ensure timely transport to a trauma centre.

RéSUMé: INTRODUCTION: Le transport direct de la scène de la blessure à un centre de traumatologie permet de sauver des vies. En Ontario, les ambulanciers paramédicaux utilisent la norme de triage des traumatismes sur le terrain (FTTS) pour déterminer si un patient répond aux critères de pontage traumatique. Des études récentes ont remis en question l'efficacité du FTTS dans l'identification des patients gravement blessés. L'objectif de cette étude était de déterminer la performance prédictive du FTTS sur le besoin de soins en centre de traumatologie chez les patients qui ont été transportés dans un centre de traumatologie. MéTHODES: Il s'agissait d'une étude des dossiers médicaux d'un seul centre portant sur des patients transportés par ambulance directement à un centre de traumatologie de niveau 1. Les besoins des centres de traumatologie hospitaliers et les besoins basés sur le score de gravité des blessures ont été définis. Les associations bivariées avec un ou plusieurs critères FTTS ont été testées à l'aide du test à deux échantillons de Wilcoxon pour les variables continues et du test de Fisher pour les indicateurs catégoriels. La sensibilité et la spécificité de chaque catégorie du FTTS ont été calculées. RéSULTATS: Il y avait 1427 patients inclus dans l'étude, avec 76% d'hommes, âge moyen de 40, et 76% avaient un mécanisme émoussé. La sensibilité et la spécificité globales du FTTS étaient de 90,9 % et de 20,8 % pour les besoins hospitaliers et de 91,6 % et de 20,3 % pour les besoins de gravité des blessures. La variable la plus sensible pour les besoins hospitaliers était les critères physiologiques (53,7). Le mécanisme de blessure était le critère le plus sensible pour le besoin de gravité de la blessure (54,8). Les critères physiologiques étaient les plus associés aux besoins hospitaliers et aux besoins en matière de gravité des blessures (rapports de cotes ajustés de 7,5 [IC à 95 % 5,8-9,8] et 5,1 [IC à 95 % 3,9-6,7]). CONCLUSION: Le FTTS a un rendement équitable pour ce qui est de déterminer le besoin de soins hospitaliers et de gravité des blessures. La pression artérielle systolique inférieure à 90mmHg, l'échelle de coma de Glasgow (moteur) inférieure à 6 et les chutes supérieures à 6m étaient les plus prédictives des besoins du centre de traumatologie. L'amélioration du triage des traumatismes avant l'hospitalisation est essentielle pour assurer un transport rapide vers un centre de traumatologie.

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective.

OBJECTIVE: to analyze nurses' role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. METHOD: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. RESULTS: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals' perceptions; 4) The professionals' actions; and 5) Team structure. CONCLUSION: Nursing professionals' skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

Dificuldades enfrentadas pelos profissionais de saúde no atendimento de emergências em unidades básicas de saúde no Brasil / Difficulties faced by health professionals in emergency care in primary health care units in Brazil / Dificultades enfrentadas por los profesionales de salud en la atención de emergencias en unidades básicas de salud en Brasil

Objetivos: compreender as dificuldades enfrentadas pelos profissionais de saúde para o atendimento de casos de urgências/emergências em unidades básica de saúde e identificar as proposições de resolubilidade. Métodos: Pesquisa qualitativa, realizada com dez profissionais de saúde, em uma unidade básica de saúde do interior paulista. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: As dificuldades foram atreladas a fatores como despreparo da equipe, falta de infraestrutura, insumos e equipamentos, carência de profissional médico, pouca aproximação das unidades básicas de saúde com o setor de emergência hospitalar e escasso investimento do município para realização desses atendimentos. As proposições de melhorias destacaram a necessidade de capacitação dos profissionais de saúde, investimentos em recursos materiais e equipamentos, permanência de médico em período integral no serviço, implantação de protocolos de atendimento e empenho dos gestores. Conclusão: Os discursos evidenciaram que o serviço não tem condições de atender casos de urgência/emergência, em virtude do despreparo da equipe e da falta de recursos humanos e materiais. Além disso, não é prioridade do município oferecer condições mínimas para a realização deste atendimento nas unidades básicas de saúde, para que sejam integrantes da rede de atenção de Atenção às Urgências no Sistema Único de Saúde.

Objective: understand the difficulties health professionals face in urgency/emergency care at primary health care units and identify the propositions of problem-solving ability. Methods: Qualitative research, conducted with ten health professionals at a primary health care unit in the interior of São Paulo. The interviews were transcribed and analyzed using the methodological strategy of the collective subject discourse. Results: The difficulties were linked to factors such as unpreparedness of the team, lack of infrastructure, supplies and equipment, lack of medical professional, little cooperation between the primary health care units and the hospital emergency sector and scarce investment of the municipality to carry out these services. The proposals for improvements highlighted the need for training of health professionals, investments in material resources and equipment, full-time presence of physician at the service, implementation of care protocols and commitment of managers. Conclusion: The discourse showed that the service is not able to attend urgency/emergency cases, due to the unpreparedness of the team and the lack of human and material resources. In addition, the municipality does not prioritize the supply of minimum conditions for this care in primary health care units to make them part of the emergency care network in the Unified Health System.

Objetivo: comprender las dificultades enfrentadas por los profesionales de salud para la atención de casos de Urgencias/Emergencias en unidades básicas de salud e identificar las proposiciones de resolubilidad. Métodos: Investigación cualitativa, desarrollada con diez profesionales de salud, en una unidad básica de salud del interior paulista. Las entrevistas fueron transcritas y analizadas utilizando la estrategia metodológica del Discurso del Sujeto Colectivo. Resultados: Las dificultades fueron ligadas a factores como la falta de preparación del equipo, falta de infraestructura, insumos y equipamientos, carencia de profesional médico, poca aproximación de las unidades básicas de salud con el sector de emergencia hospitalaria y escasa inversión del municipio para realizar esas atenciones. Las propuestas de mejorías destacaron la necesidad de capacitación de los profesionales de salud, inversiones en recursos materiales y equipamientos, permanencia de médico a tiempo completo en el servicio, implantación de protocolos de atención y empeño de los gestores. Conclusión: Los discursos evidenciaron que el servicio no tiene condiciones de atender casos de urgencia/emergencia, en virtud de la falta de preparación del equipo y de la falta de recursos humanos y materiales. Además, no es prioridad del municipio ofrecer condiciones mínimas para la realización de esta atención en las unidades básicas de salud, para que sean integrantes de la red de atención de atención a las urgencias en el Sistema Único de Salud.

Regimento interno SAMUFor / Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza / SAMUFor Internal Regulations / Technical and Management Conduct Rules for SAMU 192 - Fortaleza Regional Professionals

Trata-se do Volume 1 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza o Regimento Interno do SAMUFor. Divide-se em três capítulos: 1. Normatização Vigente; 2. Normatização Municipal Vigente; e 3. Regimento Interno SAMUFor. Esse terceiro capítulo divide-se em: Regimento Interno do SAMU 192 ­ Regional Fortaleza; Regimento Interno da Gerência SAMUFor; Regimento Interno dos Órgãos de Assessoria da Gerência do SAMUFor; Regimento Interno do Núcleo Médico; Regimento Interno do Núcleo de Enfermagem; Regimento Interno do Núcleo de Farmácia; Regimento Interno do Núcleo Administrativo; Regimento Interno do Núcleo de Educação Permanente; e Regimento Interno da Central de Regulação das Urgências

Implementation of a Teledentistry Platform for Dental Emergencies for the Elderly in the Context of the COVID-19 Pandemic in Chile.

Objectives: To develop and implement a "semi-presential" technology platform to support urgent and priority dental care for the elderly in the context of the COVID-19 pandemic among the Chilean population. Methods: A dental mobile clinic was implemented along with the development of a technological platform designed to support emergency and priority dental procedures, including teleconsultation with specialists. Under strict biosafety protocols, dental care was provided in five Chilean regions between February and May 2021. Sociodemographic, medical, and dental data were recorded. Results: A total of 135 patients over sixty years old, with a mean age of 72 years, were treated, 48 males and 87 females were attended between February and May 2021 in five different regions of Chile. 53.3% required immediate or urgent treatment, and 24.4% were derived to specialists from whom 60.6% needed immediate or urgent treatment. 74.3% of teleconsultations were derived to an oral pathology specialist. Conclusion: It was shown that a "semi-presential" technology platform implemented in a mobile dental clinic can help elderly people who are impeded to look for traditional dental assistance during a pandemic.

Urgencias estomatológicas durante la pandemia de la COVID-19. Policlínico 2 de Manzanillo / Stomatological emergencies during the COVID-19 pandemic. Polyclinic 2 of Manzanillo

La caries dental y sus complicaciones, las afecciones del periodonto y los procesos infecciosos post-extracción constituyen las causas más comunes por lo que los pacientes asisten a los servicios de urgencia estomatológica. Estudiar su incidencia y los recursos que demandan sus tratamientos es necesario para organizar los servicios estomatológicos. Identificar las urgencias estomatológicas de acuerdo a las causas que lo originan en el Policlínico 2 de Manzanillo entre abril y septiembre de 2020, durante la situación epidemiológica causada por la COVID-19, ha sido el objetivo de nuestro trabajo. Utilizamos el método de estudio descriptivo transversal en pacientes que acudieron por urgencia a los servicios estomatológicos del policlínico 2 de Manzanillo entre los meses abril a septiembre del 2020. El universo estuvo constituido por 709 pacientes. El mes de mayor afluencia de urgencias estomatológicas fue mayo con 254 pacientes, predominando entre ellos el sexo femenino con 51,9 por ciento, mientras que la caries dental y sus complicaciones fue la causa por la que más acudieron los pacientes, con un 82,5 por ciento. De las enfermedades pulpares fue la hiperemia pulpar la que predominó con 361 pacientes para un 61,7 por ciento, y de las enfermedades periapicales fue el absceso alveolar con 102 casos, para un 17,4 por ciento. Durante la COVID-19 los servicios estomatológicos mantuvieron su vitalidad a través de las consultas de urgencias estomatológicas, la caries dental y las afecciones del periodonto fueron las enfermedades de mayor incidencia, siendo la hiperemia pulpar la que predominó dentro de la patología pulpar y el absceso alveolar agudo dentro de la periapical(AU)

Tooth decay and its complications, periodontal conditions and post-extraction infectious processes are the most common causes so patients attend stomatological emergency services. Studying their incidence and the resources demanded by their treatments is necessary to organize stomatological services. Identifying the stomatological emergencies according to the causes that originate it in the Polyclinic 2 of Manzanillo between April and September 2020, during the epidemiological situation caused by COVID-19, has been the objective of our work. We used the cross-sectional descriptive study method in patients who went to the stomatological services of polyclinic 2 in Manzanillo for emergencies between April and September 2020. The universe consisted of 709 patients. The month of greatest influx of stomatological emergencies was May with 254 patients, predominating among them the female sex with 51.9 percent, while dental caries and its complications was the cause for which more patients attended, with 82.5 percent. Of the pulp diseases, pulp hyperemia predominated with 361 patients for 61.7 percent, and of the periapical diseases it was the alveolar abscess with 102 cases, for 17.4 percent. During COVID-19, stomatological services maintained their vitality through stomatological emergency consultations, dental caries and periodontal conditions were the diseases with the highest incidence, with pulp hyperemia being the one that predominated within the pulp pathology and acute alveolar abscess within the periapical(EU)

Pharmaceutical services in primary health care: dissatisfaction among users, managers and pharmacists

Abstract To assess the performance indicators for pharmaceutical services (PS) in primary health care (PHC), the level of satisfaction with pharmacy services among users and managers / pharmacists' impressions in relation to the findings were evaluated. The study used mixed methods, including a retrospective and descriptive study of the performance indicators for PS in PHC, an observational study on the level of satisfaction and a qualitative study of users' perception of pharmacy services at Health Units. Managers and pharmacists' impressions of the study results were also collected. Only 44.4% of pharmacies had a full-time pharmacist. From the establishments visited, 5.3% did not have an air-conditioned environment, and only 33.3% of the items essential to the Good Practices of Storage of Medicines and Supplies criteria were fulfilled. Although 77.9% of the prescribed medicines were dispensed, it did not reach the 80% standard. The satisfaction level of users was 3.2±0.6, indicating dissatisfaction with pharmacies' services. By means of an evaluation of each item within the questionnaire, it was possible to observe that variables related to pharmaceutical care presented low scores in relation to other domains, thus evidencing the fragility of the pharmaceutical- patient relationship in users' perception. Managers and pharmacists suggested that these results were related to the inadequate physical infrastructure of pharmacies, work overload, lack of recognition and undervaluation of pharmacists, lack of interaction within the PHC team, high turnover of pharmacists, and lack of PS prioritization by the administration. PS in PHC has structural and organizational weaknesses that require changes. In general, users are dissatisfied with pharmacies' services, especially with pharmaceutical care.

Avaliação da incidência e evitabilidade de eventos adversos no pronto atendimento / Assessment of the incidence and avoidability of adverse events in the emergency care unity

A temática da segurança do paciente vem sendo cada vez mais discutida nos sistemas de saúde, com intuito de aperfeiçoar a qualidade da assistência prestada contribuindo para diminuir a possibilidade de ocorrência de danos ou incidentes evitáveis. O pronto atendimento é considerado ambiente de constante lotação e alta pressão que podem comprometer a segurança do paciente e prejudicar a confiança de todo o sistema de atendimento. O estudo teve como objetivo avaliar a incidência e a evitabilidade de eventos adversos em pacientes adultos internados em uma unidade pública de pronto atendimento situada no município de Uberlândia, durante o ano de 2018. Trata-se de um estudo de coorte, com revisão retrospectiva de 296 prontuários por meio do uso de formulários de rastreamento (fase 1) e avaliação (fase 2), preenchidos por profissionais não médicos e médico, respectivamente. Na primeira fase foram avaliados os dados demográficos, condição clínica e os potenciais eventos adversos. Além disso, houve a verificação da qualidade das informações registradas nos prontuários. Na segunda fase, identificou-se e caracterizou-se os eventos adversos previamente rastreados. A incidência de eventos adversos encontrada foi de 4,4% (n=13) com evitabilidade de 100%, sendo 75% caracterizados como leve e 25% moderado quanto ao grau de gravidade. Referente à caracterização dos indivíduos do estudo, apontou-se que a maioria é do sexo masculino (54,4%), de raça branca (37,2%), que não informaram o nível de escolaridade (67,6%) e acima de 60 anos (52,7%). Essas características foram mantidas para os indivíduos que apresentaram eventos adversos. As maiores porcentagens em relação ao tipo de diagnóstico encontrado no indivíduo com evento adverso foram: doenças relacionadas a traumas (23,1%); doenças infecciosas e intestinais (15,4%); doenças hepáticas/pâncreas/vias biliares (15,4%) e doenças do sistema nervoso (15,4%). Quanto aos fatores intrínsecos e extrínsecos, encontrou-se uma média de fatores intrínsecos de 1,17 por paciente, com desvio padrão igual a 1,2, enquanto que o valor médio dos extrínsecos é de 1,5, com desvio padrão igual a 1. Para ambos, o mínimo é de nenhum fator, máximo de 5 e mediana de 1. Dentre aqueles que tiveram eventos adversos, 69,2% apresentaram fatores de risco intrínsecos, enquanto que 100% manifestaram os extrínsecos, bem como, o fator de risco intrínseco que teve mais ocorrências foi o de hipertensão arterial (34,8%), enquanto que o fator de risco extrínseco com maior número de aparições foi o cateter venoso periférico (54,5%). Em relação aos critérios de rastreamento, necessários para identificação do Potencial Evento Adverso, verificou-se no estudo que em 50% não foi localizada nenhuma evidência de Potencial Evento Adverso, ou seja, não houve nenhum critério de rastreamento. Acerca da classificação dos casos com eventos adversos conforme a natureza do problema principal, esses estão relacionados: ao cuidado em geral (81,2%), ao medicamento (6,2%), ao procedimento (6,2%) e ao diagnóstico (6,2%). Em relação a análise dos prontuários, dentre as 14 questões avaliadas, essas apresentaram percentual de documentação adequada entre 97,9% e 100%. Avaliar a incidência de eventos adversos e suas características permite compreender o panorama dos principais problemas em relação a segurança do paciente em uma unidade de pronto atendimento, que por sua vez, permite traçar estratégias de intervenção para o desenvolvimento de novas ações de controle e resposta. Esse é o primeiro passo na busca para incorporar uma cultura de qualidade e segurança do paciente

The issue of patient safety has been increasingly discussed in health systems, with the aim of improving the quality of care provided, contributing to reduce the possibility of damage or preventable incidents. The subject of patient safety has been increasingly discussed in health systems, in order to improve the quality of care provided, contributing to reduce the possibility of damage or avoidable incidents. Emergency care unit is considered an environment of constant crowding and high pressure that can compromise patient safety and undermine the confidence of the whole care system. This study aimed to assess the incidence and avoidability of adverse events in adult patients admitted to a public emergency care unit located in Uberlândia city (Minas Gerais State, Brazil), in 2018. This is a cohort study, with a retrospective review of 296 medical records through the use of tracking forms (phase 1) and evaluation (phase 2) fulfilled by non-medical professionals and doctors, respectively. In the first phase, demographic data, clinical condition and potential adverse events were evaluated. In addition, there was a verification of the quality of the informations recorded in the medical records. In the second phase, the previously tracked adverse events were identified and characterized. The incidence of adverse events found was 4.4% (n = 13) with 100% avoidability, 75% being characterized as mild and 25% moderate as to the degree of severity. As for the characterization of the individuals in the study, it was pointed out that the majority are male (54.4%), white (37.2%), who did not report their level of education (67.6%) and above 60 years old (52.7%). These characteristics were maintained for individuals who experienced adverse events. The highest percentages in relation to the type of diagnosis found in the individual with an adverse event were: diseases related to trauma (23.1%); infectious and intestinal diseases (15.4%); liver/pancreas/biliary disease (15.4%) and diseases of the nervous system (15.4%). As for intrinsic and extrinsic factors, an average of intrinsic factors of 1.17 per patient was found, with a standard deviation of 1.2, while the average value of extrinsic was 1.5, with a standard deviation of 1. For both, the minimum is no factor, maximum is 5 and median is 1. Among those who had adverse events, 69.2% had intrinsic risk factors, while 100% had extrinsic ones, as well as the intrinsic risk factor that had the most occurrences was arterial hypertension (34.8%), while that the extrinsic risk factor with the highest number of appearances was the peripheral venous catheter (54.5%). In relation to the tracking criteria, necessary to identify the potential adverse event, it was found in the study that in 50% no evidence of potential adverse event was found, that is, there was no tracking criterion. Regarding the classification of cases with adverse events according to the nature of the main problem, these are related to: care in general (81.2%), medication (6.2%), procedure (6.2%) and diagnosis (6.2%). In relation to the analysis of the medical records, among the 14 questions evaluated, these presented a percentage of adequate documentation between 97.9% and 100%. Assessing the incidence of adverse events and its characteristics allows us to understand the panorama of the main problems in relation to patient safety in an emergency care unit, which, in turn, allows to outline intervention strategies for the development of new control and response actions. This is the first step in the quest to incorporate a culture of quality and patient safety

Avaliação do grau de complexidade assistencial da clientela das enfermarias de um pronto-socorro adulto / Assessment of the degree of care complexity of the clientele of the wards of an adult emergency room

O pronto-socorro têm se mostrado um ambiente onde os pacientes ficam internados por longo tempo, desta forma os serviços de emergências sofrem descaracterização dos atendimentos. Uma grande problemática é quantitativo insuficiente de trabalhadores da saúde relacionado ao cuidado exigido e a crescente procura de atendimento dos pacientes de maior complexidade. Para prover o quantitativo e qualitativo dos profissionais de enfermagem é indispensável o atendimento individualizado, integral e sistematizado, almejando assistência adequada dos usuários, a enfermagem precisa categorizar o nível de dependência dos pacientes. Desta forma, tornou-se relevante avaliar a clientela quanto a necessidade de assistência de enfermagem, a fim de colaborar para proteção do paciente e um cuidado de excelência no pronto socorro, fornecendo dados para gerir as demandas dos profissionais de enfermagem da unidade e auxiliando a alocação mais eficaz da equipe. Este estudo objetivou avaliar o grau de complexidade assistencial dos pacientes internados nas enfermarias do pronto socorro adulto de um hospital de grande porte utilizando um Sistema de Classificação do Paciente. Trata-se de um estudo quantitativo, de natureza exploratória, executado no pronto socorro adulto (PSA) do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro em Minas Gerais (HC-UFTM) no qual foram averiguados os prontuários dos pacientes internados no PSA entre os meses de janeiro a dezembro de 2018. Para análise da complexidade assistencial foi utilizado o Sistema de Classificação de Paciente Fugulin e para coleta das variáveis sociodemográficas e clínicas foi utilizado um formulário desenvolvido pela autora. Foram incluídos 308 prontuários de pacientes. Os resultados mostraram que independente da variável analisada, a maioria dos pacientes foram classificados como Cuidados de alta dependência ou Cuidados intermediários. Não foi observada associação entre as variáveis sociodemográficas, comorbidades e hábitos de vida com a complexidade assistencial de acordo com a classificação de Fugulin. Houve predominância por pacientes do sexo masculino (53,9%), idade superior a 60 anos (62,3%). Em relação à regulação, observa-se predominância da Vaga Zero (42,9%), o tipo de regulação foi estatisticamente associado à complexidade assistencial. Notou-se grande frequência de comorbidades na amostra estudada, sendo que apenas 18 pacientes não apresentavam comorbidades. As comorbidades mais prevalentes na população deste estudo foram a hipertensão arterial sistêmica (HAS) (58,1%), cardiopatia (26,9%) e diabetes Mellitus (DM) (22,1%). Houve associação estatisticamente significante entre a necessidade de suporte ventilatório, sedação e uso de drogas vasoativas com a complexidade assistencial avaliada pela Classificação de Fugulin, destacando-se os pacientes classificados como Cuidados de alta dependência e Cuidados intermediários. O tempo médio de internação hospitalar foi de 7 dias, estando associado à complexidade assistencial. Em relação à classificação de risco, houve predominância das cores laranja (50,6 %) e amarelo (47,4%), sendo essas associadas à complexidade assistencial. Este estudo mostrou uma elevada dependência da assistência de enfermagem exigido pelos pacientes internados nas enfermarias do Pronto Socorro

The emergency room has been shown to be an environment where patients are hospitalized for a long time, thus the emergency services suffer from mischaracterization of care. A major problem is the insufficient number of health workers related to the required care and the growing demand for care of more complex patients. To provide the quantitative and qualitative of nursing professionals, individualized, comprehensive and systematized care is essential, aiming at adequate assistance from users, nursing needs to categorize the level of patients' dependence. In this way, it became relevant to evaluate the clientele regarding the need for nursing assistance, in order to collaborate for patient protection and excellent care in the emergency room, providing data to manage the demands of the unit's nursing professionals and helping to more effective team allocation. This study aimed to evaluate the degree of care complexity of patients admitted to the adult emergency room wards of a large hospital using a Patient Classification System. This is a quantitative, exploratory study carried out in the adult emergency room (PSA) of the Hospital de Clínicas of the Federal University of Triângulo Mineiro in Minas Gerais (HC-UFTM) in which the medical records of patients admitted to the PSA between the months of January to December 2018.For the analysis of care complexity, the Fugulin Patient Classification System was used and a form developed by the author was used to collect sociodemographic and clinical variables. 308 patient records were included. The results showed that regardless of the variable analyzed, most patients were classified as High dependency care or Intermediate care. There was no association between sociodemographic variables, comorbidities and lifestyle habits with care complexity according to the Fugulin classification. There was a predominance of male patients (53.9%), aged over 60 years (62.3%). Regarding regulation, there is a predominance of Vaga Zero (42.9%), the type of regulation was statistically associated with complexity of care. A high frequency of comorbidities was noted in the sample studied, with only 18 patients not having comorbidities. The most prevalent comorbidities in the population of this study were systemic arterial hypertension (SAH) (58.1%), heart disease (26.9%) and diabetes Mellitus (DM) (22.1%). There was a statistically significant association between the need for ventilatory support, sedation and the use of vasoactive drugs with the care complexity assessed by the Fugulin Classification, with emphasis on patients classified as Highly Dependent Care and Intermediate Care. The average hospital stay was 7 days, being associated with care complexity. Regarding the risk classification, there was a predominance of orange (50.6%) and yellow (47.4%), which are associated with care complexity. This study showed a high dependence on the nursing care required by patients admitted to the emergency room wards

El desempeño del primer nivel y su relación con las hospitalizaciones evitables / The primary care performance and its relationship with preventable hospitalizations

INTRODUCCIÓN. El enfoque de atención primaria en el diseño de servicios de salud sigue siendo importante. La coordinación asistencial y la continuidad de la atención son ejes fundamentales para el abordaje de las enfermedades crónicas no transmisibles como la diabetes mellitus, que ha sido catalogada como enfermedad susceptible de cuidados ambulatorios. Las tasas de hospitalización elevadas por este tipo de condiciones reflejan una atención ambulatoria deficiente e inadecuada para el problema de salud estudiado, lo que implica que la población no accedió a la atención, o que esta no es resolutiva. MATERIALES Y MÉTODOS. Se analizaron todas las consultas de emergencia, en 12 meses en un hospital de Quito, se buscaron consultas externas de pacientes en todos los establecimientos de primer nivel del MSP antes de la consulta por emergencia, desde el 1 de enero de 2015 hasta un día antes de la consulta por emergencia. RESULTADOS. De 41 pacientes atendidos con diagnóstico de enfermedades evitables 58% eran mujeres, 43% (18) requirió hospitalización. El promedio de días de hospitalización fue 6,51, con una dispersión de 13,0; el de consultas externas previo a la emergencia fue 3,07, con máximo 22 consultas. Los hospitalizados tuvieron, en promedio, 5,05 consultas externas antes de la emergencia y hospitalización, aproximadamente 4 más que el promedio (0,95) de los pacientes no hospitalizados. DISCUSIÓN. las elevadas tasas de hospitalización podrían reflejar una atención primaria deficiente, lo que implica que la población no accedió a la atención, sin embargo, habría que analizar la gravedad de los pacientes.

INTRODUCTION. Primary care services are important for the delivery of comprehensive health services. The coordination and continuity of care are the main characteristics to approach non-communicable diseases like diabetes mellitus, which has been classified as ambulatory care sensitive condition. The high hospitalization rate might reveal poor and inadequate out-patient care, implying that the population did not access care, or that care was not effective. MATERIALS AND METHODS. All emergency consultations within 12 months in one hospital in Quito were analyzed according to their ICD-10 codes. They were compared with the consultations at the first level of care facilities of the Ministry of Public Health, from January 1st, 2015 until one day before the emergency consultation. RESULTS. Of 41 patients who attended with a diagnosis of preventable diseases 58% were wo-men, 43% (18) required hospitalization. The average number of days of hospitalization was 6.51, with a dispersion of 13.0; the number of external consultations prior to the emergency was 3.07, with a maximum of 22 consultations. The hospitalized patients had, on average, 5.05 outpatient visits before the emergency and hospitalization, approximately 4 more than the average (0.95) of the non-hospitalized patients. DISCUSSION. The high hospitalization rate, due to this condition, might reveal poor and inadequate ambulatory care, nevertheless it is necessary to analyze the severity of the cases in the studs.

Relevamiento de drogas en carros de emergencia de un hospital pediátrico. Estudio antes-después de una intervención educativa / Assessment of emergency trolley drugs in a children's hospital. Before and after study on an educational intervention

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación.Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa.Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención.Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza ­IC­ del 95 %: 38,4-49,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,5-5,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición.Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.

Introduction. The approach to pediatric emergencies requires specialized resources, and medication errors are common.Objectives. To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.Methods. The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.Results. The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [CI]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.2-75.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurementshowed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.Conclusions. The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period

Mejoramiento de la vigilancia de mortalidad por COVID-19 en América Latina y el Caribe mediante la vigilancia de mortalidad por todas las causas / Improving surveillance of COVID-19 mortality in Latin America and the Caribbean through surveillance of all-cause mortality

La finalidad de este documento es brindar orientación a los países de América Latina y el Caribe a fin de mejorar la vigilancia de la mortalidad por COVID-19. En este documento se amplían los métodos deanálisis de la mortalidad por todas las causas como uno de los enfoques propuestos para contribuir a la evaluación de la magnitud real de la carga de la epidemia de COVID-19 en los países de América Latina y el Caribe. Este documento está dirigido a las autoridades nacionales de salud, incluidos los equipos de vigilancia epidemiológica y de emergencia de salud pública que participan en la respuesta a la epidemia de COVID-19, así como a otros profesionales o instituciones a cargo de la vigilancia (como los departamentos de epidemiología) y de seguimiento de la mortalidad (como los institutos nacionales de estadística).

Evaluación de las prácticas de prevención y control de infecciones en áreas de aislamiento en establecimientos de salud agudos en el contexto del nuevo coronavirus (COVID-19). Recomendaciones provisionales, 14 de Abril de 2020 / Assessment of infection prevention and control practices in isolation areas in acute healthcare settings in the context of the novel coronavirus (COVID-19). Interim recommendations, 14 April 2020

Las prácticas de prevención y control de infecciones necesitan implementarse para garantizar la seguridad de los trabajadores de salud y pacientes en establecimientos de salud, es fundamental prevenir la contaminación cruzada y contener la propagación del COVID 19. • Al día de esta publicación, están recomendadas las siguientes precauciones para el cuidado del paciente con sospecha o confirmación de COVID-19‡: o Para cualquier caso sospechoso o confirmado de COVID-19: precauciones estándares + contacto + precauciones en la transmisión por gotitas o Para cualquier caso sospechoso o confirmado de COVID-19 y procedimientos generadores de aerosoles: precauciones estándares + contacto + transmisión aérea (aerosoles o núcleo de gotitas) • Los resultados de la aplicación de esta herramienta de evaluación, en conjunto con otras herramientas§, proveerán una visión general sobre el cumplimiento de las actividades de prevención y control de infecciones asociadas a la atención médica en un establecimiento de salud, sin realizar juicios sobre el riesgo individual de los pacientes, o en casos particulares. Por su naturaleza, esta herramienta es sólo un diagnóstico externo de apoyo a profesionales de PCI y gerentes para evaluar las brechas y tomar medidas correctivas.

Infection prevention and control practices need to be implemented to guarantee the safety of healthcare workers and patients in healthcare settings, it is fundamental to prevent cross contamination and containment of spread of COVID 19. As of the day of this publication, the following precautions are recommended for the care of patients with suspected or confirmed cases of COVID-19: - For any suspected or confirmed cases of COVID-19: standard + contact + droplet precautions. -For any suspected or confirmed cases of COVID-19 and Aerosol Generated Procedure: standard + contact + airborne precautions. - The results of the application of this evaluation tool, in addition to other tools, will provide an overview regarding compliance with the activities of prevention and control of infections associated with provision of care in acute healthcare services in a health setting, without making judgments about the individual risk of patients, nor on particular cases. By its nature, this tool is only an external diagnostic to support IPC professionals and managers to assess the gaps and take corrective measures. To provide a tool for assessment of infection prevention and control practices in isolation areas in acute healthcare settings in the context of the novel coronavirus (COVID-19). These recommendations are preliminary and subject to review as new evidence becomes available.

Recomendaciones: Servicios de Emergencias Médicas Prehospitalarias (SEM) COVID-19 / Recommendations: Prehospital Medical Emergency Services (SEM) COVID-19

En este documento se presenta orientación general para que los servicios de emergencias médicas (SEM) estén preparados para dar respuesta frente a la COVID-19. Hay que tener en cuenta que la configuración de las regulaciones y los recursos pueden variar a nivel local y estatal. Por tanto, además de estas recomendaciones, las entidades que prestan servicios de emergencias médicas deben consultar con los socios locales. Los primeros respondientes y los trabajadores de salud que prestan servicios prehospitalarios de emergencias médicas o transporte interhospitalario de pacientes trabajan en un entorno único con retos muy particulares, como realizar su labor en entornos prehospitalarios no controlados, transportar pacientes en un espacio cerrado y enfrentar la variabilidad de los recursos. Considerando la propagación que hasta la fecha tiene el virus, se prevé que la COVID-19 afectará a buena parte de la población mundial. A medida que evolucionen los brotes de COVID-19, los trabajadores prehospitalarios, incluido el personal de los servicios de emergencias médicas (SEM) y otros que responden a las situaciones de emergencia pueden verse expuestos a la enfermedad al estar en contacto con los pacientes o con entornos contaminados. Es sumamente importante que estos presta

Care transition of patients with chronic diseases from the discharge of the emergency service to their homes / Transición del cuidado de pacientes con enfermedades crónicas desde el alta del servicio de emergencia hasta el domicilio / Transição do cuidado de pacientes com doenças crônicas na alta da emergência para o domicílio

ABSTRACT Objective: To evaluate the quality of the care transition for patients with chronic non-communicable diseases discharged from the emergency department to home. Method: A cross-sectional observational and epidemiological study conducted at an emergency department in the South of Brazil with 117 patients and 81 caregivers. The Care Transitions Measure was applied by phone to collect data. A descriptive and analytical statistical analysis was performed. Results: The quality of the care transition's total score was close to satisfactory (69.5). The "Self-Management Training" factor had the highest score (70.6), while "Understanding medications" had the lowest (68.3). Items related to understanding medications and confidence in carrying out care after discharge obtained lower scores. Conclusions: A moderate quality of the care transition was evidenced, as well as the need to adopt strategies to improve the emergency department discharge process and the continuity of the care of patients with chronic diseases.

RESUMEN Objetivo: Evaluar la calidad de la transición de los cuidados de pacientes con enfermedades crónicas no transmisibles desde el alta del servicio de emergencia hasta el domicilio. Método: Estudio epidemiológico, observacional y transversal realizado en un servicio hospitalario de emergencia en el sur de Brasil con 117 pacientes y 81 cuidadores. En la recolección de los datos, se aplicó telefónicamente el instrumento Care Transitions Measure. Se realizó un análisis estadístico, descriptivo y analítico. Resultados: El puntaje total de la calidad de la transición de los cuidados fue cercano a satisfactorio (69,5). El factor "Preparación para el automanejo" obtuvo el mayor puntaje (70,6), mientras que "Entender los medicamentos" obtuvo el menor (68,3). Se obtuvieron puntajes más bajos en los ítems relacionados con el conocimiento sobre los medicamentos y la seguridad en realizar los cuidados después del alta. Conclusiones: Se evidenció una calidad moderada de la transición de los cuidados y la necesidad de adoptar estrategias para mejorar el proceso del alta del servicio de emergencia y la continuidad de los cuidados de portadores de enfermedades crónicas.

RESUMO Objetivo: Avaliar a qualidade da transição do cuidado de pacientes com doenças crônicas não transmissíveis na alta do serviço de emergência para o domicílio. Método: Estudo epidemiológico observacional transversal realizado em serviço de emergência de hospital no Sul do Brasil com 117 pacientes e 81 cuidadores. Na coleta de dados, aplicou-se por telefone o instrumento Care Transitions Measure. Realizou-se análise estatística descritiva e analítica. Resultados: O escore total da qualidade da transição do cuidado foi próximo ao satisfatório (69,5). O fator "Preparação para autogerenciamento" teve maior escore (70,6), enquanto "Entendimento sobre medicações", o menor (68,3). Escores inferiores foram obtidos nos itens relacionados a conhecimento sobre medicamentos e segurança em realizar os cuidados após a alta. Conclusões: Evidenciou-se qualidade moderada da transição do cuidado e necessidade de adoção de estratégias para melhorar o processo de alta da emergência e a continuidade do cuidado de portadores de doenças crônicas.