Protocolo de avaliação e classificação de risco de pacientes em unidade de emergência

OBJETIVO: elaborar, validar el contenido y verificar la confiabilidad de un protocolo de clasificación de riesgo para Unidad de Emergencia. MÉTODO: desarrollada en un Hospital Universitario del interior paulista, la validación de contenido fue elaborada en dos etapas: la primera con la evaluación individual de los especialistas y la segunda con reunión entre las investigadoras y los especialistas. La aplicación del protocolo siguió guión específico. En la confiabilidad, se utilizó el método de concordancia o equivalencia entre observadores. RESULTADOS: el protocolo elaborado mostró validez de contenido y, después de efectuar las alteraciones sugeridas, la confiabilidad alcanzó resultados excelentes. CONCLUSIÓN: el diagrama del flujo de atención se mostró de aplicabilidad fácil, facilitando la búsqueda por la queja en cada prioridad de atención.OBJETIVO: elaborar e validar o conteúdo e verificar a confiabilidade de um protocolo de classificação de risco para Unidade de Emergência. MÉTODO: desenvolvido em um hospital universitário do interior paulista. A validação de conteúdo realizou-se em duas etapas: a primeira com a avaliação individual dos especialistas e a segunda com reunião entre as pesquisadoras e os especialistas. A aplicação do protocolo seguiu roteiro específico. Na confiabilidade utilizou-se o método de concordância ou equivalência entre observadores. RESULTADOS: o protocolo elaborado apresentou validade de conteúdo e, após a realização das alterações sugeridas, obtiveram-se resultados de confiabilidade excelentes. CONCLUSÃO: o fluxograma de atendimento mostrou-se de fácil aplicabilidade, sendo facilitador para a busca, pela queixa, em cada prioridade de atendimento.OBJECTIVE: to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. METHOD: the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. RESULTS: the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. CONCLUSION: the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority

Assessment and risk classification protocol for patients in emergency units

OBJECTIVE: to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit.METHOD: the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used.RESULTS: the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability.CONCLUSION: the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority

Protocolo de avaliação e classificação de risco de pacientes em unidade de emergência

to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit. METHOD: the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used. RESULTS: the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability. CONCLUSION: the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority222218225elaborar e validar o conteúdo e verificar a confiabilidade de um protocolo de classificação de risco para Unidade de Emergência. MÉTODO: desenvolvido em um hospital universitário do interior paulista. A validação de conteúdo realizou-se em duas etapas: a primeira com a avaliação individual dos especialistas e a segunda com reunião entre as pesquisadoras e os especialistas. A aplicação do protocolo seguiu roteiro específico. Na confiabilidade utilizou-se o método de concordância ou equivalência entre observadores. RESULTADOS: o protocolo elaborado apresentou validade de conteúdo e, após a realização das alterações sugeridas, obtiveram-se resultados de confiabilidade excelentes. CONCLUSÃO: o fluxograma de atendimento mostrou-se de fácil aplicabilidade, sendo facilitador para a busca, pela queixa, em cada prioridade de atendiment

Protocolo de evaluación y clasificación de riesgo de pacientes en unidad de emergencia

OBJECTIVE:to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit.METHOD:the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used.RESULTS:the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability.CONCLUSION:the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority.OBJETIVO:elaborar e validar o conteúdo e verificar a confiabilidade de um protocolo de classificação de risco para Unidade de Emergência.MÉTODO:desenvolvido em um hospital universitário do interior paulista. A validação de conteúdo realizou-se em duas etapas: a primeira com a avaliação individual dos especialistas e a segunda com reunião entre as pesquisadoras e os especialistas. A aplicação do protocolo seguiu roteiro específico. Na confiabilidade utilizou-se o método de concordância ou equivalência entre observadores.RESULTADOS:o protocolo elaborado apresentou validade de conteúdo e, após a realização das alterações sugeridas, obtiveram-se resultados de confiabilidade excelentes.CONCLUSÃO:o fluxograma de atendimento mostrou-se de fácil aplicabilidade, sendo facilitador para a busca, pela queixa, em cada prioridade de atendimento.OBJETIVO:elaborar, validar el contenido y verificar la confiabilidad de un protocolo de clasificación de riesgo para Unidad de Emergencia.MÉTODO:desarrollada en un Hospital Universitario del interior paulista, la validación de contenido fue elaborada en dos etapas: la primera con la evaluación individual de los especialistas y la segunda con reunión entre las investigadoras y los especialistas. La aplicación del protocolo siguió guión específico. En la confiabilidad, se utilizó el método de concordancia o equivalencia entre observadores.RESULTADOS:el protocolo elaborado mostró validez de contenido y, después de efectuar las alteraciones sugeridas, la confiabilidad alcanzó resultados excelentes.CONCLUSIÓN:el diagrama del flujo de atención se mostró de aplicabilidad fácil, facilitando la búsqueda por la queja en cada prioridad de atención.21822

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology