[Patient safety in emergency care]. / La seguridad del paciente en urgencias y emergencias.

Patient safety is an essential dimension of quality in Emergency Departments (EDs). The incidence of appearance of adverse events in these departments is estimated at between 1.6 and 14% according to different studies and methodologies. The strategies for achieving a safe clinical practice in EDs involve policies aimed at improving safety in the use of medication with special emphasis on the administration and on the reconciliation of the medication, as well as on the employment of high risk drugs; on preventing nosocomial infection due to emergency care, with special importance manual hygiene; on improving patient identification; on improving communication and information, especially during patient transfers; on the prevention of specific risks; and, above all, on creating a climate and culture of patient safety in EDs. Different proactive and reactive tools are available for evaluating patient safety in EDs. There is an outstanding need to publish the system of event notification to facilitate analysis of such events and the subsequent development of improvement actions in EDs.

[Geriatric assessment in the emergency departments of acute hospitals]. / Abordaje del anciano en el servicio de urgencias de un hospital de agudos.

Elderly people use often and in an appropriate way the Emergency Department (ED). However, we don't dispose of evidences that demonstrate utility of a specific model of geriatric assessment (GA) applied in ED. Nowadays; GA in ED should be used being adapted to the environment and with some clear objectives that allow to carry out a multidimensional diagnosis and to establish therapeutic priorities. GA contributes benefits in the continuity of care on the part of the Primary Attention when elderly people are discharged from an ED.

Abordaje del anciano en el servicio de urgencias de un hospital de agudos / Geriatric assessment in the emergency departments of acute hospitals

Los ancianos utilizan mucho y de forma adecuada los servicios de urgencias (SU). No existen evidencias que demuestren la efectividad de un modelo concreto de valoración geriátrica (VG) aplicado en los SU. Sin embargo, la VG en los SU debería utilizarse adecuándola al entorno y con unos objetivos claros que permitan realizar un diagnóstico multidimensional y establecer prioridades terapéuticas. La VG aporta beneficios en la continuidad de cuidados por parte de la atención primaria cuando los ancianos son dados de alta de un SU (AU)

Elderly people use often and in an appropriate way the Emergency Department (ED). However, we don’t dispose of evidences that demonstrate utility of a specific model of geriatric assessment (GA) applied in ED. Nowadays; GA in ED should be used being adapted to the environment and with some clear objectives that allow to carry out a multidimensional diagnosis and to establish therapeutic priorities. GA contributes benefits in the continuity of care on the part of the Primary Attention when elderly people are discharged from an ED (AU)

Home hospitalization unit: an alternative to standard inpatient hospitalization from the emergency department.

OBJECTIVE: To assess the characteristics of the patients admitted to a home hospitalization unit (HHU) after a first emergency department (ED) visit. METHODS: This was a descriptive, retrospective study. The setting of the study was the ED of a 500-bed teaching hospital, which treats 125 000 emergency visits per year. HHU admits patients from the ED when hospitalization is imminent. Participants were all patients attending our ED from 1 January 2005 to 31 December 2005 and finally admitted to HHU. Variables were age, sex, diagnostic, mean length of stay, and readmission rate. RESULTS: A cohort composed of 250 patients admitted to HHU directly from the ED was identified. Mean age was 75 years. One hundred and fifty-eight were males (63%). The most common diagnoses were acute exacerbation of chronic obstructive pulmonary disease (127 of 250 patients, 50.8%), acute exacerbation of chronic heart failure (32 of 250 patients, 12.8%), pneumonia (24 of 250 patients, 9.6%), urinary tract infection (20 of 250 patients, 8%), and leg deep venous thrombosis (14 of 250 patients, 5.6%). Mean length of stay was 8 days. Readmission rate was 9%. CONCLUSION: A HHU proved to be effective and safe for acutely ill individuals who required hospitalization.

Artículos publicados en EMERGENCIAS entre 2000 y 2004: participación de los urgenciólogos y comparación con su aportación en las revistas indexadas / Scientific papers published in “EMERGENCIAS” from 2000 to 2004: participation of emergency department physicians and comparison with their contribution to indexed journals

Objetivos: Analizar las principales características de la producción científica de los urgenciólogos españoles entre 2000 y 2004, tanto en revistas indexadas por el Scienci Citation Index (SCI) como en la revista EMERGENCIAS, al no encontrarse ésta incluida endicha base de datos. Método: Se revisaron manualmente todos los documentos publicados en EMERGENCIAS durante el período 2000-2004. Se aceptó como documento de un urgenciólogo español si en la filiación figuraba su erradicación en España y cualquiera de las siguientes expresiones identificativas de un servicio-dispositivo de urgencias: urgencias, urgències,urxencias, larrialdiak, larrialdia, emergentziak, emergencias, emergències, emerxencias,emergency, 061, SAMU, 1006, SUC, SEM, SEMSA, SERCAM, 112, DEIAK o EPES. Esta misma estrategia fue la utilizada para la búsqueda en revistas del SCI durante el mismo período. Se registraron y analizaron los principales datos e indicadores bibliométricos utilizados en los estudios previos de nuestro grupo. Para determinar las líneas de investigación se utilizó el índice del Tratado de Medicina de Urgencias de Tintinalli,ligeramente modificado. Resultados: En el periodo estudiado, los urgenciólogos españoles publicaron 594 documentos,290 en EMERGENCIAS y 304 indexados por el SCI. El 51% de ellos fueron realizados por autores pertenecientes a 26 servicios de urgencias hospitalarios y 3 Sistemas de Emergencias, además de la propia SEMES. Hubo diferencias importantes entre la aportación que realizó cada Comunidad y cada Centro a EMERGENCIAS y al SCI en cuanto a la producción científica, en las características bibliométricas y en los temas delos trabajos. Madrid predominó en EMERGENCIAS, Cataluña y Andalucía en el SCI y presentaron una producción balanceada Galicia y el País Vasco. La producción científica publicada en EMERGENCIAS presentaba un menor número de originales, fue firmada por menos autores, el urgenciólogo firmó con mayor frecuencia en primer lugar, hubo una mayor frecuencia de urgenciólogos extrahospitalarios y de pertenencia a un servicio de urgencias independiente. Conclusiones: Los urgenciólogos que publican en EMERGENCIAS aportan un volumen similar de trabajos a los que publican en revistas indexadas en el SCI, aunque la mayoría de características bibliométricas y la temática difieren entre ambas (AU)

Aims: To assess the predominant characteristics of scientific papers published by Spanish clinicians from emergency departments physicians, from 2000 to 2004, in journals indexed in the Science Citation Index (SCI) database and in the journal EMERGENCIAS, which is not included in the aforementioned index. Material and method: All the articles published in the journal EMERGENCIAS during the period 2000-2004 were reviewed. A scientific paper was considered a Spanish emergency department physician document if the setting was Spain and if it included any of the following expressions related to an emergency service: urgencias, urgències, urxencias,larrialdiak, larrialdia, emergentziak, emergencias, emergències, emerxencias, emergency, 061, SAMU, 1006, SUC, SEM,SEMSA, SERCAM, 112, DEIAK or EPES. The same strategy was used to search for journals in the SCI during the sameperiod. All data and bibliometric indicators used in previous studies by our group were registered and analyzed. Aslightly modified index of the text “Tratado de Medicina de Urgencias” by Tintinalli was used to determine the lines ofinvestigation. Results: Throughout the whole study period, the Spanish emergency department clinicians published 594 scientific papers; among which 290 appeared in EMERGENCIAS and 304 were indexed in SCI. 51% were written by clinicians from 26 hospitalary emergency departments and 3 emergency systems, in addition to the SEMES. Significant differences were observed in the contribution of each community are centre to the scientific prroduction, the bibliometriccharacteristics and the topics reported between EMERGENCIAS and the SCI. Madrid prevailed in EMERGENCIAS, Cataloniaand Andalusia in the SCI and Galicia and the Basque Country had a balanced scientific production. EMERGENCIAS had a lower number of original studies, signed by fewer authors, emergency department physicians more frequently signed in first place, and frequency of physicians from extrahospitalary emergency departments and independent emergency services was hister. Conclusions: The volume of studies by emergency department physicians pulishing in EMERGENCIAS is similr to that of studies published in journals indexed in the SCI albeit with differences in the bibliometric characteristics and subjects (AU)

Proyecto EMERGER: primera valoración de resultados / EMERGER project: first outcome assessment

No disponible

[Direct discharge from triage in emergency departments: assessment, risks and patient satisfaction]. / Derivación sin visita desde los servicios de urgencias hospitalarios: cuantificación, riesgos y grado de satisfacción.

BACKGROUND AND OBJECTIVE: After triage assessment, some hospitals refer emergency department (ED) patients with minor chief complaints to off-site clinics. The potential for 2 different referral models introduced in 2 urban hospitals was assessed, as well as the suitability of this measure. PATIENTS AND METHOD: After triage assessment, patients with minor complaints were identified. ED from Hospital Clínic of Barcelona (HCB) proposed that these patients should be referred to a hospital affiliated off-site clinic, whereas ED from Hospital Mútua de Terrassa (HMT) tried to refer such patients to their primary care setting. Within a year, we assessed on both ED the following items: number of arrivals, percentage of proposed referrals (PR), percentage of accepted referrals (AR), percentage of carried-out referrals (CR: patients who, once discharged, really attended the other setting), and percentage of returned referrals (RR) to the ED, as well as return reasons, and the percentage of returned patients finally admitted. The degree of patient satisfaction was evaluated by means of a telephone survey. RESULTS: From both ED, 44,764 arrivals and 7,297 (16.3%) PR were registered. The percentage of AR and CR was 94.3% and 75.3%, respectively. The percentage of PR from HMT was higher (18.7% vs 13.1%; p < 0.001), yet HCB obtained a greater percentage of AR (98.9% vs 92%, p < 0.001) and CR (93.7% vs 65%; p < 0.001). The percentage of RR from both ED was 1.5% (2.8% vs 0.4%; p < 0.001). Among returned patients, 12 of them (0.17% respect to AR) were finally admitted. Only 41% of patients who were found to be eligible for direct discharge would have agreed with being referred to another clinical setting, but after the experience, up to 93% of them said they would go through it again. HMT gave referral information to patients faster than HCB (p < 0.05), but HCB got a better model evaluation (p < 0.01), a greater medical complaint solution (p < 0.05), and generated a smaller number of subsequent consultations (p < 0.05). CONCLUSIONS: After a rapid triage assessment, a percentage of patients arriving on EDs may be directly and safely discharged and referred to other clinical settings. This is achieved by both proposed models without additional risks for patients. However, patients feel more satisfied with an hospital-affiliated off-site clinic instead of their primary care setting.

Derivación sin visita desde los servicios de urgencias hospitalarios: cuantificación, riesgos y grado de satisfacción / Direct discharge from triage in emergency departments: assessment, risks and patient satisfaction

Fundamento y objetivo: Desde hace unos años, algunos centros hospitalarios redirigen a los pacientes que acuden a urgencias con enfermedades menores hacia niveles asistenciales más adecuados sin que se les visite. A continuación se presenta la experiencia de 2 hospitales que aplican modelos diferenciales y se analiza la idoneidad de esta medida. Pacientes y método: A los pacientes con síntomas menores que consultan en la Unidad de Urgencias de Medicina (UUM) del Servicio de Urgencias Hospitalario (SUH), del Hospital Clínic de Barcelona (HCB), se les propone que se les visite en un centro externo de urgencias extrahospitalarias que depende del propio hospital, mientras que el Hospital Mútua de Terrassa (HMT) los remite a los centros de asistencia primaria correspondientes. Durante un año, se ha medido la actividad de ambos hospitales, se ha cuantificado el porcentaje de derivaciones propuestas (DP) por los médicos de la UUM, de derivaciones aceptadas (DA) por los pacientes, de derivaciones consumadas (DC, pacientes que acuden realmente al centro externo), de derivaciones retornadas (DR) al SUH, la causa de las DR y el porcentaje de ingresos. Además se ha realizado una encuesta de satisfacción. Resultados: Durante el período de estudio se visitaron 44.764 pacientes y a un 16,3% se les propuso acudir al centro externo sin visita previa. El porcentaje de DA y DC fue del 94,3 y del 75,3%, respectivamente. El de DP fue superior en el HMT (el 18,7 frente al 13,1%; p < 0,001), mientras que el HCB tuvo mayores porcentajes de DA (el 98,9 frente al 92,0%; p < 0,001) y DC (el 93,7 frente al 65,0%; p < 0,001). Se registró un 1,5% de DR, que fueron superiores en el HCB (el 2,8 frente al 0,4%; p < 0,001). El índice global de ingresos fue del 0,17%. Sólo al 41% de los pacientes le pareció bien de entrada acudir a otro recurso asistencial, pero tras la experiencia el 93% afirmó que volvería a aceptarla. El HMT fue más rápido en facilitar la información (p < 0,05), mientras que el HCB tuvo una mejor valoración global del sistema (p < 0,01) y del grado de resolución del problema (p < 0,05) y generó un menor número de consultas médicas posteriores (p < 0,05). Conclusiones: Es posible derivar sin visita previa a un porcentaje sustancial de pacientes que consultan por situaciones menores desde una UUM del SUH a un centro externo, sin que ello signifique un riesgo para ellos. Estos pacientes muestran mayor satisfacción con un modelo en el que el centro externo depende del propio hospital que con uno en que el centro externo sea el propio centro de asistencia primaria

Background and objective: After triage assessment, some hospitals refer emergency department (ED) patients with minor chief complaints to off-site clinics. The potential for 2 different referral models introduced in 2 urban hospitals was assessed, as well as the suitability of this measure. Patients and method: After triage assessment, patients with minor complaints were identified. ED from Hospital Clínic of Barcelona (HCB) proposed that these patients should be referred to a hospital affiliated off-site clinic, whereas ED from Hospital Mútua de Terrassa (HMT) tried to refer such patients to their primary care setting. Within a year, we assessed on both ED the following items: number of arrivals, percentage of proposed referrals (PR), percentage of accepted referrals (AR), percentage of carried-out referrals (CR: patients who, once discharged, really attended the other setting), and percentage of returned referrals (RR) to the ED, as well as return reasons, and the percentage of returned patients finally admitted. The degree of patient satisfaction was evaluated by means of a telephone survey. Results: From both ED, 44,764 arrivals and 7,297 (16.3%) PR were registered. The percentage of AR and CR was 94.3% and 75.3%, respectively. The percentage of PR from HMT was higher (18.7% vs 13.1%; p < 0.001), yet HCB obtained a greater percentage of AR (98.9% vs 92%, p < 0.001) and CR (93.7% vs 65%; p < 0.001). The percentage of RR from both ED was 1.5% (2.8% vs 0.4%; p < 0.001). Among returned patients, 12 of them (0.17% respect to AR) were finally admitted. Only 41% of patients who were found to be eligible for direct discharge would have agreed with being referred to another clinical setting, but after the experience, up to 93% of them said they would go through it again. HMT gave referral information to patients faster than HCB (p < 0.05), but HCB got a better model evaluation (p < 0.01), a greater medical complaint solution (p < 0.05), and generated a smaller number of subsequent consultations (p < 0.05). Conclusions: After a rapid triage assessment, a percentage of patients arriving on EDs may be directly and safely discharged and referred to other clinical settings. This is achieved by both proposed models without additional risks for patients. However, patients feel more satisfied with an hospital-affiliated off-site clinic instead of their primary care setting

Valoración geriátrica en un servicio general de urgencias hospitalarias / Geriatric assessment in a general hospital emergency service

Objetivo: Conocer la población que se está atendiendo en el Área deObservación de Urgencias y saber las características diferenciadoras,principales, de esta población en comparación con la población adultajoven, definiendo las características clínico asistenciales de los pacientesmayores de 64 años, atendidos en el AOSU, por enfermedad orgánicaaguda. Describir cuales son aquellas variables que se relacionan conriesgo de estancia hospitalaria prolongada y/o con riesgo de reingreso alser dados de alta del Área de Observación de Urgencias.Paciente y método: El trabajo expuesto consta de varias fases sucesivas.Se define cada etapa desde el inicio del trabajo, en el año 1995, hasta laactualidad ya que de cada una de ellas se deriva la siguiente. Estudiollevado a término en el Área de Observación de Urgencias del HospitalMútua de Terrassa mediante la utilización de “The AppropriatenessEvaluation Protocol” y aquellos intrumentos más utilizados en la ValoraciónGeriátrica Integral: para el cribado cognitivo / afectivo utilizamos elMini Examen Cognoscitivo de Lobo y el Examen Cognoscitivo SPMSQ dePfeiffer, la Escala de Depresión Geriátrica de Yesavage, el Índice deReisberg previo y el Confussion Assesment Method; el estado funcionalha estado evaluado con el Índice de Barthel previo al ingreso y el deingreso; además se ha evaluado el estado nutricional de los pacientescon la escala Mini Nutricional Assesment, el riesgo de ulceración cutáneacon la escala de Norton y se han buscado la presencia de otrossíndromes geriátricos.Resultados: Mayor número de ingresos observados en la población ≥65 años, respecto a la población adulta joven (p<0,00001). Apreciamosdiferencias significativa (p<0,0001), en favor de los ≥ 65 años, endistintos apartados referentes a la situación clínica del paciente y a lanecesidad de asistencia dentro de los criterios de ingreso adecuado. Lomismo en lo referente a la estancia adecuada. En solo 24 pacientes(0,9%), mayores 64 años, la causa de estancia inadecuada ha sidoaquella ocasionada por el medio social o la falta de recursos dentro dela red asistencial.Conclusiones: La atención geriátrica en urgencias debe basarse, en primerlugar, en el profundo conocimiento de la realidad que estamosatendiendo. En segundo lugar se debería de incrementar la formación engeriatría entre los profesionales de urgencias que deben atender a poblaciónen edad geriátrica. En tercer tener conocimiento de que los instrumentosutilizados en la práctica diaria en la atención geriátrica, sonextremadamente útiles, siempre que el paciente ya esté identificado,como geriátrico frágil, desde su entorno habitual. Una buena relación ycomunicación entre distintos niveles asistenciales, la utilización de instrumentosútiles en la valoración geriátrica integral habitual y la detecciónprecoz de los pacientes geriátricos frágiles desde las AOSU permiten,sin duda, mejorar la atención de nuestros ancianos enfermos, quesón en definitiva los que más y mejores utilizan los recursos sanitarios

Objective: Knowing the population assisted in the emergency ObservationRoom (EOR), main differential features of this population in relation to ayoung adult population while defining the clinical characteristics of elderpatients (64 year old and older) assisted in the EOR due to acute organiccondition.Describing variables related to long hospital admisión and/or to readmisiónafter discharging from EOR.Patients and Methods: This study was done in the EOR of the HospitalMútua de Terrassa using “The Appropriateness Evaluation Protocol” andthe widely used in Geriatric Assessment tools: Lobo's cognoscitive minitest,Pfeiffer's SPMSQ cognoscitive test, Yesavage's geriatric depressionscale, Reisberg´s index and Confussion Assesment Method; functionalstatus has been evaluated through Barthel’s Index; nutritional assessmentthrough Mini Nutritional Assessment and Norton's scale to evaluate skinulcer risk. Other geriatric syndromes have been evaluated.Results: More admissions were found in the population ≥ 65 year-oldrespect to young adults (p<0,00001). We apreciate significativedifferences (p<0001) in favour of those older than ≥ 65 in severalissues related to clinical situation of the patient and needing of assistanceinside appropiate admission criteria. The same for appropiate stay. Onlyin 24 older patients (0,9%) the reasion of inadequate stay has been dueto social reasons or lack of resources in the assistential network.Conclusions: Geriatric assistance in the Emergency Room must be based,first of all, in a deep knowledge of the reality we are assisting. In secondplace geriatric training should be increased in ER physicians assistinggeriatric population. In third place recognising the utility of extrematelyuseful tools in geriatric assessment whenever the patient is properlyindentified as frail elderly patientsl. A good relation and comunicationamong diferent assistential levels, the use of appropiate tools for geriatricassessment and early detection of geriatric frail patients from EOR permitto improve the atention to our ill elders who the most and better usemedical resources