Avaliação da implantação de sistema de triagem cirúrgica de urgências e emergências em hospital terciário
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Data
2019-01-29
Autores
Coelho, Monique Antonia [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A classificação não eletiva de cirurgias em emergências e urgências é subjetiva e altamente variável entre os cirurgiões. Na tentativa de padronizar essa classificação e diminuir a subjetividade, o Grupo de Estudos da Sociedade Mundial de Cirurgias de Emergência, baseado na experiência adquirida em catástrofes, propôs a classificação para cirurgias de urgência em uma escala de cores que pudesse ser mais facilmente reproduzível. Este estudo avaliou a aplicabilidade do sistema Timing of Acute Care Surgery (TACS - Classificação para atendimento de cirurgias de urgência) em um hospital público terciário de um país em desenvolvimento. Métodos: Este foi um estudo longitudinal, ambispectivo, analítico, de centro único, de março a agosto de 2016 e 2017. Foram selecionadas quatro especialidades cirúrgicas; seus chefes classificaram previamente os seus procedimentos cirúrgicos de urgências e emergências de acordo com o sistema TACS. Para comparação, emergências foram consideradas como vermelhas e laranjas e urgências como amarelas, com tempo ideal para a cirurgia de 1 hora e 6 horas, respectivamente. Resultados: Os procedimentos não eletivos foram 61% do total de cirurgias. Houve predomínio das cores, vermelho, laranja e amarelo. Ocorreram várias alterações nas cores de forma ascendente. Não houve diferença na relação entre o tempo ideal para a cirurgia e o tempo real para a cirurgia antes e depois do sistema TACS. Houve melhora do tempo para cirurgias na cor amarela após o sistema TACS. Os horários noturnos e diurnos influenciaram o tempo até a cirurgia, com melhores resultados durante as noites. Conclusão: Este é o primeiro estudo que utilizou o TACS diariamente. Concluímos que o sistema TACS melhorou o tempo de cirurgia para aqueles classificados como amarelos. Planejamos medir esses parâmetros novamente após todo o processo de educação pelo qual passamos e ver se os resultados seriam diferentes. Outros estudos precisam ser feitos em diferentes configurações para testar se o sistema TACS proposto pela Sociedade Mundial de Cirurgia de Emergência é superior à nomenclatura subjetiva usada em todo o mundo.
Background: The non-elective classification of surgeries in emergencies and urgencies is subjective and highly variable between surgeons. In an attempt to standardize this classification and diminish the subjectivity, the World Emergency Surgery Study Group, based on the experience gained from catastrophes, proposed the classification for emergency surgeries in a colour scale that could be more easily reproducible. This study evaluated the applicability of the Timing of Acute Care Surgery (TACS) system in a public tertiary hospital in a developing country. Methods: This was a longitudinal, ambispective, single-centre study from March to August of 2016 and 2017. Four surgical specialties were selected; their chiefs previously classified all the acute surgical procedures based on TACS. For comparison, emergencies were considered as red and orange and urgencies as yellow, with ideal time to surgery of 1 hour and 6 hours, respectively. Results: The non-elective procedures were 61 % of the total number of surgeries. Red, orange, and yellow were predominant. There were several changes in colours in an ascending manner. There was no difference in the ratio between ideal time to surgery and actual time to surgery before and after the TACS system. There was an improvement of the time to surgeries in the yellow colour after the TACS system. Night and day times influenced the time to surgery, with better results during nights. Conclusions: This is the first study that used the TACS on a daily basis. We concluded that the TACS system improved the time to surgery for those classified as yellow. We plan to measure these parameters again after all the education process we have been through and see if the results would be different. Other studies need to be done in different settings to test if the TACS system proposed by the World Society of Emergency Surgery is superior to the subjective nomenclature used worldwide.
Background: The non-elective classification of surgeries in emergencies and urgencies is subjective and highly variable between surgeons. In an attempt to standardize this classification and diminish the subjectivity, the World Emergency Surgery Study Group, based on the experience gained from catastrophes, proposed the classification for emergency surgeries in a colour scale that could be more easily reproducible. This study evaluated the applicability of the Timing of Acute Care Surgery (TACS) system in a public tertiary hospital in a developing country. Methods: This was a longitudinal, ambispective, single-centre study from March to August of 2016 and 2017. Four surgical specialties were selected; their chiefs previously classified all the acute surgical procedures based on TACS. For comparison, emergencies were considered as red and orange and urgencies as yellow, with ideal time to surgery of 1 hour and 6 hours, respectively. Results: The non-elective procedures were 61 % of the total number of surgeries. Red, orange, and yellow were predominant. There were several changes in colours in an ascending manner. There was no difference in the ratio between ideal time to surgery and actual time to surgery before and after the TACS system. There was an improvement of the time to surgeries in the yellow colour after the TACS system. Night and day times influenced the time to surgery, with better results during nights. Conclusions: This is the first study that used the TACS on a daily basis. We concluded that the TACS system improved the time to surgery for those classified as yellow. We plan to measure these parameters again after all the education process we have been through and see if the results would be different. Other studies need to be done in different settings to test if the TACS system proposed by the World Society of Emergency Surgery is superior to the subjective nomenclature used worldwide.
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Palavras-chave
Triagem, Sistema de classificação, Cirurgias, Urgência e emergência, Serviço de atendimento agudo, Critério de triagem, Screening, Classification system, Surgeries, Urgency and emergency, Acute care service, Triage criterion