0373/2019 - Saturación del servicio de urgencias en la ciudad de Bogotá: Una comprensión sistémica del problema. Emergency services crowding in Bogotá: A systemic comprehension of the problem.
La saturación de urgencias a menudo se asocia con ineficiencias en la atención. Sin embargo, este trabajo centra la mirada en otro aspecto relevante como es la asistencia de usuarios no urgentes. Para comprender las dinámicas asociadas a ello, se construye un modelo conceptual de dinámica de sistemas a partir de una caracterización de usuarios y de sus criterios de decisión. Se realizó un estudio descriptivo a partir de una encuesta estructurada, definiendo, a partir de una regresión logística binomial y un análisis de varianza, las diferencias entre usuarios y su probabilidad de asistencia a urgencias. Se encontraron como criterios relevantes: eficacia del servicio, disponibilidad de medicamentos y exámenes y cercanía del centro a la vivienda. El tiempo de espera es más significativo para pacientes pediátricos y la disponibilidad de medicamentos y exámenes lo es para usuarios de ingreso medio; estos últimos le dan menos importancia al costo comparados con los de ingreso bajo. El modelo muestra que los recursos generan un ciclo virtuoso o vicioso de usuarios en espera de atención tanto en urgencias como en atención prioritaria (AP). Se propone una segregación para usuarios pediátricos en la AP y fomentar la confianza de los usuarios en las opciones alternativas a los centros de urgencias.
Emergency overcrowding is often associated with efficiency issues. However, this work focuses on other relevant aspect, such as the non-urgent Emergency Department attendance. In order to understand the dynamics associated with this aspect, it is constructed a conceptual model of system dynamics based on a characterization of users and their decision criteria. A descriptive study was conducted based on a structured survey; additionally, a binomial logistic regression and an analysis of variance were used to estimate probability of emergency department visits and to define differences among users. The following criteria are relevant: service effectiveness, availability of medications and exams, and proximity of the emergency center. The waiting time is more significant for pediatric patients and the availability of medications and exams is for middle-income users; the latter gives less importance to cost compared to low income. The model shows that resources create a virtuous or a vicious cycle of users waiting for attention in both emergencies and priority care center (PC). It is proposed a segregation for pediatric users in PC and a promotion of users\' confidence in alternative options to emergency centers.
Keywords:
crowding, emergency services, social behavior, comprehension.
Emergency services crowding in Bogotá: A systemic comprehension of the problem.
Resumo (abstract):
Emergency overcrowding is often associated with efficiency issues. However, this work focuses on other relevant aspect, such as the non-urgent Emergency Department attendance. In order to understand the dynamics associated with this aspect, it is constructed a conceptual model of system dynamics based on a characterization of users and their decision criteria. A descriptive study was conducted based on a structured survey; additionally, a binomial logistic regression and an analysis of variance were used to estimate probability of emergency department visits and to define differences among users. The following criteria are relevant: service effectiveness, availability of medications and exams, and proximity of the emergency center. The waiting time is more significant for pediatric patients and the availability of medications and exams is for middle-income users; the latter gives less importance to cost compared to low income. The model shows that resources create a virtuous or a vicious cycle of users waiting for attention in both emergencies and priority care center (PC). It is proposed a segregation for pediatric users in PC and a promotion of users\' confidence in alternative options to emergency centers.
Palavras-chave (keywords):
crowding, emergency services, social behavior, comprehension.
Morales, J.C, Díaz, A, Martínez, J.S. Saturación del servicio de urgencias en la ciudad de Bogotá: Una comprensión sistémica del problema.. Cien Saude Colet [periódico na internet] (2019/Nov). [Citado em 06/07/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/saturacion-del-servicio-de-urgencias-en-la-ciudad-de-bogota-una-comprension-sistemica-del-problema/17447?id=17447
