FIRST EVALUATION OF NURSE’S CARE AT EMERGENCY ROOMS: THE APPROXIMATE OF MODEL THE CASE MANAGEMENT STRATEGY

 

Marcia Silva Valentim, MPEA/UFF.

 Advisor: Drº Mauro Leonardo Salvador Caldeira dos Santos/ Escola de Enfermagem - Universidade Federal Fluminense (UFF)

 Bibliografic reference: Valentim MRS. Avaliação primária do enfermeiro na emergência: a aproximação da estratégia do modelo de Gerenciamento de Caso. [Dissertação] Niterói (RJ): Universidade Federal Fluminense; 2006.

Abstract: This paper reflects the current problem of difficulties in attending first care cases at emergency rooms in health care and the population difficulty to make an immediate appointment at day units, causing an increase in the number of people who look for tertiary care services, overloading the emergency rooms1 2. The scenario observed at the moment is that the emergency rooms from private and public hospitals are gradually getting more and more full, making the real emergency care patient, whose life is in risk, wait for hours for a medical care3. The purpose of this research is to identify the effectiveness of the nurse’s care in the first evaluation and to describe the use of the case management4 strategy in the emergency room. The main scope of the discussions about the case manager role was based on a Commission that focus the definition of management as a pro-active process, which provides access to a care with quality, safety, efficiency and in a short time, where the case manager works with 07 elements to develop his/her activities: Punctuation, Planning, Implementation, Coordination, Monitorizing, Evaluation and Results5. For quantity approach research, the statistical method was used, whereas for data collect and analysis, the EPI INFO software was used. The collect of data was done with 1,184 medical care reports collected in January and February of 2005 from adult patients of medical clinic with 1, 2 and 3 clinical complexity cared by the nurse on the first evaluation. The variables taken from the medical care reports were divided in three categories to identify the effectiveness and describe the link of the Case Manager on the first evaluation made by the nurse in the emergency room: Care fragment, Clinic making decision and Care Monitorizing. The results found in the fragment care category were: In complexity 1: 65,8% of patients did not have fragmented care, in complexity 2: 78,3% and in complexity 3: 82,6%. In making decision category the results found were that from the patients cared by the nurse, 68,8% had their syndromic diagnoses checked. In care monitorizing, the patients of complexity 3: 34,6% had monitorized care related to the risk factors. We conclude that the relation  to what it is offered by the nurse care generates effectiveness, however in relation to the ideal we face limits in the medical reports. On the other hand, the steps described in the case management get closer to be applied to the emergency nurse work. Based on the inconsistencies and limitations of the research due to the data collect instrument, we suggest and recommend a technical improvement on the medical care report, mainly in the history taking by the nurse because of its importance in defining the kinds of complexity and syndromic diagnoses, for the nurse be able to register his/her performance as case manager and facilitate the evaluation in each category proposed.

Main Bibliografy

 1.Toscano LNP. Uma ferramenta integrada de suporte a decisões em casos de emergências médicas hospitalares. [Tese] Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro/COPPE; 2001.

2.Rotstein Z. Management by constraints: considering patient volume when adding medical staff to the emergency departament. Int Med Australian J 2002; 4:171-174.

3.Goldim JR. Aspectos Éticos da Assistência em Situações de Emergência e Urgência. Disponível em <http://www.bioetica.ufrgs.br/emergen.htm>.  Acesso em: 15 jul 2003.

4.Gonzales RIC, Casarin SNA, Caliri MHL, Sassaki CM, Monroe MA, Villa TCS. Gerenciamento de Caso: Um novo enfoque no cuidado à saúde. Rev. Latino–am Enfermagem 2003 mar/abr; 11(2): 227-31.

5.Sabbadini SF, Gonçalves AA. A Unidade de emergência no Contexto do Ambiente Hospitalar. Artigos Originais P 1-13

Adress for correspondence: Márcia Rejane da Silva Valentim. marciarv@superig.com.br

Fellowship: Hospital de Clínicas Niterói

Received Aug 19th, 2007

Accepted: Aug 25th , 2007