An Sist Sanit Navar
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"Triage" is a process that enables us to manage clinical risk in order to safely and suitably handle patient flows when demand and clinical needs exceed resources. At present, triage systems that are employed are structured according to five levels of priority. Levels are allocated according to the concept that what is urgent is not always serious and that what is serious is not always urgent. ⋯ We also discuss the system of triage devised in Navarre--integrated in the computerised clinical history--and used in the hospital network of Navarre. All are multidisciplinary systems based on the reasons and urgency of consultation, but not on diagnoses, and are carried out by nursing staff with medical support when required. In addition, they all include monitoring of the quality of the accident and emergency service itself, and can be applied in the outpatient field.
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Health research is consubstantial with clinical excellence, a fact that is also inherent in urgency and emergency medicine (UEM). Besides, the specific characteristics of the Spanish health CARE system and the organisation of hospital emergency CARE offer a probably unique scenario, offering unique opportunities for their scientific analysis and study. ⋯ To increase scientific production in UEM there is a need to solve some aspects that hinder this task, such as: the lack of a scientific culture, doubtless united to the lack of a recognised specialty; the limited training in research methodology; the lack of explicit recognition of scientific work; the limited scientific infrastructure; the practically 100% dedication to the work of care tasks; the scarce participation in national grants for research projects; and the absence in Spain of an indexed journal specialising in UEM. Besides, we believe that it is necessary to promote and interrelate the research groups of different hospitals and emergency medical systems, both locally and amongst the different autonomous communities, so that they work in a coordinated way and thus obtain the necessary critical mass that will enable the formation of a thematic network of cooperative research.
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In this article, the authors explore the factors that, in their opinion, currently explain the complexity of emergency care in Spain. Since the start of the XXI century, and in spite of the fact that accident and emergency medicine in the world is undergoing considerable scientific-technical progress, accident and emergency care in Spain is immersed in a care maelstrom acting on a terrain that is ill-prepared for the successive emergent technological advances to take root and develop. ⋯ Due to all of this, advances are frequently achieved more through inertia, or through the overflow of information from other disciplines, than due to the initiative of the professionals of emergency medicine in Spain. Similarly, there is a growing tendency amongst these professionals to move to other disciplines or fields of care that offer better working conditions or simply better professional expectations.