Analysis of the implementation of the Hospital Component in the Emergency Care Network

Radel, Marilei Elisangela; Shimizu, Helena Eri

doi:10.1590/0103-1104202313602I

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ORIGINAL ARTICLE • Saúde debate 47 (136) • Jan-Mar 2023 • https://doi.org/10.1590/0103-1104202313602I copy

Analysis of the implementation of the Hospital Component in the Emergency Care Network

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aims to describe the implementation of the Hospital Component of the Urgent and Emergency Care Network (RUE), and to evaluate the delivery of priority Lines of Care in places that serve as gateways in Brazilian regions, between 2011 and 2019. This is a descriptive and analytical study, using data from the National Registration System of Health Institutions (CNES) of the Ministry of Health. To assess significant differences before and after the implementation of Priority Lines of Care, the Wilcoxon test was used. It was found that the Southeast region had the largest increase, including the implementation of technologically denser care points, followed by the Northeast, South, North, and Midwest regions. The South region stood out for the implementation of Priority Lines of Care. Not only did it implement the most of these lines, but it also increased the number of visits and decreased the average length of stay. The Trauma Line of Care was found to be the most effective, when verifying the number of visits with population growth. It was concluded that the Hospital Component of the RUE has made considerable advance, but regional inequalities are still significant.

KEYWORDS
Delivery of health care; Emergency service, hospital; Emergencies; Critical care

STATE/REGION/TYPE		2011	2012	2013	2014	2015	2016	2017	2018	2019
SP	Specialty Hosp. Type I		2	7	3		3		2
	Specialty Hosp. Type II	2	7	3	10		3		4
	General hospital				3		3		3
MG	Specialty Hosp. Type I	2			3
	Specialty Hosp. Type II	4				1	5			1
	General hospital					4	5			2
RJ	Specialty Hosp. Type I			2			2
	Specialty Hosp. Type II		1			3	2		1
	General hospital			5		2	3	2	1
ES	Specialty Hosp. Type I			1	1
	Specialty Hosp. Type II		4
	General hospital					8		1
Southeast Subtotal		8	14	18	20	18	26	3	11	3
CE	Specialty Hosp. Type I		1	1			6			1
	Specialty Hosp. Type II	2	1	1			1
	General hospital			1			6
MA	Specialty Hosp. Type I			1
	General hospital		3	4	1		7
PE	Specialty Hosp. Type I		2
	Specialty Hosp. Type II		6		2
	General hospital			1			1
BA	Specialty Hosp. Type I				3
	Specialty Hosp. Type II	1	3		1
	General hospital		1		1
SE	Specialty Hosp. Type I	1			1
	Specialty Hosp. Type II	1
	General hospital				6
AL	Specialty Hosp. Type I		2
	General hospital		1		1				3
PB	Specialty Hosp. Type II			2
	General hospital				3				1
PI	General hospital		2			2	1
RN	Specialty Hosp. Type II		1
	General hospital		3
Northeast Subtotal		5	26	11	19	2	22		4	1
SC	Specialty Hosp. Type I		2	3				1
	Specialty Hosp. Type II		6	10			1	1
	General hospital						5		2
PR	Specialty Hosp. Type I		1				2	1
	Specialty Hosp. Type II		5	5			1	4
	General hospital		3	2			1	2
RS	Specialty Hosp. Type I		3		1					2
	Specialty Hosp. Type II		5		3					3
	General hospital				8					2
South Subtotal			25	20	12		10	9	2	7
PA	Specialty Hosp. Type I		2
	Specialty Hosp. Type II		1
	General hospital		7
AM	Specialty Hosp. Type I		1
	General hospital		1		6
TO	Specialty Hosp. Type I				1	1
	Specialty Hosp. Type II			1
	General hospital			1	3
RO	Specialty Hosp. Type II		1
	General hospital		2		1					1
RR	Specialty Hosp. Type I		1
	Specialty Hosp. Type II		1
AP	General hospital		2
AC	General hospital			2
North Subtotal			19	4	11	1				1
MS	Specialty Hosp. Type I			1
	Specialty Hosp. Type II		3	1
	General hospital			7
GO	Specialty Hosp. Type I		1	1		1
	Specialty Hosp. Type II	1
	General hospital				3	2		1		1
DF	Specialty Hosp. Type I						3
	Specialty Hosp. Type II	1
	General hospital					3
MT	Specialty Hosp. Type I		1
	Specialty Hosp. Type II		1
	General hospital		2
Midwest Subtotal		2	8	10	3	6	3	1		1
Grand total		15	92	63	65	27	61	13	17	13

STATE/REGION	2011	2012	2013	2014	2015	2016	2017	2018	2019
MG	315	106	351	223	44	150	191	341	16
RJ			830		8	9	44		40
SP		289		515		72
ES			30	40	259	18
Southeast Subtotal	315	395	1.211	778	311	249	235	341	56
PE					15	697	20	245	306
CE					44	606
BA		462
AL		176		22		38	20		35
PI		34		14	61	83	18
RN		159		23
MA			10			145			6
PB						24	40	30
SE					26
Northeast Subtotal		831	10	59	146	1.593	98	275	347
PR		181			44		496	30
RS				564	53			102
SC		20		84		291	148	40	18
South Subtotal		201		648	97	291	644	172	18
PA		584
RO		167	29			12
AP		188
RR		57			44
AM				81
TO			9
North Subtotal		996	38	81	44	12
MT		267
MS			257	10
GO					230
Midwest Subtotal		267	257	10	230
Grand total	315	2.690	1.516	1.576	828	2.145	977	788	421

REGION/STATE /TYPE		2012	2013	2014	2015	2016	2017	2018	2019
SP	Adult ICU II	92	154	370	5	98		137	27
	Adult ICU III		139	107		62		8	21
	Pediatric ICU II		60	61		11		2
	Pediatric ICU III		67	31		16
MG	Adult ICU II	70	72	177	23	298	33	101	75
	Adult ICU III		20
	Pediatric ICU II		1						3
	Pediatric ICU III		13
RJ	Adult ICU II		17		48	195		33	112
	Adult ICU III					18
	Pediatric ICU II					16			4
ES	Adult ICU II		40		140	1		9	9
	Pediatric ICU II				10
Southwest Subtotal		162	583	746	226	715	33	290	251
PE	Adult ICU II	37	74	18		268			55
	Adult ICU III	30		38		22
BA	Adult ICU II	148	121	46	5				14
	Pediatric ICU II	29					7		10
CE	Adult ICU II		18	22		170		4	4
	Pediatric ICU II		23	11		23
SE	Adult ICU II		10	122
	Pediatric ICU II			17
MA	Adult ICU II	55	54		5	8
	Pediatric ICU II		10					7
AL	Adult ICU II	52		23	7
	Adult ICU III			7
	Pediatric ICU II	6						4
	Pediatric ICU III			7
RN	Adult ICU II	22		56
	Pediatric ICU II			12
PB	Adult ICU II			25				13	20
	Pediatric ICU II							11	10
PI	Adult ICU II	24			8	7
	Adult ICU III				5
	Pediatric ICU II	6				8
Northeast Subtotal		409	310	404	30	506	7	39	113
PR	Adult ICU II	189	85	3	15	181	130	22	22
	Adult ICU III	26	80			20	25
	Pediatric ICU II	32	2			14	16
	Pediatric ICU III	27	12
SC	Adult ICU II	42	4	10	5	201	36	7	49
	Adult ICU III	5			4	8
	Pediatric ICU II	5				41			10
	Pediatric ICU III					2
RS	Adult ICU II			92				14	116
	Adult ICU III			62
	Pediatric ICU II			18		4			27
South Subtotal		326	183	185	24	471	207	43	224
GO	Adult ICU II	7	25	33	189	3			69
	Pediatric ICU II			16	24				8
MS	Adult ICU II		71						23
	Adult ICU III	11	57
	Pediatric ICU II		15						4
	Pediatric ICU III		10
MT	Adult ICU II	83
	Adult ICU III	14
	Pediatric ICU II	22
DF	Adult ICU II					57			20
	Adult ICU III					16
	Pediatric ICU II					22
	Pediatric ICU III					2
Midwest Subtotal		137	178	49	213	100			124
PA	Adult ICU II	70			5				51
	Pediatric ICU II	35							15
RO	Adult ICU II	33	71	4					4
	Pediatric ICU II	6	9
AM	Adult ICU II	5		69
	Pediatric ICU II			52
TO	Adult ICU II	18	22	14	15
	Pediatric ICU II		6	2	1				10
AC	Adult ICU II		14		8
	Pediatric ICU II		7
RR	Adult ICU II	4	10					5
	Pediatric ICU II							5
North Subtotal Norte		171	139	141	29			10	80
Grand total		1.205	1.393	1.525	522	1.792	247	382	792

STATE/REGION	2013	2014	2015	2016	2017	2018	2019
MG
LCH			1
LCU		65		40	65	45	50
SP
LCU	20	22		60		86	35
RJ
LCH			1
Southeast Subtotal	20	87	2	100	65	131	85
SC
LCU		70		15		30	85
RS							151
LCU							151
PR
LCU				22
South Subtotal		70		37		30	236
PB
LCU				100
PE
LCU							40
AL
LCU						40
Northeast Subtotal				100		40	40
MS
LCH			1
LCU	68						20
GO
LCI						25
Midwest Subtotal	68		1			25	20
RO
LCU		15
North Subtotal		15
Grand total	88	172	3	237	65	226	381

South region	Before		After		p*
South region	Median	IQR	Median	IQR	p*
Production (Number of HA) – Both sexes	10949.00	17360.50	11101.00	16533.00	0.001
Production Rate × Inhabitants – Both sexes	19.69	30.28	22.15	23.51	0.006
Production (Number of HA) – Male	5619.50	8139.00	5879.00	9096.50	0.003
Production Rate × Inhabitants – Male	19.23	33.09	25.19	23.56	0.011
Production (Number of HA) – Female	6042.00	9297.00	6325.00	9769.50	0.001
Production Rate × Inhabitants – Female	20.42	35.22	23.68	35.11	0.003
Average Length of Stay	5.44	2.61	5.19	2.44	0.031
Age – Trauma
Male – 0-19 years old	1543.00	1691.88	2055.75	2513.75	0.036
Male – 0-19 years old (Rate: pop. × inhab.)	18.12	49.47	20.10	52.76	0.025
Female – 0-19 years old	1372.00	2058.50	1564.75	2595.88	0.123
Female – 0-19 years old (Rate: pop. × inhab.)	15.25	4 7.2 8	14.75	52.79	0.093
Male – 20-39 years old	1560.25	2393.88	2104.50	2379.25	0.208
Male – 20-39 years old (Rate: pop. × inhab.)	22.87	43.03	26.66	40.27	0.123
Female – 20-39 years old	2362.25	3460.75	2980.00	3888.38	0.069
Female – 20-39 years old (Rate: pop. × inhab.)	20.00	69.46	20.78	77.61	0.025
Male – 40-59 years old	1771.25	3322.00	1953.25	4060.13	0.069
Male – 40-59 years old (Rate: pop. × inhab.)	27.34	82.32	31.55	77.15	0.161
Female – 40-59 years old	1499.00	3339.13	1570.00	3618.50	0.069
Female – 40-59 years old (Rate: pop. × inhab.)	21.21	60.91	23.88	60.71	0.123
Male – 60 or older	1558.00	3990.88	1608.25	5129.63	0.036
Male – 60 or older (Rate: pop. × inhab.)	62.28	191.23	65.04	189.75	0.889
Female – 60 or older	1360.00	3102.25	1494.00	4312.38	0.017
Female – 60 or older (Rate: pop. × inhab.)	38.81	137.90	46.44	129.72	0.327

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[1] Conflict of interests: non-existent