医疗监管办公室和移动应急出勤系统的实施及其对大学医院治疗的非创伤性疾病严重程度概况的影响：一项研究

The implementation of the Medical Regulation Office and Mobile Emergency Attendance System and its impact on the gravity profile of non-traumatic afflictions treated in a University Hospital: a research study.

作者信息

Lopes Sérgio L B, Dos Santos José Sebastião, Scarpelini Sandro

机构信息

Department of Medicine, University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Rua Bernardino de Campos, 1000, Ribeirão Preto, São Paulo, Brazil.

出版信息

BMC Health Serv Res. 2007 Oct 24;7:173. doi: 10.1186/1472-6963-7-173.

DOI:10.1186/1472-6963-7-173

PMID:17958885

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2194684/

Abstract

BACKGROUND

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 objective of this study was to analyze the impact of these services on the gravity profile of non-traumatic afflictions in a University Hospital.

METHODS

The 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.

RESULTS

From 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.

CONCLUSION

The 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.

摘要

背景

巴西的公共卫生系统由一个日益复杂的网络构成，但院前急救单位的低分辨率以及患者流量缺乏组织使医院不堪重负，尤其是那些复杂度较高的医院。对这一现象的了解促使里贝朗普雷图实施了医疗监管办公室和移动紧急出诊系统。本研究的目的是分析这些服务对一家大学医院非创伤性疾病严重程度分布的影响。

方法

该研究对906名13岁以上进入圣保罗大学医学院里贝朗普雷图医院急诊科的患者的病历进行了回顾性分析。所有患者均患有急性非创伤性疾病，并在两个研究时间段内被内科、外科或神经科收治：1996年5月（实施前）和2001年5月（实施医疗监管办公室和移动紧急出诊系统后）。确定了人口统计学数据以及通过急性生理学和慢性健康状况评估II（APACHE II）计算出的死亡风险水平。

结果

从1996年到2001年，平均年龄从49±0.9岁增至52±0.9岁（P = 0.021），合并症百分比从66.6%增至77.0%（P = 0.0001），院内并发症数量从260例增至284例（P = 0.0001），计算得出的APACHE II平均死亡风险从12.0±0.5增至14.8±0.6（P = 0.0008），死亡率从6.1%增至12.2%（P = 0.002）。在内科收治的患者中，差异更为显著。