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espanolIntroduccion. La adecuacion de ingresos hospitalarios garantiza la sostenibilidad del sistema sanitario y contribuye a incrementar la seguridad de los pacientes. Los hospitales universitarios deben tener como prioridad que el ejercicio de la docencia no repercuta en detrimento de la adecuacion de los ingresos hospitalarios. Objetivo. Determinar si nuestro modelo de supervision de residentes, conocido como no piramidal, garantiza una homogenea proporcion de ingresos hospitalarios adecuados desde el servicio de urgencias con independencia de la situacion de supervision que tenga el medico responsable del ingreso. Sujetos y metodos. Se aplico el protocolo de adecuacion de ingresos hospitalarios a un registro aleatorizado obtenido para un estudio previamente realizado sobre prevalencia de adecuacion de los ingresos hospitalarios. La proporcion de ingresos hospitalarios adecuados se comparo en funcion de quien habia realizado la indicacion del ingreso: un facultativo especialista, un residente de primer ano bajo supervision facultativa o un residente de segundo o tercer ano. Resultados. Los ingresos hospitalarios indicados por un facultativo especialista, por un residente de primer ano bajo supervision de un facultativo especialista y por un residente de segundo o tercer ano fueron 125, 93 y 78, respectivamente. En estos tres grupos, los ingresos hospitalarios considerados inadecuados fueron 4 (3,2%), 5 (5,4%), y 4 (5,1%), respectivamente, sin identifi carse diferencias estadisticamente signifi cativas. Conclusiones. En todos los grupos, la proporcion de ingresos inadecuados fue inferior a la comunicada en estudios nacionales previos. Creemos que nuestro modelo de supervision no piramidal garantiza una sostenibilidad del sistema sanitario al ahorrar costes de ingresos inadecuados y contribuye a aumentar la seguridad de los pacientes. EnglishIntroduction. 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.

revista de la fundación educación médica/revista de la fundación educación médica

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