Public Health

Médodo emergency care reduces overcrowding and time of surgical decision

Acute Care Surgical Emergency Service (ACCESS) decreased by 15% the time of referral to surgery

Foto: Divulgação/Arsenator
Uso do serviço Acute Care Emergency Surgical Service (ACCESS) pode reduzir a superlotação nos atendimentos de emergência
Uso do serviço Acute Care Emergency Surgical Service (ACCESS) pode reduzir a superlotação nos atendimentos de emergência

Use of Acute Care Surgical Emergency Service (ACCESS), emergency services, can lead to significant reductions in key measures of patient care, such as length of stay, time of surgical decision making and "time litter" ( a measure of overcrowding in emergency), according to a study published in the August issue of the Journal of the American College of Surgeons.

Emergency departments are a crucial point of access to health care for patients with a wide spectrum of injuries and illnesses, and overcrowding has been identified as a widespread and serious problem, with adverse consequences. "This is the first study to show that the establishment of an acute care service to general surgery can improve emergency care (AE), reducing overcrowding and the decision time for all surgical patients in general surgery. In the last five years there was a great support both in Canada and the USA to create these services for various reasons, such as the increasing difficulty of surgical treatment of acute conditions and a decrease in cases of surgical trauma surgery, "said the study's senior author, Tien Homer, Associate Scientist Sunnybrook Health Sciences Centre, University of Toronto.

The researchers found that the implementation of access is linked to a 15% reduction in surgical decision time (12.6 hours vs. 10.8 hours) and a 20% decrease in the average "time on a stretcher" for all patients in an emergency. The researchers also focused on an isolated group of cases of appendicitis and found access service reduced the time to decision for surgery by 30 percent for these patients.

The study was conducted between January 1, 2007 and June 30, 2009, the Center for Health Sciences and Sunnybrook, Toronto academic hospital, which receives approximately 42,000 calls per year. ACCESS was implemented in LA in July 1, 2008 and 2510 patients participated in the study. There were 1,448 patients in the pre-access and access in the post-1062. The primary study outcome was the time of surgical decision, the secondary outcome was a general measure of overcrowding in AE.

In order to better understand the fundamental factors that contribute to overcrowding, the researchers developed a conceptual model that partitioned the overcrowding of the LA in three interdependent components: income, input and output. The input component refers to factors that contribute to the volume of calls to the emergency room. The component of income refers to factors that contribute to the time a patient spends in the LA. The inability to move patients to an LA hospital bed is considered one of the main factors contributing to the overcrowding of emergency care.