A Classificação de Risco foi implantada nos serviços de urgência com a finalidade de priorizar o atendimento, considerando a gravidade da situação clínica e a necessidade de cuidados imediatos dos usuários. No entanto, há dificuldades em relação ao desenvolvimento desta atividade pelo enfermeiro. Assim, o objetivo do estudo é avaliar a Classificação de Risco nos serviços de urgência na perspectiva dos enfermeiros. Para atingir essa finalidade foi realizado estudo exploratório, quantitativo, de mensuração de opinião, por meio da técnica Delphi. Foram realizadas três rodadas de aplicação de questionários interativos, que circularam entre os participantes até obtenção de consenso. Para a composição do painel dos especialistas foi utilizada a técnica de bola de neve. Os dados foram coletados por meio de questionário inserido na plataforma eletrônica SurveyMonkey®, de acesso on-line, e foram submetidos a tratamento estatístico. Foi estipulado como consenso o percentual acima ou igual a 70% das respostas. Os resultados obtidos indicaram que a Classificação de Risco é um dispositivo orientador de fluxo de usuários e de priorização da gravidade clínica, contribuindo para a diminuição do tempo de espera dos pacientes em condições clínicas graves e permitindo a redução de agravos e sequelas de pacientes urgentes. Além disso, os participantes concordaram que a classificação de risco organiza o trabalho dos enfermeiros e do serviço de urgência. A avaliação do estado clínico por meio do desenvolvimento da escuta qualificada às queixas dos usuários foi identificada como uma das ações dos enfermeiros na classificação de risco, sendo que a autonomia no exercício dessa atividade foi considerada como uma das potencialidades. Quanto à formação necessária para a realização da classificação de risco, foi indicado o conhecimento clínico como base para a tomada de decisão na priorização do atendimento ao paciente. A experiência profissional em classificação de risco foi também identificada para o julgamento da prioridade de atendimento do paciente e a capacidade intuitiva foi apontada como facilitadora. Para isso, os enfermeiros necessitam de habilidades de comunicação e de enfrentamento dos conflitos com os usuários. Dentre as fragilidades, houve consenso de discordância de que o ambiente da classificação de risco seja capaz de promover o acolhimento do paciente e de favorecer a privacidade. Foi considerado que o dimensionamento do número de enfermeiros por turno de trabalho não é suficiente para a realização da classificação de risco nos serviços de urgência, de forma que a demanda excessiva de usuários e o número inadequado de profissionais podem expor os enfermeiros da classificação de risco à elevada carga de trabalho. Também houve consenso de discordância quanto à disponibilização de capacitações periódicas aos enfermeiros sobre a utilização dos protocolos/escalas de classificação de risco. Quanto à fragilidade de ações dos enfermeiros na classificação de risco, foi indicada a falta de reavaliação da condição clínica do paciente durante o período de tempo de espera pelo atendimento, o que pode gerar agravamento da condição clínica do paciente e prejuízos ao exercício profissional do enfermeiro. Conclui-se que os enfermeiros representam suporte profissional, cognitivo e emocional na Classificação de Risco. Os resultados sinalizam que a qualificação permite que os enfermeiros continuem atuando na avaliação e classificação do risco nos serviços de urgência e permanecerão realizando essa atividade no futuro. / The Risk Classification was deployed in emergency services in order to prioritize care, considering the severity of clinical status and need immediate attention from users. However, there are difficulties regarding the development of this activity by nurses. The objective of the study is to evaluate the triage performed at emergency services, from the nurses‘ perspective. To achieve this purpose was conducted exploratory study, quantitative measurement of opinion by the Delphi technique. The subjects answered interactive questionnaires, which circulated among the participants for three rounds, until reaching consensus. The board of experts was composed using the snowball method. Data were collected using a questionnaire available on SurveyMonkey®,an online electronic platform, and submitted to statistical analysis. It was established that consensus would be reached when 70% or more answers were equal. The findings show that triage is a tool that guides patient flow and rates clinical severity, thus contributing to reducing the waiting time for patients in severe clinical conditions, and permitting to reduce complications and sequels in emergency patients. Furthermore, the participants agreed that triage organizes the work of nurses and the emergency service. It was identified that the evaluation of the clinical condition by carefully listening to the patient‘s complaints was one of the actions that nurses used to classify the risk, and that the autonomy of this activity was considered one of its strengths. As to the necessary training to conducttriage, it was indicated that clinical knowledge should be the foundation for making decisions when establishing priorities in patient care. Professional experience was also considered important in triage to judge the priority of patient care, and intuition was pointed out as a facilitator. Nurses, therefore, must have communication skills as well as coping skills to deal with the patients‘ conflicts. Among the weaknesses, there was consensus of the disagreement that the triage environment promotes patient embracement and offers privacy. It was considered that nurse staffing per working shift is insufficient to perform triage at emergency services, in a way that the excessive demand of patients and the insufficient number of professionals can expose triage nurses to high work overload. There was also consensus regarding the disagreement of the availability of periodic training for nurses on how to use triage protocols/scales. Regarding the weaknessof the triage nurses‘ practice, it was indicated there was a lack of reevaluations of the patient‘s clinical condition during the waiting time, which could worsen the patient‘s clinical condition and harm the nurses‘ practice. In conclusion, nurses represent professional, cognitive and emotional support to triage. The findings indicate that qualification allows nurses to continue conducting triage at emergency services and will continue performing this activity in the future. / La clasificación de riesgo se desplegó en los servicios de emergencia con el fin de priorizar la atención, teniendo en cuenta la gravedad de la situación clínica y la necesidad de atención inmediata por parte de los usuarios. Sin embargo, existen dificultades en relación con el desarrollo de esta actividad por las enfermeras. El objetivo del estudio es evaluar la clasificación de riesgo los servicios de emergencia desde la perspectiva de las enfermeras. Para lograr este propósito se realizó un estudio exploratorio, la medición cuantitativa de la opinión por la técnica Delphi. Se realizaron tres rondas de aplicación de cuestionarios interactivos, que circularon entre los participantes hasta obtenerse consenso. Para conformar el panel de especialistas se utilizó la técnica de la bola de nieve. Datos recolectados mediante cuestionario ingresado en plataforma informática SurveyMonkey®, disponible online, sometidos a tratamiento estadístico. Fue estipulado como consenso un porcentaje igual o superior al 70% de respuestas. Los resultados obtenidos indicaron que la Clasificación de Riesgo es un dispositivo orientador de flujo de usuarios y de priorización de gravedad clínica, contribuyendo a disminuir el tiempo de espera de pacientes en condiciones clínicas graves y permitiendo la reducción de agravamientos y secuelas en pacientes de urgencia. Además, los participantes concordaron en que la clasificación de riesgo organiza el trabajo de los enfermeros y del servicio de urgencias. La evaluación del estado clínico mediante el desarrollo de escucha calificada de quejas de pacientes fue señalada como una de las acciones de enfermería en la clasificación de riesgo, considerándose la autonomía en el ejercicio de la actividad como una de las potencialidades. Respecto a la formación necesaria para realización de clasificación de riesgo, se indicó el conocimiento clínico como base para toma de decisiones en priorización de atención del paciente. La experiencia profesional en clasificación de riesgo fue también mencionada para determinar la prioridad de atención del paciente, la capacidad intuitiva resultó señalada como facilitadora. Para ello, los enfermeros necesitan poseer habilidades comunicacionales y de enfrentamiento a los conflictos de los pacientes. Entre las fragilidades, hubo consenso de discordancia sobre que el ámbito de clasificación de riesgo sea capaz de promover la recepción del paciente y favorecer su privacidad. Se consideró que el dimensionamiento numerario de enfermeros por turno laboral es insuficiente para la realización de clasificación de riesgo en los servicios de urgencias, dado que la demanda excesiva de pacientes y la escasez de exponen a los enfermeros de clasificación de riesgo a una carga laboral elevada. También hubo consenso de discordancia respecto a la disponibilización de capacitación periódica para los enfermeros sobre la utilización de protocolos/escalas de clasificación de riesgo. Acerca de la fragilidad de acciones de los enfermeros en la clasificación de riesgo, se indicó la falta de reevaluación de la condición clínica del paciente durante el tiempo de espera previo a la atención, lo cual puede agravar la condición clínica del mismo y perjudicar el ejercicio profesional del enfermero. Se concluye en que los enfermeros representan soporte profesional, cognitivo y emocional en la Clasificación de Riesgo. Los resultados señalan que la calificación permite que los enfermeros continúen actuando en la evaluación y clasificación del riesgo en los servicios de urgencias, y continuarán realizando dicha actividad en el futuro.

The current system and working status of medical rescue service related to mass accidents has undergone changes in recent years, including gradual development, progress, modification and improvement. Together with that development, the conditions and opportunities needed for provision of timely and high-quality urgent pre-hospital care have transformed and improved automatically. The provision of professional pre-hospital urgent care for conditions endangering human life has been becoming the basic contents of activity of the rescue service. The care can be provided through operation centres that should receive and evaluate distress calls on line 155 and through field rescue vehicles pulling out of a network of trip points all over the country. The unification of the procedures and organization when settling mass accidents constitutes an indispensable measure leading to improvement of such interventions. The adequate procedure may lead to life rescue and to mitigation of the consequences of injuries for a number of persons equal to the number of the whole year of standard activity of the medical rescue service. Of course, the opposite may apply too. Therefore each physician or rescue worker should know the basic rules of behaviour at the point of the accident. The goal of the submitted dissertation is to map the general suggestions for the work of the medical rescue service of the Czech Republic, to analyze three medical rescue services related to mass accidents - that of the South Bohemian Region, the South Moravian Region and the Vysočina Region - and to compare weak and strong points of the medical rescue service of the Czech Republic based on the analysis of the three organizations in connection to mass accidents - of the Medical rescue service of the South Bohemian Region, the South Moravian Region and the Vysočina Region. Based on the SWOT analysis of selected medical rescue services, it was possible to identify their strengths and weaknesses, opportunities and threats. Each of the analyzed medical rescue services can see the opportunities of their respective organizations in other points. The medical rescue service of the South Bohemian Region sees its opportunities in the improvement of the education and training centre; the medical rescue service of the South Moravian Region sees its opportunities in the development of solution of mass accidents and the medical rescue service of the Vysočina Region sees its opportunities in finishing the urgent admission and first aid for schools; but all the analyzed medical rescue services see their threats in the expected lack of funds, caused by funding of new ambulances or new trip points or by increasing wages in the public sector. The lack of physicians in permanent employment is not only a matter of the above stated rescue services. The problem has countrywide character at present. The importance of the lack of physicians is not proportionally dependent only on cases of mass accidents. At present, it can be stated in general that there are multiple causes of lack of interest for internal work in rescue service. Low attractiveness of work in ambulance crews of rescue services becomes one of the main causes. Also the working conditions are usually incomparable. The crew of the rescue service must perform actions of pre-hospital urgent care in field under all and any circumstances. Another difference, as compared to the work of a physician in the hospital, consists in the need of right and quick decision-making without the opportunity to consult a specialist and without support of laboratory examinations. So the rescue service physician must constantly master different situations, from childbirth to post-mortem examination.

This thesis is divided into two basic parts a theoretical and a practical one. Its aims are to evaluate the emergency preparedness of the chosen regional emergency squad to emergencies and the efficiency of the feedback on an emergency as well as to compare the amount of human forces and the means used in chosen emergencies. Hypotheses are added to individual aims. The theoretical part constitutes an introduction to the topic. The Integrated Rescue System and the classification of incidents are mentioned in the first chapter. The second chapter is focused on an emergency, its definition and a possible procedure of rescue squads dealing with an emergency as well as on the way the injured are sorted. Following chapters deal with crisis management in health care with an emphasis on crisis management planning and preparation of individual. Last two chapters of the theoretical part are devoted to the Emergency Medical Service of the Central Bohemian Region and material and technical equipment important for a successful dealing with emergencies is mentioned there. In order to achieve the first goal, i.e. to evaluate the emergency preparedness of the chosen regional emergency squad to emergencies, I made a survey via questionnaires which was divided into two parts: The purpose of the first part was to evaluate the preparedness of the Emergency Medical Service of the Central Bohemian Region as a whole, which was achieved via a questionnaire survey conducted among medical employees working in leading positions. In order to compare the survey results with those of the South Moravian and South Bohemian Regions, the questionnaire was borrowed from Mgr. Zuzana Němečková after her personal consent. The second part is based on a survey via questionnaires the target group of which was the medical personnel of the Emergency Medical Service of the Central Bohemian Region. The questionnaire was designed according to a questionnaire by Mgr. Zuzana Táchová after her personal consent in order to compare her results received in Nemocnice České Budějovice, a.s. České Budějovice Hospital. The results of both surveys are thoroughly analysed in the discussion part. However, as regards the preparedness of the Emergency Medical Service of the Central Bohemian Region, there was no difference found compared to the preparedness of medical facilities of the South Moravian and South Bohemian Regions. On the other hand, there was quite a surprising outcome of the survey conducted among the medical personnel of the Emergency Medical Service of the Central Bohemian Region. From the statistical measurement, it was revealed that the results achieved by the medical personnel working for the Emergency Medical Service of the Central Bohemian Region for a longer time were worse than those achieved by the medical personnel with a shorter work experience. For the purposes of the second and the third aim of this thesis, namely the evaluation of the efficiency of the feedback on an emergency and the comparison of the amount of human forces and the means used in chosen emergencies, I have chosen two emergencies which took place in the Central Bohemian Region. Consequently, I compared both of them with the Recommended Procedure No. 18 issued by the Czech Society for Emergency and Disaster Medicine within the Czech Medical Association of J. E. Purkyně Health Affected in Disasters coping with the situation on scene by the emergency medical service. The outcome of the comparison is thoroughly analysed in the discussion part. In conclusion, it is possible to state the importance of the final report on the intervention.

Medical rescue workers are routinely employed in emergency medicine. In emergencies where a large number of people are affected, knowledge of medical disaster practices is necessary. Within a second, the intervening crews should switch to another mode with a different approach to the patients than they use daily. The diploma thesis has set the following goals: to map the level of knowledge of medical rescuers in the field of emergency response with mass health impairment, their personal experience and, last but not least, education and training. Three research questions were asked to reach these objectives. What are the skills of medical rescuers in dealing with emergency health issues with mass health impairment? How do medical rescuers assess incidents with mass health impairment at which they were present and what is their attitude towards training and education in the field of dealing with emergencies with mass health impairment? The research part consists of interviews with two groups of participants: eight medical rescuers of the Medical Rescue Service of the Pardubice Region and the same number of medical rescuers of the Medical Rescue Service of the South Bohemian Region. These interviews supplemented the information provided by the crisis preparedness managers of both medical rescue services. The survey used a qualitative research strategy, conversations were recorded on a dictaphone, then processed into categories, subcategories, tables and evaluated. From the results of the work, a great difference in the knowledge of health rescuers in the field of emergency health problems can be seen. Participants of the South Bohemian Medical Emergency Rescue Service showed shortcomings in both the basic terminology and the solving of extraordinary events in particular, from reporting the situation with a report form to the classification of the disabled. On the contrary, the majority of participants in the Paramedical Rescue Service of the Pardubice Region would be able to file an initial emergency report and categorize and transport patients correctly. On the basis of the evaluated results, this difference in knowledge can be attributed mainly to the frequency and content of the training provided. In the case of South Bohemian participants, we can find the cause in the absence of practical training. The alarming results were noted in the participants' ability to use the START sorting method, from all of the sixteen respondents only one was able to answer there. The elaborated case report of an extraordinary event points to the fact that theoretical shortcomings can subsequently be transferred into practice.

This study investigates the role of unconscious and conscious coping strategies in the mediation of stress in high risk occupational contexts. The Social Readjustment Rating Scale, the Multidimensional Coping Inventory and the Defense Style Questionnaires were completed by 194 police, ambulance and teaching personnel. A sample of 37 teachers served as a non high risk occupation control group. Descriptive statistics, regression analysis, analysis of variance, analysis of difference and principal component analysis were performed on the data. Results indicated minimal significant between group differences. Within group variances were yielded. A minor relationship between levels of stress and usage of positive and negative mechanisms was observed. The significance of these findings is discussed and recommendations made for further study.

Made available in DSpace on 2016-06-02T19:50:24Z (GMT). No. of bitstreams: 1 TeseAPI.pdf: 1231033 bytes, checksum: 51120574caaa9608efc8725f12321b14 (MD5) Previous issue date: 2005-03-11 / Financiadora de Estudos e Projetos / The purpose of this study is to develop effective methods to analyze the configuration and operation of the emergency medical systems (EMS) on highways. Due to the stochastic nature of these systems, especially in the arrival and assistance processes of the emergency calls, we apply the Hypercube Queuing Model to evaluate the performance measures of the system. This is a well-known model in the location literature, which is based on spatially distributed queuing theory. The EMS on highways operate within a particular dispatching policy which considers that only some ambulances in the system can travel to certain regions (partial backup) and multiple dispatch of ambulances to respond to certain calls. In this study we extend the Hypercube model to deal with these situations. Since the Hypercube model is a descriptive model, we also develop a Hypercube embedded genetic algorithm to create a prescriptive approach to optimize the configuration and operation of EMS on highways. This approach can support decisions at the strategic level, for example, the location of ambulances along the highway and the primary response area to each ambulance, as well as, decisions on the operational level, for example, the optimal dispatch policy of ambulances to respond to the emergency calls and the coverage area to each ambulance (if the system configuration can be modified according to the operational conditions of the week or the day). In order to evaluate the performance of the proposed approach, we conducted experiments using the data of two realsystems: the EMS Anjos do Asfalto (Presidente Dutra highway) and EMS Centrovias (portions of the highways Washington Luis, Eng. Paulo Nilo Romano e Comandante João Ribeiro de Barros) in São Paulo State. The results show that the approach is effective to support planning and operation decisions in such systems. / O objetivo deste trabalho é desenvolver métodos efetivos para analisar a configuração e operação de sistemas de atendimento emergencial (SAEs) em rodovias. Devido às características estocásticas de tais sistemas, principalmente nos processos de chegada e atendimento dos chamados de emergência, aplicamos o modelo Hipercubo para analisar as medidas de desempenho do sistema. Este modelo, conhecido na literatura de localização de sistemas de emergência, é baseado em teoria de filas espacialmente distribuídas. Os SAEs em rodovia operam com uma política de despacho particular, a qual admite que apenas algumas ambulâncias do sistema possam viajar a determinadas regiões (backup parcial) e utiliza múltiplo despacho de ambulâncias para atender a certas chamadas. Neste trabalho estendemos o modelo Hipercubo para analisar tais situações. Como o modelo Hipercubo é descritivo, combinamos estas extensões do modelo Hipercubo com um algoritmo genético para obter uma abordagem prescritiva capaz de otimizar a configuração e operação de SAEs em rodovias. Tal abordagem pode ser útil para apoiar decisões no plano estratégico, por exemplo, a localização das bases das ambulâncias ao longo da rodovia e o dimensionamento das regiões de cobertura de cada base. Assim como apoiar decisões no plano operacional, por exemplo, a escolha da política de despacho das ambulâncias para atender chamados de urgência e a determinação das áreas de cobertura de cada servidor (quando a configuração do sistema puder ser alterada de acordo com as condições operacionais de uma semana ou de um dia). Para analisar o desempenho desta abordagem, realizamos estudos de casos com dados reais do sistema Anjos do Asfalto (rodovia Presidente Dutra) e da concessionária Centrovias (trechos das rodovias Washington Luis, Eng. Paulo Nilo Romano e Comandante João Ribeiro de Barros), no interior de São Paulo. Os resultados mostram que a abordagem é efetiva para apoiar decisões relacionadas ao planejamento e operação destes sistemas.

Made available in DSpace on 2015-05-08T14:53:29Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1355369 bytes, checksum: 9c8287916a30feac7e9a3d355e472d28 (MD5) Previous issue date: 2012-12-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This Project brings a Chance Constrained Programming substantial approaching (CCP). This kind of optimization is used to pattern uncertainties and became useful to all kind of knowledge areas. The project main idea was to show CCP s theories and beyond this to present some applications on Engineering and Public Politics areas. It is noteworthy to say that this tool is pretty important for the production systems because of its uncertainties process. So after showing the theory whose purpose is to comprehend the Chance Constrained Programming, this subject commits itself to apply such technique in Emergency Medical Care Production Services (SAMU) in João Pessoa using the proposed model from Beraldi et al. (2004). This application was really useful to define the necessary ambulances to supply João Pessoa s city as well as the local they must be. However, to understand this technique and also work with it it s necessary a previous knowledge of Statistics, Applied Mathematics and Computing. Therefore, this work emphasizes the continuous and discreet random variables, as well as the probabilistic functions and concepts. In Applied Mathematics, this work brings a Linear Optimization, Facility Location and log concave functions. Concerning to computing, it was used MATLAB R007, Google Maps and CPLEX to provide the model. The great benefit of using CCP is that it offers possible solutions to the person who chooses between them, according to the reality. / Este trabalho apresenta uma abordagem de Otimização Probabilística (OP). Esse tipo de Otimização é utilizada para modelar incertezas e se tornou útil em diversas áreas do conhecimento. O objetivo principal deste trabalho foi apresentar a teoria de OP e, além disso, expor algumas aplicações nas áreas de Engenharia e Políticas Públicas. Vale ressaltar que tal ferramenta é muito interessante para Sistemas de Produção por existir incertezas inerentes ao processo. Assim, depois de apresentada tal teoria, com o intuito de melhor compreender a melhor a ferramenta de OP, este trabalho, se propôs a aplicar tal técnica no Sistema de Produção dos Serviços de Atendimento Médico de Urgência (SAMU) da cidade João Pessoa usando o Modelo proposto por Beraldi et al.(2004). A aplicação serviu para definir a quantidade de ambulâncias necessárias para atender a demanda de João Pessoa, assim como os possíveis locais que as mesmas devem estar posicionadas. No entanto, para entender melhor sobre essa técnica e trabalhar com a mesma, é necessário um conhecimento prévio de Estatística, Matemática Aplicada e Computação. Portanto, este trabalho aborda as variáveis aleatórias discretas e contínuas, bem como conceitos de Funções de Probabilidade. Na parte da Matemática Aplicada, este trabalho aborda conceitos de Otimização Linear, Facility Location e funções log. côncavas. Quanto à computação foi utilizado MATLAB R007,Google Maps e CPLEX para realizar a aplicação do Modelo. A grande vantagem da utilização de OP é que a mesma oferece soluções viáveis cujo tomador de decisão tem a opção de escolher qual a melhor solução de acordo com sua realidade.

Submitted by RITA DE CÁSSIA ALTINO DELARMELINDO null (altino.blv@terra.com.br) on 2017-04-19T16:32:07Z No. of bitstreams: 1 TeseRitadeCássiaAltino.pdf: 1177929 bytes, checksum: 5973d9ac7cdd543da8b590d9369a39bf (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-19T16:56:10Z (GMT) No. of bitstreams: 1 altino_rc_dr_bot.pdf: 1177929 bytes, checksum: 5973d9ac7cdd543da8b590d9369a39bf (MD5) / Made available in DSpace on 2017-04-19T16:56:10Z (GMT). No. of bitstreams: 1 altino_rc_dr_bot.pdf: 1177929 bytes, checksum: 5973d9ac7cdd543da8b590d9369a39bf (MD5) Previous issue date: 2017-02-24 / Introdução. A Rede de Atenção à Urgência e Emergência (RUE), organizada por Unidades de Pronto Atendimento (UPA) e outros serviços de urgência tem finalidade de oferecer assistência à saúde de complexidade intermediária entre a rede de Atenção Básica à Saúde (ABS) e a Rede Hospitalar. Contudo, estudos têm apontado a utilização expressiva das UPA, por usuários não urgentes, que poderiam ser atendidos em Unidades de Atenção Básica e da Família, alocadas nas regiões das UPA. Objetivo geral. Analisar a utilização de usuários, acima de 13 anos, da RUE de município do interior paulista, levando-se em consideração o aparelhamento da ABS adscrita às UPA. Método. Pesquisa epidemiológica do tipo transversal, conduzida junto à RUE, em município com 366.769 habitantes. Coletou-se dados secundários, de 2014 a 2015, referentes a atendimentos de usuários em unidades de urgência e emergência, a partir de sistema de informações, assim como realizou-se análise documental de planilhas sobre classificação de risco. Esses dados integraram o banco de dados em planilhas eletrônicas e foram analisados por estatística descritiva. Resultados. A população adscrita às UPA totalizou 328.900, a qual conta com 21 unidades da ABS, sendo 15 Unidades Básicas de Saúde (UBS) e seis Unidades Saúde da Família (USF). Dos 270.990 usuários submetidos à classificação de risco, apenas 6% configurou-se em atendimentos de emergência (vermelho) e urgência (amarela) e a maioria (94%) pouco urgente (verde) e não urgente (azul). Dos agrupamentos de doenças, propostos pelo CID, destacou nas UPA (18 a 23%) sintomas, sinais e achados anormais de exames clínicos e de laboratório, seguido de 15 a 17% de doenças do aparelho respiratório. As faixas etárias de usuários economicamente produtivos foram as mais acometidas por esse perfil diagnóstico. O período diurno reuniu 75% dos atendimentos realizados. O intervalo de quatro a sete vezes atendimentos anuais abarcou a maior porcentagem de usuários frequentes, de oito a 11%. Apenas um por cento dos usuários atendidos nas UPA tiveram desfecho para internação hospitalar. De acordo com a Correlação de Pearson, o número de usuários classificados como não urgentes (verde e azul), independe do número de UBS e USF alocadas nas regiões das UPA. Conclusões. As UPA que contam com maior número de unidades da ABS por habitante, não apresentaram números menores de atendimentos de usuários, com classificação de risco não urgente (verde e azul). Considera-se este estudo contribuir, principalmente, para reestruturação da acessibilidade de usuários a partir da ABS, para então reduzir o número de atendimentos não urgentes nas UUE. A originalidade deste estudo está na resposta à objeto escasso de pesquisa, analisando usuários da RUE, com o número de unidades e população adscrita à ABS. / Introduction. The Urgent and Emergency Care Network (RUE), organized by Emergency Care Units (UPAs), and other urgent services have the purpose of providing intermediate-complexity health care between the Primary Health Care Network (ABS) and the Hospital Network. However, studies have shown the expressive use of UPAs by non-urgent users who could be treated at Primary Care and Family Units allocated in the regions surrounding the UPAs. Goal. To analyze the utilization of RUE by users older than 13 years in a city in inner in São Paulo state, taking into account the facilities found at the ABS adjoined to the UPAs. Method. This is a cross-sectional epidemiological study conducted at the RUE in a city with 366,769 inhabitants. Secondary data referring to 2014 and 2015 concerning the treatment provided to users at urgent and emergency units were collected from an information system. The documental analysis of spreadsheets containing risk classifications was also performed. These data integrated the database in the form of Excel spreadsheets and were analyzed by descriptive statistics. Results. The population adjoined to the UPAs totaled 328,900 inhabitants, and counted on 21 ABS units, of which 15 were Primary Health Care Units (UBSs) and six were Family Health Care Units (USFs). Of the 270,990 users who underwent risk classification, only 6% showed to be emergency (red) and urgent (yellow) treatments, and most of them (94%) were fairly urgent (green) and non-urgent (blue). Of the groups of diseases, as proposed by ICD, symptoms, signs and abnormal findings of clinical and laboratory tests (18 to 23%) were noteworthy at the UPAs, which was followed by 15 to 17% of diseases of the respiratory system. The age ranges of economically productive users were the ones most often affected by such diagnostic profile. 75% of the treatments were performed at daytime. The interval of four to seven annual treatments comprised the highest percentage of frequent users, from eight to 11%. Only 1% of the users treated at the UPAs had a hospitalization outcome. According to Pearson Correlation, de number of users classified as non-urgent (green and blue) does not depend on the number of UBSs or USFs allocated in the regions of the UPAs. Conclusions. The UPAs that have the largest number of ABS units per inhabitant do not show smaller numbers of users’ treatments with a non-urgent risk classification (green and blue). This study is thought to mainly contribute to the reorganization of users’ accessibility starting from ABS so as to then reduce the number of non-urgent treatments at the RUEs. The originality of this study lies in the response to a scarce research object by analyzing RUE users with the number of units and population adjoined to the ABS.

Submitted by Caio Vítor Beojone null (beojone@hotmail.com) on 2017-10-25T17:47:50Z No. of bitstreams: 1 Caio Vitor Beojone - Dissertação.pdf: 10092472 bytes, checksum: 470115087a1c1f987a7a8e2cffec7cd4 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-10-31T16:52:11Z (GMT) No. of bitstreams: 1 beojone_cv_me_bauru.pdf: 10092472 bytes, checksum: 470115087a1c1f987a7a8e2cffec7cd4 (MD5) / Made available in DSpace on 2017-10-31T16:52:11Z (GMT). No. of bitstreams: 1 beojone_cv_me_bauru.pdf: 10092472 bytes, checksum: 470115087a1c1f987a7a8e2cffec7cd4 (MD5) Previous issue date: 2017-10-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Vários Sistemas de Atendimento Emergenciais (SAE’s) sofrem com as variações diárias da demanda e da disponibilidade das ambulâncias. Nesses sistemas pode haver flutuação do desempenho ao longo do dia devido, por exemplo, a mudança no número de servidores e nas taxas de chegada, levando à necessidade de considerar explicitamente tais variações em uma extensão ao modelo hipercubo ainda não explorada na literatura. Como ocorre em alguns SAE’s, as ambulâncias melhor equipadas são reservadas para o atendimento exclusivo de chamados com risco de vida. Dessa maneira, a política de despacho pode ser diferenciada com a finalidade de reservar totalmente o atendimento de alguns servidores para certas gravidades de ocorrências. Além disso, somam-se à natureza aleatória desses sistemas, como por exemplo, as incertezas da disponibilidade das ambulâncias, a chegada de um novo chamado e sua localização. Nesse contexto, os objetivos do presente estudo são: (i) estender o modelo hipercubo de filas para reserva total de capacidade, dependendo do tipo do chamado; (ii) estender o modelo hipercubo de filas para torná-lo mais eficiente computacionalmente, sem haver perda de precisão durante a modelagem e resolução; e (iii) propor uma abordagem baseada no modelo hipercubo não-estacionário para organização do trabalho das ambulâncias em qualquer momento do dia. Para verificar a viabilidade e a aplicabilidade dessas abordagens, é realizado um estudo de caso no SAMU da cidade de Bauru (SAMU-Bauru) que, além de reservar suas ambulâncias avançadas para ocorrências mais graves, é afetado pelas variações diárias na demanda e disponibilidade das ambulâncias. Além da configuração original do SAMU-Bauru, estudada em duas etapas, foram analisados um total de quatro cenários alternativos que consideram questões importantes: o impacto do aumento na demanda do período mais congestionado; a mitigação desse impacto incluindo uma nova ambulância; a alteração do horário das pausas diárias; e o impacto de aumentos na demanda em horários específicos do dia. Foram calculadas importantes medidas de desempenho para cada cenário como a carga de trabalho, tempos médios de espera e tempos médios de resposta. Os resultados mostram que as extensões realizadas no modelo hipercubo são capazes de analisar satisfatoriamente sistemas como o SAMU-Bauru, além de possibilitar a criação e mensuração de propostas de melhorias nos níveis táticos e operacionais. / Many Emergency Service Systems face daily variations on demand and ambulance availability. These systems may suffer, for example, performance fluctuations throughout the day, changes on the number of servers and on arrival rates, leading to the need to explicitly consider such variations in a hypercube model extension not yet explored in the literature. As occurs in some SAMU’s, which reserve their best equipped ambulances to exclusively serve life-threating requests. Therefore, the dispatch policy can be differentiated in order to completely reserve the service of some ambulances to more severe requests. These problems add up to the random nature of these systems with uncertainties upon ambulance availability or the arrival of a new request and its location. Thus, this study aims to: (i) extend the hypercube queueing model to be able to capture the complete capacity reservation of advanced ambulances, depending on the request classification; (ii) extend the hypercube model in order to make it more computationally efficient, without losing any information during modeling and resolution. (iii) propose an approach based on nonstationary hypercube queueing model to organize the operation of ambulances at any time of the day. To verify the feasibility of these approaches, a case study is carried out on the SAMU from Bauru city (SAMU-Bauru), which, in addition to the advanced ambulance reservation for life-threating requests, is affected by daily variations in demand and ambulance availability. In addition to the original configuration of SAMU-Bauru, studied on a two-step approach, we studied a total of four alternative scenarios that exploited important matters as: the impact of average demand increase on the congestion peak; mitigation of this impact by including a new ambulance; changing the schedule of daily breaks; and the impact of increases in the demand at specific hours of the day. We calculated important performance measures for each scenario, such as workload, mean waiting times and mean response times. Results show that the proposed extensions to the hypercube model are capable of satisfactorily analyze systems such as SAMU-Bauru, besides making it possible to create and to measure improvements proposals in tactical and operational levels.

The main purpose of the thesis was to identify potential for improvement of communication with a pre-medicated patient.This research was motivated by the fact that this subject has not yet been explored and it has not been fully discovered whether the communication needs of patients are sufficiently satisfied before the execution of a medical surgery.This paper was based on a quantitative research, including an anonymous questionnaire concerning areas relevant to the mental state of the patient. One part of the research file was made up of clients hospitalized after a medical surgery. The second part of the file was created from Anestesiology and Operating Room nurses. The best solution seems to be creation of communication standards with pre-medicated patients and elaboration of educational plans for patients before medical surgery.