Assessment of user embracement with risk rating in emergency hospital services Avaliação do acolhimento com classifi cação de risco em serviços de emergência hospitalar Evaluación de acogimiento con clasifi cación de riesgo en los servicios de emergencia hospitalaria

Cross-sectional and quantitative study, conducted in 2013, aiming to evaluate the implementation of User Embracement with Risk Rating (ACCR) in four Emergency Hospital Services. One hundred fi fty six nurses participated and answered the questionnaire “User Embracement with Risk Rating”. The data were treated through descriptive and inferential statistics, from the Kruskal-Wallis test. The implementation of ACCR was assessed as precarious, mainly due to the lack of referral of low complexity cases to the basic health system, the inadequate physical space for companions and the lack of discussion and periodic assessment of the fl ow of care in ACCR. The dimension Result of Implementation obtained a slightly higher score and Structure was the dimension with the lowest score. It was concluded that the negative assessments by nursing professionals of the referred dimensions in the investigated sites suggests the need for improvements, especially in the dimension Structure. Descriptors: Rating. User embracement. Emergency nursing. RESUMO Estudo transversal, quantitativo, realizado em 2013, com o objetivo de avaliar a implantação do Acolhimento com Classifi cação de Risco (ACCR) em quatro Serviços Hospitalares de Emergência. Participaram 156 profi ssionais de enfermagem, os quais responderam ao questionário Instrumento para Avaliação do Acolhimento com Classifi cação de Risco. Os dados foram tratados por meio de estatística descritiva e inferencial, a partir do teste Kruskal-Wallis. A implantação do ACCR foi avaliada como Precária, devido, principalmente, à falta de encaminhamento dos casos de baixa complexidade à rede básica de saúde, ao espaço físico inadequado para acompanhantes e à falta de discussão/avaliação periódica sobre o fl uxo de atendimento no ACCR. A dimensão Resultado da implantação obteve avaliação um pouco melhor e a Estrutura foi a dimensão que obteve a maior pontuação. Concluiu-se que, nos locais investigados, a avaliação negativa dos profi ssionais sugere que há necessidade de se investir em melhorias, com destaque para a dimensão Processo. Descritores: Classifi cação. Acolhimento. Enfermagem em emergência. RESUMEN Estudio transversal, cuantitativo, realizado en 2013, con el objetivo de evaluar la implantación del Acogimiento con Clasifi cación de Riesgo (ACCR) en cuatro servicios hospitalarios de emergencia. Participaron 156 profesionales de enfermería, que respondieron al cuestionario de instrumento para el Acogimiento con Clasifi cación de Riesgo. Los datos fueron analizados utilizando estadística descriptiva e inferencial de la prueba de Kruskal-Wallis. La aplicación de la ACCR fue evaluada como precaria, debido principalmente a la falta de remisión de los casos de baja complejidad en el sistema básico de salud; al espacio físico inadecuado de compañeros y, a la falta de discusión y revisión periódica del fl ujo de servicio en ACCR. La dimensión Resultado de la implantación obtuvo evaluación mediana y; la Estructura obtuvo la puntuación más baja. Se concluyó que en los sitios investigados, hubo una evaluación negativa por los profesionales, lo que sugiere la necesidad de invertir en mejoras, destacando dimensión Estructura. Descriptores: Clasifi cación. Acogimiento. Enfermería de urgencia. Original article Versa GLGS, Vituri DW, Buriola AA, Oliveira CA, Matsuda LM 22 Rev Gaúcha Enferm. 2014 set;35(3):21-28. INTRODUCTION The Emergency Hospital Service (EHS) is aimed to assist people with severely impaired health and refer non-complexity patients to primary care services. Thus, the basic assumption of EHS is the guarantee of access of people with more complex, urgent health care needs, in an organized way, in order to prevent iatrogenic complications caused by incorrect handling or treatments, preventing death or physical disability, either temporary or permanent Despite the advances in the effective implementation of emergency units, they still present deficiencies, particularly regarding their inadequate resources to deal with overcrowding due to the rapidly increasing demand for healthcare services. And in an attempt to restructure the work process in this environment, as well as to reinforce the guidelines established by the National Program for Humanization of Hospital Care, User Embracement with Risk Rating (ACCR) was proposed in 2004, within the scope of the National Policy of Humanization (PNH) The ACCR is based on international concepts established by the Manchester care protocol to replace the biomedical model according to which patients are seen in order of arrival, and not in order of urgency. Under this new approach, the patients that arrive at the emergency health services are assisted according to clinical criteria, a dynamic health process that prioritizes care according to patient’s potential risk and/or extent of injuries, in order to ensure higher quality care in emergency services. The implementation of the ACCR is aimed to reduce overcrowding and mortality rates in the EHS, by reducing the waiting time, based on risk rating of patients, integration of the healthcare network and referral of non-complexity patients to primary care units. Therefore, ACCR is a strategy aimed to increase organizational efficiency through the restructuring of the healthcare system in Brazil. Regarding the implementation of ACCR, the nursing staff may act as the central coordinator of this new dynamics of care in the institution, because through risk rating management the nursing staff may increase their activities of support to comprehensive and compassionate care, enhancing the idea of comprehensive care and improving access to health care for users. However, the consolidation of ACCR in the EHS remains a challenge, since it does not depend entirely on the wishes of nurses, managers and/or users, but rather on the rearrangement of the diff erent structural elements, human resources and on the healthcare process established by health care institutions. In view of the aforementioned, it is necessary to identify the gaps in the effective implementation of ACCR in EHS, and then discuss the adoption of measures aimed to improve compliance with the National Policy of Humanization (PNH). Thus, it is recommended that assessment tools especially designed and validated for the referred purpose are used, such as the one proposed by Bellucci Júnior and Matsuda based on Donabedian’s dimensions. The dimensions of assessment of quality in health care proposed by Donabedian include the Structure of health services, which assesses the asoects related to human, physical and material resources, equipment and financial aspects required by healthcare; the Process, which assesses the mode of work of the professionals; and Result, which concerns the health status of the patient seen in the healthcare service. So, studies related to the quality of EHS are compelling because they may support improvements in these locations and facilitate decision making regarding the implementation of ACCR, regarding the provision of high-quality care. Therefore, the following question can be asked: How do health professionals perceive the quality of EHS after the implementation of ACCR? In order to answer this question, the present study aimed to assess the implementation of User Embracement with Risk Rating (ACCR) in four Emergency Hospital Services of Paraná.