Serviços de urgência e emergência hospitalar: atendimento não urgente nas redes de atenção às urgências, num contexto de transformações demográficas

Abstract

The study was carried out in a Brazilian public hospital, located in the municipality of Belo Horizonte, in Minas Gerais; it aimed at identifying determinants of the use of urgency and emergency (U&E) hospital services in cases of non-emergency condition. We choose the University Hospital Risoleta Tolentino Neves (HRTN) and the corresponding population for the area of the Health Centre Venda Nova (CSVN), located within the Sanitary District of Venda Nova (DSVN). Characterization of the non-emergency conditions among those looking for health care was done using the Manchester Triage System (Manchester Protocol). According to the Manchester Protocol, the health conditions of those looking for U&E services is classified according to severity levels: red (immediately), orange (very urgent), yellow (urgent), green (less urgent), blue (not urgent). Thus, the colors green and blue were the cases classified by this study as non-emergency care. Because of the official pact between the Belo Horizonte Municipal Department of Health (Secretaria Municipal de Saúde de Belo Horizonte) and the HRTN these patients should be sent by HRTN to the Emergency Service Units (UPA) or basic health units (UBS). To allow comparisons the study also analyses the characteristics of service users of the UPA in Venda Nova and CSVN from a health care network system point of view. UPA and UBS are pre-hospital care fixed units to attend U&E cases from DSVN/BH. Definition of factors included in the study followed Aday and Andersen's model (1974): predisposing factors, enabling factors and health needs. The research was a case study that adopted quantitative and descriptive (or deductive) data analysis, using univariate analysis. Secondary data source provided by the institutions involved in the study were used. It is a cross-sectional population-based study, covering the period from August 2009 up to July 2010. Data points out no clear objective factors which may distinguish the use of U&E hospital services in cases of non-emergency care. What distinguishes these cases from emergency conditions is pain intensity, which is a subjective factor, since it involves the individual's perception. It also points out, on one side, that primary health care networks are indeed targeting U&E conditions as not suitable for complex hospital services; and this is an achievement itself. On the other side, most of the health care carried out at HRTN and classified as U&E does not need the complexity that this hospital has; thus HRTN is not acting as a gateway to the Health System in Belo Horizonte.