Triage: experiencia en un Servicio de Urgencias Pediátricas
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Rev. bol. ped.
Abstract
Introducción: Los sistemas Triage (neologismo: selección o clasificación) son una forma de organización de los servicios de urgencia. Toma en cuenta número de pacientes, urgencia del cuadro y recursos disponibles; busca mejorar la accesibilidad a la atención médica urgente y disminuir tiempos de espera. Objetivos: Evaluar el resultado de la aplicación de un sistema Triage en el servicio de urgencias pediátricas del Hospital Central del Instituto de Previsión Social (HCIPS). Diseño y Metodología: Estudio observacional descriptivo, prospectivo, sobre 1122 niños que consultaron en julio de 2005, de 07:00 a 16:00 horas de lunes a viernes. Los datos asientan en el sistema informático y fueron tabulados mediante el programa Microsoft Excel. Se elaboró un listado de patologías y signos y/o síntomas a considerarse como urgentes, por gravedad y riesgo de compromiso vital, número de pacientes y frecuencia de su presentación en este servicio. Se denominó prioridad uno (P1) a las que requerían atención inmediata y prioridad dos (P2) al resto. Se marcó como tiempo de corte 30 minutos para evaluar la capacidad de atención a los pacientes de mayor gravedad. Resultados: Total de pacientes clasificados como P1: 272/ 1122(24%), P2 850/1122 (76%). Mediana de tiempo de espera fue para P1: 10 min., p25 - p75 (5-13min) tiempo máximo para la atención fue 65 min. Para P2 la mediana fue 65 min. p25-p75 (20-139min) tiempo máximo para la atención 300min; la proporción atendida dentro de los primeros 30 minutos fue P1: 79 %; P2: 36%. Pacientes hospitalizados según prioridad: P1: 25/272 (9%), ninguno del grupo de P2. Conclusión: La implementación de un sistema Triage, en el servicio de urgencias pediátricas del HCIPS, permitió conocer que solo una cuarta parte de los pacientes que acuden a la consulta fueron clasificados como urgencias, lo que hace presumir, por la similitud de los motivos de consulta, que la gran mayoría de los mismos, representan a aquellos que no pudieron ser absorbidos por los consultorios externos. Demostró que más de las tres cuartas partes de las urgencias fueron atendidas dentro de los treinta minutos de su admisión.
Introduction: Triage systems are a way to organize emergency services, taking the number of patients, urgency of the clinical situation and available resources into account, in order to improve access to emergency medical care and decrease waiting times. Objectives: To evaluate the results of the application of a triage system in the pediatric emergency service of the Hospital Central del Instituto de Previsión Social (HCIPS). Design and Methods: Observational, descriptive, prospective study including 1122 children seen in July 2005, between 7AM and 4PM from Monday to Friday. Data were taken from computer records and analyzed using Microsoft Excel. A list was drawn up of diseases and signs and/or symptoms to be considered urgent due to severity or risk of death, the number of patients and their frequency at the hospital. Those requiring immediate care were categorized priority 1 (P1), and the remainder were called priority 2 (P2). Thirty minutes was designated as the cut-off point for evaluating the more severely ill patients. Results: Total number of patients designated P1: 272/ 1122(24%), P2: 850/1122 (76%). Median waiting time for P1: 10 min., p25 - p75 (5-13min) maximum waiting time was 65 min. For P2 median was 65 min. p25 -p75 (20-139min) maximum waiting time 300min. The proportion of patients seen within 30 minutes was P1: 79 %; P2: 36%. Patients were admitted according to priority: P1: 25/272 (9%), none of P2. Conclusion: the implementation of a triage system in the pediatric emergency service of the HCIPS showed that one quarter of patients coming to the service were considered emergencies. Presumably, and given the similarity in chief complaints, most cases were patients who had not been able to see a physician in the out patient clinic that day. Over three fourths of all emergency patients were seen within thirty minutes.
Introduction: Triage systems are a way to organize emergency services, taking the number of patients, urgency of the clinical situation and available resources into account, in order to improve access to emergency medical care and decrease waiting times. Objectives: To evaluate the results of the application of a triage system in the pediatric emergency service of the Hospital Central del Instituto de Previsión Social (HCIPS). Design and Methods: Observational, descriptive, prospective study including 1122 children seen in July 2005, between 7AM and 4PM from Monday to Friday. Data were taken from computer records and analyzed using Microsoft Excel. A list was drawn up of diseases and signs and/or symptoms to be considered urgent due to severity or risk of death, the number of patients and their frequency at the hospital. Those requiring immediate care were categorized priority 1 (P1), and the remainder were called priority 2 (P2). Thirty minutes was designated as the cut-off point for evaluating the more severely ill patients. Results: Total number of patients designated P1: 272/ 1122(24%), P2: 850/1122 (76%). Median waiting time for P1: 10 min., p25 - p75 (5-13min) maximum waiting time was 65 min. For P2 median was 65 min. p25 -p75 (20-139min) maximum waiting time 300min. The proportion of patients seen within 30 minutes was P1: 79 %; P2: 36%. Patients were admitted according to priority: P1: 25/272 (9%), none of P2. Conclusion: the implementation of a triage system in the pediatric emergency service of the HCIPS showed that one quarter of patients coming to the service were considered emergencies. Presumably, and given the similarity in chief complaints, most cases were patients who had not been able to see a physician in the out patient clinic that day. Over three fourths of all emergency patients were seen within thirty minutes.
Description
Vol. 46, No. 1