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      Welcoming with risk classification in teaching hospitals: assessment of structure, process and result Translated title: Acolhimento com classificacao de risco em hospitais de ensino: avaliacao da estrutura, processo e resultado Translated title: Acogida con clasificacion del riesgo en hospitales de ensenanza: evaluacion de la estructura, procesos y resultados

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          Abstract

          OBJECTIVE: to assess, from the worker's viewpoint, the structure, the process and the results of the Emergency Hospital Services that have taken up the guideline of "Welcoming with Risk Classification" in two teaching hospitals of the state of Paraná. METHOD: quantitative and descriptive research, exploratory and prospective, using random sampling stratified by professional category, comprising a universe of 216 professional people. RESULTS: they found some points of agreement regarding the promotion of a welcoming and humane environment; privacy and security; welcome and shelter of the companion and also the sheltering and classification of all patients; however, there was disagreement about the comfort of the environment, reference system and counter-reference, prioritisation of seriously ill patients in post-classification service, communication between the members of the multi-professional team and reassessment of the guideline. CONCLUSION: the workers assess the development of the guideline as being precarious, due mainly to the lack of physical structure, due to the lack of physical structure and shortcomings in the service process.

          Translated abstract

          OBJETIVO: avaliar, na ótica dos trabalhadores, a estrutura, o processo e o resultado de Serviços Hospitalares de Emergência que adotam a diretriz Acolhimento com Classificação de Risco, em dois hospitais de ensino do Estado do Paraná. MÉTODO: pesquisa quantitativa, descritiva, exploratória e prospectiva de amostragem aleatória e estratificada por categoria profissional, constituída por 216 profissionais. RESULTADOS: apontaram pontos concordantes em relação à promoção de ambiente acolhedor e humano, privacidade e segurança, acolhimento do acompanhante e acolhimento e classificação de todos pacientes, porém, houve discordância sobre o conforto do ambiente, sistema de referência e contrarreferência, priorização de pacientes graves no atendimento pós-classificação, comunicação entre os membros da equipe multiprofissional e reavaliação da diretriz. CONCLUSÃO: os trabalhadores avaliam o desenvolvimento da diretriz como precário, em razão, principalmente, da falta de estrutura física e deficiências no processo de atendimento.

          Translated abstract

          OBJETIVO: evaluar la estructura, procesos y resultados de Servicios de Emergencias Hospitalarios de que adoptaron la directriz "Acogida con Clasificación del Riesgo" desde la perspectiva de los trabajadores de dos hospitales de enseñanza en el estado de Paraná. MÉTODO: estudio cuantitativo, descriptivo, exploratorio y prospectivo con muestreo aleatorio estratificado por categoría profesional constituido por 216 profesionales de la salud. RESULTADOS: los participantes manifestaron puntos de acuerdo en relación a los siguientes ítems: promoción de ambiente acogedor y humano; privacidad y seguridad; acogida de acompañantes; acogida y clasificación de todos los pacientes. Los entrevistados manifestaron desacuerdo en relación a los siguientes aspectos: ambiente confortable; sistema de referencia y contrarreferencia; priorización de la atención de pacientes en estado grave consiguiente a la clasificación; comunicación entre los profesionales del equipo multidisciplinario; reevaluación de la directriz Acogida con Clasificación del Riesgo. CONCLUSIÓN: los trabajadores entrevistados evaluaron como precaria la implantación de la directriz Acogida con Clasificación del Riesgo, especialmente debido a falta de estructura física adecuada y deficiencias en el proceso de atención.

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          Does the Manchester triage system detect the critically ill?

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          The Manchester triage system (MTS) is now widely used in UK accident and emergency (A&E) departments. No clinical outcome studies have yet been published to validate the system. Safety of triage systems is related to the ability to detect the critically ill, which has to be balanced with resource implications of overtriage. To determine whether the MTS can reliably detect those subsequently needing admission to critical care areas. Analysis of emergency admissions to critical care areas and comparison with original A&E triage code by a nurse using the MTS at time of presentation. Retrospective coding of all cases according to the MTS by experts and case analysis to determine whether any non-urgent coding was due to the system or to incorrect coding. Sixty one (67%) of the patients admitted to a critical care area were given triage category 1 or 2 (that is, to be seen within 10 minutes of arrival). Eighteen cases given lower priority were due to incorrect coding by the triage nurse. Six cases were correctly coded by the MTS, of which five deteriorated after arrival in the A&E department. Only one case was critically ill on arrival and yet was coded as able to wait for up to one hour. The MTS is a sensitive tool for detecting those who subsequently need critical care and are ill on arrival in the A&E department. It did fail to detect some whom deteriorated after arrival in A&E. Most errors were due to training problems rather than the system of triage. Analysis of critically ill patients allows easy audit of sensitivity of the MTS but cannot be used to calculate specificity.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rlae
                Revista Latino-Americana de Enfermagem
                Rev. Latino-Am. Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
                1518-8345
                September 2013
                : 21
                : 5
                : 1179-1187
                Affiliations
                [1 ] Universidade de Sao Paulo Brazil
                [2 ] Hospital Universitario de Londrina Brazil
                [3 ] Universidade Estadual de Maringa Brazil
                [4 ] Faculdade Inga Brazil
                [5 ] Universidade Estadual do Norte do Parana Brazil
                [6 ] Hospital Universitario de Londrina Brazil
                [7 ] Universidade Estadual de Maringa Brazil
                [8 ] Universidade Estadual de Maringa Brazil
                Article
                S0104-11692013000501179
                10.1590/S0104-11692013000500023

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                NURSING

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