Estimación de la utilización inadecuada del servicio de urgencias de un hospital universitario

Resumen

The objective of this study is to evaluate the appropriateness of the admissions into the emergency room of a University Hospital.Methods: Longitudinal, retrospective and descriptive study of a sample of the total of clinical histories performed in the emergency room of the HUS in 2003. this has been assesed using the PAUHM instrument.Results: Out of the 1068 histories reviewed, 48.2% (515) were men and 51.8% (553) women. average Age WAS 48 TO 21 years (D.T.: 22.56). age range: 13-99 years.71.7%?3 (766) of the patients go to the emergency rooms on their own initiative , being the main reason speed and convenience; more than half, 53.5%?3 (571), come from the city of Salamanca and in 90.9%?2 (971) of the cases is not known how they have arrived at the hospital. The reasons for the consultations were: 75.2%?3 (804) an acute problem and 11.6%?2 (124) the worsening of a chronic problem. The beginning of the symptoms started in 53.7%?3 (573) of the cases a few hours earlier.87.4%?2 (933) of the patients present unchanged vital signs. there was no need for a diagnostic test in 29.4%?3 (314) of the cases nor a pathological test in 56.9%?3 (608). In 58.7%?3 (627) there was no need to start a treatment in HIS.More than half (59,3% ?3) of the urgencies were seen by a mir-i (doctor trainee) by themselves 26,9%?3 (287), or supervised 32,4% ?3 (346). 79,7%?2 (851) of the emergencies were taken care of in the Clinical Hospital at the doctor's office 53,6%?3 (573). 41%?3 (438) of the urgencies were taken care of in the evening, 39,5%?3 (422) in the morning and 19%?2 (203) at night; busiest times were from 8-12h (20,7% ?2), 15-18h (19,8%?2), 12-15h (16,4% ?2) and 18-20h (11,8% ?2). The differences in the days of the week were minimum: Monday-164, Thursday-163 and Tuesday and Wednesday-154. The differences between months were also small, August, May and JulY-100.Most of the urgencies ended with a discharge 82,1%?2 (877), being the diagnosis to the discharge in 90%?2 (961) of the cases a diagnosis CIE, mainly, traumatisms and poisoning.The visits according to PAUHm, were appropriated in 70,8%? (756) of the cases and inappropriated 28,2%?3 (301). The intensity criteria diagnostic, turned out to be the most important 65,2%?3 (696).The multi-variant study showed as independent variables associated to a greater risk of inadequacy of the visit, according to the PAUHm: referred on their own initiative , absence of diagnosis CIE, absence of personal antecedents and consultation for non-acute problems.