Auditoria em enfermagem: revisão sistemática da literatura

Disallowance analysis through the audit of accounts performed by nurses: an integrative review

ABSTRACT Objective: Evidence the scientific production on the analysis of disallowances through the audit of accounts made by nurses. Method: Integrative literature review whose sample of ten articles was selected on the basis of The Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, EMBASE, Scielo, Web of science, Virtual Health Library and on the portal PubMed. Results: The ten articles obtained were published in Brazil, 80% covering hospital contexts; with a quantitative (50%), exploratory (40%) and descriptive (60%) approach. Studies investigating the occurrence of disallowance prevailed to identify the most impacting items on billing and possibilities for improvements in the process of auditing accounts by nurses. Conclusion: The verticalized knowledge of the disallowance analysis process is essential to identify non-conformities and propose improvements, aiming at assistance quality, adequate billing and consequent financial sustainability to health organizations.

Out-of-pocket payments in hospital bills: a challenge to management

OBJETIVE

To analyse out-of-pocket payments (OOP) by health insurance company in hospital bills.

METHOD

Cross-sectional study with quantitative approach. The information was obtained in the database of a health insurance company in the north of Paraná State and categorised into administrative and technical OOP. We analysed reports regarding OOP made in eight hospitals of the accredited network company, from 2013 to 2015.

RESULTS

The analysed data totalled 36 thousand items paid out-of-pocket. The highest OOP rates occurred in hospital 1 (67.6%); emergency room service (50.1%); time of hospitalization, ≤ 1 day (70.8%) and medical-hospital materials (59.2%). The year with the highest rates of administrative (54.51%) and technical (48.05%) OOP was 2013.

CONCLUSION

We concluded that OOP are indicators for the institutions to check the critical topics to be improved and that managers must work on originator aspects of OOP, to prevent greater loss.

Use of Balanced Indicators as a Management Tool in Nursing

Objective:

to develop a proposal for a nursing panel of indicators based on the guiding principles of Balanced Scorecard.

Method:

a single case study that ranked 200 medical records of patients, management reports and protocols, which are capable of generating indicators.

Results:

we identified 163 variables that resulted in 72 indicators; of these, 32 nursing-related: two financial indicators (patient's average revenue per day and patient's revenue per day by product used); two client indicators (overall satisfaction rate of patient with nursing care and adherence rate to the patient satisfaction survey); 23 process indicators, and five learning and growth indicators (average total hours of training, total of approved nursing professionals in the internal selection process, absenteeism rate, turnover rate and index of performance evaluation).

Conclusion:

although there is a limit related to the amount of data generated, the methodology of Balanced Scorecard has proved to be flexible and adaptable to incorporate nursing services. It was possible to identify indicators with adherence to more than one area. Internal processes was the area with the higher number of indicators.