EMERGENCIAS CLINICAS USP 2015 PDF
Encontre emergencias clinicas 10 edicao no mercado livre brasil. Emergencias clinicas abordagem herlon saraiva baixe gratis o arquivo emergencias clinicas. Article (PDF Available) in Revista da Escola de Enfermagem da U S P Hospital de las Clínicas de la Facultad de Medicina de Ribeirão Preto, USP, PDF | Objective Describing the evaluation of the Structure, Process and Article (PDF Available) in Revista da Escola de Enfermagem da U S P 52 · April Formulas for the study calculations-Florianópolis, SC, Brazil, que atuam no Pronto-Socorro Adulto do Hospital das Clínicas da Universidade.
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Rev Esc Enferm USP · ; 49(3) 1 Enfermeira, Especialista em . mento às emergências clínicas, uma sala para o atendimento às emergências. Paulo (USP) – São Paulo. (SP), Brasil. [email protected] 3 École de Santé do atendimento de urgências e emergências . (PARANÁ, ) e o Cadastro Nacional .. análises clínicas em 85,7%; ultrassonografia em . Brasília, março de ISBN Brasil. DIRETORIA DO CONASS / . Hospital das Clínicas da Faculdade de Medicina da USP .
Table 1 describes the distribution according to partner hospital, unit of origin and outcome in the partner institution. The transfers occurred mainly for patients with cardiovascular problems and degenerative diseases Clinical Group , stroke and other neurological disorders Neurological Group , and trauma Surgical Group , with the aim of completion of treatment Table 1. Thumbnail Table 1 Distribution of transfers carried out according to municipality, unit of origin type and outcome in the long-stay hospital.
We estimated the Charlson index of comorbidity for patients referred to partner hospitals Table 2. Table 2 Charlson index according to partner municipality. Regarding beds in general, these and the other clinics benefited totaled a 9. We observed this total number of discharges after an increase from 15 to 30 long-stay beds.
Thumbnail Figure 2 Number of new beds offered in Intensive Therapy and Neurology Lines - Y Axis to the left by the tertiary institution according to the number of patients transferred to long-stay hospitals Columns - Y Axis to the right versus time X Axis.
The unfilled arrow marks the beginning of Stage 1 of the project and the filled arrow marks the beginning of Stage 2. The total stay in the tertiary hospital and long-stay beds was 9, patient days.
Of these, 4, were of the tertiary hospital Considering the mean length of stay of seven days in the tertiary hospital, the length of stay in partner hospitals would allow approximately new patients being treated.
There was no significant difference among partner hospitals, both in univariate analysis and multivariate analysis by logistic regression or Cox semiparametric regression Figure 3. About The Charlson index was the only variable that significantly increased the chance of death or return to the tertiary hospital Odds Ratio — 2. Figure 3 Kaplan-Meier graph for the length of stay of patients in each institution. Examining the most frequent ICD codes, we observed that those resulting from cerebrovascular diseases accounted for Considering only the death as an outcome in Cox regression analysis, none of the variables included in the model was significant.
After the expansion of the project to 30 beds, we observed a trend of increase in the general offer of beds in the tertiary hospital. The degree of comorbidity, measured by the Charlson index, was associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. Patients stayed in partner hospitals mainly in the first days.
Full management of health by the municipalities has created the understanding that each municipality should be responsible for providing such support for long-stay patients, transferring them to primary instances of SUS located in the municipalities where patients dwell.
Such transfers are desirable, especially for the benefit of maintaining family support. However, most municipalities use the system of service download of public or charity hospitals, i. Portaria no , de 27 de maio de In addition, it is accepted that the hub municipality should receive patients from other municipalities, but the smaller ones are unaware that when they receive patients from the hub municipality for high dependency care they benefit the whole system by increasing the supply of beds for tertiary emergencies.
Cad Saude Publica. Various efforts have been made for the high dependency nursing classification. Although they are contributing greatly to determine the staff necessary to provide this care, they have not progressed in the design of strategies for relocating these patients in institutions of lower complexity, optimizing SUS tertiary resources.
Texto Contexto Enferm. Patient classification system: a proposal to complement the instrument by Fugulin et al.
However, qualifying health professionals in specific skills proved to be the most important action, including not only nursing professionals, but the entire multidisciplinary health care team.
After qualification, health professionals in the partner hospitals started feeling more confident about patient care and demanding better working conditions. In addition, the Charlson index proved to predict death and return to the hospital of origin, being easily estimated using administrative data. Many cases were not transferred due to family refusal, fearing that going away from the tertiary institution would impair their treatment.
To convince them, we invited family members to visit the partner hospitals and obtained resources as the guarantee of direct return to the tertiary hospital if necessary, without intervention of the Regulation, and transportation assistance to visit patients. Family members reluctant to the transfer were stimulated to think of alternative care strategies in other health spaces, including at home.
The impact of long-stay beds on the system depends on the quantity installed, because the increase in common beds was only observed when their number went from 15 to The necessary number is still unknown; however, the transfer capability of the tertiary hospital will probably be limited in more complex cases that require an intermediate institution between the tertiary and partner hospitals. Furthermore, continuing qualification can improve transfer capability.
Regardless of the full training provided for in the ordinance, we observed The increase in discharges from the tertiary institution in stage 2 of the project did not result in a lower number of hospitalizations, as expected. The deaths occurred predominantly in patients with cerebrovascular diseases, specifically those with severe stroke sequelae. Time to death was similar among the hospitals observed, indicating that appropriate care was provided, since a shorter time would be expected in hospitals providing care inconsistent with patient needs.
The greatest mortality observed in Guariba can be explained by the increased referral of patients in serious condition.
Autorizar que um acompanhante sempre esteja presente pode ser uma alternativa a ser adotada. Certos pacientes que decidem se matar podem, deliberadamente, esconder isso da equipe assistencial.
Tal fato causa um impacto muito grande nos outros pacientes, entre os familiares e na equipe assistencial, ocasionando sentimentos de culpa, raiva e ansiedade.
Em geral, precisase ouvir muito, pois o paciente necessita falar sobre seus pensamentos e sentimentos. Ao final de 18 meses, verificou-se o que aconteceu nos dois grupos. Primary prevention of mental, neurological and psychosocial disorders. Geneva: World Health Organization; Suicide and mental disorders: do we know enough?
Br J Psychiatry. Available from: http:www. Roy A.
Suicide: a multi-determined act. Psychiatr Clin North Am. Selfdirected violence. World report on health and violence. Bertolote JM, Fleischmann A. A global perspective on the magnitude of suicide mortality. In: Wasserman D, Wasserman C, editors.
Oxford textbook of suicide and suicide prevention. The length of stay in long-stay beds was 4, patient days, which would represent patients at the tertiary hospital, considering the average hospital stay of seven days.
The tertiary hospital increased the number of patients treated in Patients stayed in long-stay beds mainly in the first 30 The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.
Rev Bras Enferm. Rev Latino Am Enfermagem.
Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med. Understanding hospital and emergency department congestion: an examination of inpatient admission trends and bed resources.
Costs of most frequent nursing activities in highly dependent hospitalized patients. Camarano AA, Kanso S. Rev Bras Estud Popul. The unpreparedness of these institutions to deal with high dependency causes a great number of acute exacerbations of chronic conditions, with high rates of counter-referral to emergency rooms. Emergency medical coordination using a web platform: a pilot study.
Rev Saude Publica.
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It has high-complexity diagnostic and treatment resources and is the only referral facility for some clinical conditions within a radius of kilometers in the northeastern state of Sao Paulo, in Brazil. Tuberculosis among health care workers in a Brazilian tertiary hospital emergency unit.
Am J Emerg Med. Technical visits were carried out and long-stay patient referral protocols were defined, registering the capabilities and responsibilities of each institution. Thumbnail Figure 1 Municipalities in the 13th regional department of health of the state of Sao Paulo, according to district. The larger sphere marks the hub municipality and the smaller spheres, the project partner municipalities, showing the strategic location of each district. Partner hospitals were selected based on the profile required by Ordinance of December 7, , and on the willingness to take the risk of carrying out the project with their own resources until receiving those offered by the state of Sao Paulo.
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The involvement in the project did not occur at the same time for all hospitals, since the time they needed to prepare for receiving patients varied among them, with a three-month interval between the first and the last one. These hospitals had different initial conditions to receive patients.
One of them was already prepared for more severe patients, while the others had to be qualified. The strategic position of these municipalities was also considered Figure 1. The tertiary hospital would free beds to receive more high-complexity patients.
Partner hospitals would have the prospect of financial gain, because for each patient day they would be given an incentive of BRL In addition, they would be connected to the tertiary hospital and receive qualification from its employees. The transfer process started with the agreement from patients and their family members, and provided an on-site visit of a family member to the partner hospital to evaluate the conditions and the guarantee of transport assistance by the city halls of the municipalities in which the patients resided so that family members could continue to visit them after the transfer.
It was clarified that, if there was any need to return the patient to a tertiary hospital, it would be done regardless of the Medical Regulation. After the agreement from the patient and family members, a bed request was made to the partner municipality, chosen by proximity from their home, bed availability or for specific hospital conditions matching the problem presented by the patient.
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No patient was transferred without the mutual agreement of the health teams of the institutions tertiary and partner and of the patient or family member. If the partner city agreed to the transfer, the patient was referred with medical, nursing, physical therapy, nutritional, psychological and social assistance reports.
These reports detailed patient needs so that treatment could be continued in the partner hospital. Five beds were initially established in each partner hospital. As financial resources were still not available at this stage September to March , each institution involved in the project contributed in some way, e. Staff of the partner hospitals was trained by the referral hospital on care that limited transfers such as tracheostomy management, use of BiPAP and preparation of special diets.
Starting in April , the project was sanctioned and financially supported by the Department of Health of the State of Sao Paulo. Other hospitals in the hub municipality began to transfer patients following the guidelines created.
If a partner kept its 10 beds occupied the whole month, their revenue would correspond to three to four times its total monthly revenue. Patients ceased to be monitored only when they left the partner hospital by death or discharge , making these hospitals an extension of the tertiary one.
Categorical variables were expressed as percentages and quantitative variables as mean and standard deviation or median and interquartile range, according to their distribution. Survival analysis was used to evaluate the length of stay of referred patients in each partner hospital.
In these cases, discharge, death or transfer were considered outcomes.Examining the most frequent ICD codes, we observed that those resulting from cerebrovascular diseases accounted for La Celula - Geoffrey M.
Ecologia de individuos a Ecossistemas - 4 Ed. Harrison-medicina-internaed- Vol 1. Ao final de 18 meses, verificou-se o que aconteceu nos dois grupos.
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