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Advisor(s)
Abstract(s)
Introdução: A triagem de prioridades representa uma etapa fundamental na
abordagem e gestão de situações em que o número de doentes excede a capacidade de
resposta das equipas de socorro, classificando-os por diferentes níveis de gravidade, o
que proporciona uma observação mais rápida, pelas equipas médicas, aos mais graves.
Contudo, independentemente do número absoluto de doentes, a triagem pode ser útil na
gestão de risco do doente individual. O Sistema de Triagem de Manchester é o sistema
usado em Portugal, alocando os doentes em uma das cinco categorias de urgência, que
determinam o máximo de tempo até ao primeiro contacto com um médico. Para além
disso, estudos apontam para a sua capacidade em predizer a evolução dos doentes
durante a sua permanência hospitalar, ou seja, mostrou-se uma ferramenta muito
poderosa para discriminar, entre outros, o risco de morte, necessidade de internamento
hospitalar e consumo de recursos.
É com base nisto, e também pela evidente necessidade de mais estudos que validem a
crucial fiabilidade e reprodutibilidade do Sistema de Triagem de Manchester, que a
relevância deste trabalho surge.
Objetivo: Com este estudo pretende-se validar a eficácia do Sistema de Triagem de
Manchester em diferenciar e responder, convenientemente, às situações de urgência,
enquanto no seu uso na realidade específica do Centro Hospitalar Universitário Cova da
Beira.
Metodologia: Constitui-se como um estudo observacional, analítico e retrospetivo,
cuja população-alvo são os doentes classificados de “Muito Urgentes” – Pulseira Laranja,
e os classificados de “Pouco Urgentes” – Pulseira Verde, pelo Sistema de Triagem de
Manchester, desde o dia 1 de janeiro de 2019 ao dia 12 de agosto de 2019, admitidos na
Urgência Geral do Centro Hospitalar Universitário Cova da Beira, o que perfaz uma
amostra de 3503 casos. Posteriormente, à extração dos dados que interessavam do
sistema operativo ALERT, realizou-se a análise estatística recorrendo-se ao programa
SPSS ®.
Resultados: Identificaram-se diferenças significativas entre os dois níveis de
prioridade clínica analisados. Mais concretamente, observou-se uma menor carga de
trabalho associada aos cuidados prestados, menor intervalo de tempo desde o momento
de entrada nos administrativos até ao momento da primeira observação médica, menor intervalo de tempo desde o momento do fim da triagem até ao momento da primeira
observação médica, tempo de permanência no Serviço de Urgência superior e gravidade
do destino dos doentes maior, com consequente maior percentagem de óbitos e de
internados em Unidade de Cuidados Intensivos, nos casos triados como Pulseira Laranja
por comparação com os Triados com Pulseira Verde. Verificou-se, também, similaridade
na velocidade de resposta dos processos administrativos e de triagem por parte dos
enfermeiros, para os dois níveis de urgência em estudo.
Conclusão: Evidenciaram-se resultados que validam o uso do Sistema da Triagem de
Manchester na realidade específica do Centro Hospitalar Universitário Cova da Beira.
Assim sendo, a maioria das hipóteses, inicialmente, postuladas foram confirmadas.
Ademais, identificaram-se elementos em que a intervenção em prol da melhoria é
necessária, sobretudo no que se refere ao número de especialidades médicas que
observam os Pulseira Verde, pela evidência de um maior número de especialidades
médicas que observaram estes casos face aos Pulseira Laranja.
Introduction: Priority triage is a key step in the approach and management of situations in which the number of patients exceeds the response capacity of the rescue teams, classifying them by different levels of severity, which provides faster observation by medical teams of the most severe patients. However, regardless of the absolute number of patients, triage can be useful in individual patient risk management. The Manchester Triage System is the system used in Portugal, allocating patients to one of five emergency categories, which determine the maximum time until first contact with a physician. In addition, studies point to its ability to predict the evolution of patients during their hospital stay, that is, it has proven to be a very powerful tool to discriminate, among others, the risk of death, the need for hospitalization and resource consumption. It is on this basis, and also due to the evident need for further studies to validate the crucial reliability and reproducibility of the Manchester Triage System, that the relevance of this work arises. Objective: This study aims to validate the effectiveness of the Manchester Triage System in differentiating and responding appropriately to emergency situations, while using it in the specific reality of the Cova da Beira University Hospital Center. Methodology: This is an observational, analytical and retrospective study, whose target population are the patients classified as "Very Urgent" - Orange Color, and those classified as "Less Urgent" - Green Color, by the Manchester Triage System, from January 1, 2019 to August 12, 2019, admitted to the General Emergency Department of the Cova da Beira University Hospital Center, which amounts to a sample of 3503 cases. After extracting the relevant data from the ALERT operating system, statistical analysis was performed using the SPSS® software. Results: Significant differences were identified between the two levels of clinical priority analyzed. More specifically, we observed a lower workload associated with the care provided, a shorter time interval from the moment of admission to the administrative department until the first medical observation, a lower time interval from the end of triage until the moment of the first medical observation, a longer length of stay in the Emergency Department and a higher severity of patient outcome, with a consequent higher percentage of deaths and admissions to the Intensive Care Unit in cases triaged as Orange Color compared to those triaged with Green Color. A similarity was also found in the speed of response of administrative processes and triage by nurses, for both levels of urgency in this study. Conclusion: Results were found to validate the use of the Manchester Triage System in the specific reality of the Cova da Beira University Hospital Center. Thus, most of the hypotheses initially postulated were confirmed. Furthermore, elements were identified where intervention for improvement is needed, particularly with regard to the number of medical specialties observing Green Color cases, by the evidence of a greater number of medical specialties observing these cases compared to Orange Color cases.
Introduction: Priority triage is a key step in the approach and management of situations in which the number of patients exceeds the response capacity of the rescue teams, classifying them by different levels of severity, which provides faster observation by medical teams of the most severe patients. However, regardless of the absolute number of patients, triage can be useful in individual patient risk management. The Manchester Triage System is the system used in Portugal, allocating patients to one of five emergency categories, which determine the maximum time until first contact with a physician. In addition, studies point to its ability to predict the evolution of patients during their hospital stay, that is, it has proven to be a very powerful tool to discriminate, among others, the risk of death, the need for hospitalization and resource consumption. It is on this basis, and also due to the evident need for further studies to validate the crucial reliability and reproducibility of the Manchester Triage System, that the relevance of this work arises. Objective: This study aims to validate the effectiveness of the Manchester Triage System in differentiating and responding appropriately to emergency situations, while using it in the specific reality of the Cova da Beira University Hospital Center. Methodology: This is an observational, analytical and retrospective study, whose target population are the patients classified as "Very Urgent" - Orange Color, and those classified as "Less Urgent" - Green Color, by the Manchester Triage System, from January 1, 2019 to August 12, 2019, admitted to the General Emergency Department of the Cova da Beira University Hospital Center, which amounts to a sample of 3503 cases. After extracting the relevant data from the ALERT operating system, statistical analysis was performed using the SPSS® software. Results: Significant differences were identified between the two levels of clinical priority analyzed. More specifically, we observed a lower workload associated with the care provided, a shorter time interval from the moment of admission to the administrative department until the first medical observation, a lower time interval from the end of triage until the moment of the first medical observation, a longer length of stay in the Emergency Department and a higher severity of patient outcome, with a consequent higher percentage of deaths and admissions to the Intensive Care Unit in cases triaged as Orange Color compared to those triaged with Green Color. A similarity was also found in the speed of response of administrative processes and triage by nurses, for both levels of urgency in this study. Conclusion: Results were found to validate the use of the Manchester Triage System in the specific reality of the Cova da Beira University Hospital Center. Thus, most of the hypotheses initially postulated were confirmed. Furthermore, elements were identified where intervention for improvement is needed, particularly with regard to the number of medical specialties observing Green Color cases, by the evidence of a greater number of medical specialties observing these cases compared to Orange Color cases.
Description
Keywords
Centro Hospitalar Universitário Cova da Beira Muito Urgentes Pouco Urgentes Serviço de Urgência Sistema de Triagem de Manchester Validação