Adecuación de los ingresos hospitalarios en función del personal sanitario facultativo responsable bajo un modelo de supervisión no piramidal de médicos residentes en urgencias

Abstract

Introduction. A hospital admission adequacy warrants sustainability of a healthcare system and contributes increasing patients’ safety. Teaching hospitals must assure that pedagogic exercise with residents do not affect the adequacy of hospital admissions. Aim. To determine if our resident supervision model, known as non-pyramidal, warrants and homogeneous proportion of hospital admissions from the emergency department with independence of the different kind of physician who performs the instruction of hospital admission. Subjects and methods. A validated international protocol of hospital admission adequacy was applied to a randomized group of registries of hospital admissions which was used in a study of prevalence of adequate hospital admissions performed previously. The proportion of adequate hospital admission was compared according to who was who ordered the admission: a urgency physician staff, a first year resident under staff supervision and a second or third year resident. Results. The hospital admissions from the emergency department ordered by a staff physician, a first year resident and a second or third year resident were 125, 93 and 78 respectively. In those three groups, hospital admissions considered inadequate were 4 (3.2%), 5 (5.4%) and 4 (5.1%), respectively. There was no statistically signifi cant diff erence among those proportions. Conclusions. In all groups, proportion of inadequate hospital admissions was less than those found in national reports. We believe that our non-pyramidal supervision model assures sustainability of the healthcare system saving costs of inadequate hospital admissions and contributes to warrant patients’ safety.