Análise dos atendimentos de um pronto-socorro público de grande porte um ano antes e no primeiro ano da pandemia da COVID-19

Abstract

The prompt care of urgent and emergency hospitals works as an observatory of the population's usual health needs. Knowing that the COVID-19 pandemic has modified and impacted health services, it is essential to know the results of the services carried out in this context and what changes occurred in relation to the period before the pandemic. The objective was to analyze the care provided in a large public emergency room (ER) one year before and in the first year of the COVID-19 pandemic. This is a quantitative, descriptive, retrospective and comparative study. All patients treated at the ER, registered in the institution's electronic system and classified by the Manchester triage scale (MTS) were included. A total of 111,851 patients were analyzed, 59,615 in the period before the pandemic (03/01/2019 to 02/28/2020) and 52,236 in the first year of the pandemic (03/01/2020 to 02/28/2021). Data collection was performed using a database generated by the institution's electronic system and submitted to descriptive statistical analysis. The number of visits reduced by 12.4% (p<0.001) in the first year of the pandemic. In the previous year, the elderly sought care more (24.38%) and in the pandemic, patients aged 18 to 29 years predominated (22.60%). Females (50.12%) prevailed in the year before and males (50.15%) in the first year of the pandemic. The month with the most attendances before the pandemic was May (9.39%) and with the least was August (7.78%). During the pandemic, December (10.39%) had more calls and April (5.66%) had less. In the year before the pandemic, the majority, 48.97% arrived accompanied by family members and in the first year of the pandemic, most 49.02% arrived without a companion. The proportion of use of public services for referring patients was similar in both periods (3.13% and 3.25% respectively). As for the MTS data, the flowchart most accessed in both periods was “problems in extremities” (25.73% in the previous year and 22.47% in the first year of the pandemic). In the previous year, the discriminator “moderate pain” predominated (26.73%) and in the first year of the pandemic “recent mild pain” (26.60%). The most frequent clinical priority level was urgent/yellow (40.32%) before the pandemic and less urgent/green (40.66%) in the year of the pandemic. In the previous year (50.56%) and in the first year of the pandemic (55.76%), most patients were referred for evaluation by the general practice. The most frequent medical diagnosis category was external causes in both periods (29.94% and 29.83%). As an outcome, more than half of the patients were discharged in both periods (57.86% and 66.27%) and the proportion of patients who dropped out of care after risk classification decreased from 17.83% to 10.06% in the first year of the pandemic (p<0.001). It can be seen that even with the reduction in the number of visits in the first year of the pandemic, the characterization of the usual demand for the service did not undergo major changes, which shows the relevance of the institution in the emergency care network for the studied municipality, even in a context of isolation social. The knowledge of this information allows managers of emergency rooms to be more assertive when planning and executing management and care actions in emergency services.