Abstract
BackgroundThe public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity. The knowledge of this phenomenon induced Ribeirão Preto to implement the Medical Regulation Office and the Mobile Emergency Attendance System. The objective of this study was to analyze the impact of these services on the gravity profile of non-traumatic afflictions in a University Hospital.MethodsThe study conducted a retrospective analysis of the medical records of 906 patients older than 13 years of age who entered the Emergency Care Unit of the Hospital of the University of São Paulo School of Medicine at Ribeirão Preto. All presented acute non-traumatic afflictions and were admitted to the Internal Medicine, Surgery or Neurology Departments during two study periods: May 1996 (prior to) and May 2001 (after the implementation of the Medical Regulation Office and Mobile Emergency Attendance System). Demographics and mortality risk levels calculated by Acute Physiology and Chronic Health Evaluation II (APACHE II) were determined.ResultsFrom 1996 to 2001, the mean age increased from 49 ± 0.9 to 52 ± 0.9 (P = 0.021), as did the percentage of co-morbidities, from 66.6 to 77.0 (P = 0.0001), the number of in-hospital complications from 260 to 284 (P = 0.0001), the mean calculated APACHE II mortality risk increased from 12.0 ± 0.5 to 14.8 ± 0.6 (P = 0.0008) and mortality rate from 6.1 to 12.2 (P = 0.002). The differences were more significant for patients admitted to the Internal Medicine Department.ConclusionThe implementation of the Medical Regulation and Mobile Emergency Attendance System contributed to directing patients with higher gravity scores to the Emergency Care Unit, demonstrating the potential of these services for hierarchical structuring of pre-hospital networks and referrals.
Highlights
The public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity
With the clear expansion of primary care and pre-hospital emergency care, which has occurred with international financial help, the general clinical attendance and emergency care management continue to be centralized in hospitals designed to guarantee first aid to patients presenting acute diseases of all levels of severity, creating excessive demands on hospitals of greater complexity located in large urban centers such as the city of Ribeirão Preto [4]
The APACHE II was chosen by its easy retrospective application, the experience accumulated with its use in front of various clinical and surgical situations and of the capacity to serve as an indicator of changes in the
Summary
The public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity. The knowledge of this phenomenon induced Ribeirão Preto to implement the Medical Regulation Office and the Mobile Emergency Attendance System. The Unified Health System of Brazil, instituted in 1988, is organized into a network of increasing complexity, with integrated, regionalized hierarchies that ensure that the principles of equity in access to health resources, universality and integration of care are guaranteed for all citizens [1-3]. It has 761 beds distributed between the University Campus Unit (with 604 beds for elective admissions) and the Emergency Center (EC) downtown (with 157 beds for emergency admissions, being 43 for critical care [4])
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