The emerging patient in the emergency department: stratification

stratification of clinical risk

Abstract

Introduction: The Emergency Department attendance increase leads to the need to implement an effective process in the management of healthcare foremerging patients. The triage system prevails, as an answer to this problem. It is an instrument that establishes the clinical priority of care for the first medicalobservation and, in this way, promotes the management of clinical risk and equity in access to the Emergency Service.

Objective: To determine the most prevalent clinical risk level in emerging priority clients.

Methods: Descriptive study, with a retrospective cohort, carried out in patients who were screened with emerging clinical priority upon admission to the emergency department, in which 52.7% of the sample was male. Data were collected by consulting the Alert® Information System of a hospital in the Center region of Portugal.

Results: The prevailing clinical risk level for males was 10 (ten) and 7 (seven) for females. It was observed that 61.9% of clients with clinical risk belong to the age group greater than or equal to 71 years. The factors: age less than or equal to 70 years (OR=0.422), length of stay in the emergency room less than or equal to 120 minutes and between 120 and 240 minutes, and the shortest medical observation time (1 to 10 minutes), represented a decrease in clinical risk of 57.8%, 94.7%, 67.7% and 72.9%, respectively. On the other hand, a stay longer than 240 minutes represented an increase in the risk index of 152.8%. The odds ratio of the occurrence of cardiopulmonary resuscitation maneuvers (OR=0.333) decreases to 66.7% the risk level when they are not performed.

Conclusion: The variables male gender, age over 70 years and length of stay proved to be determinants of clinical risk, which is why it is important to considerthem when managing emergent treatment in the emergency department.