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de Souza Amarante LC, Gonçalo Mialhe C, Guerra LM, Vilela Bugarelli de Faria J, Mialhe FL. [Reasons given by patients for inappropriate use of emergency medical services]. Rev Salud Publica (Bogota) 2023; 22:440-446. [PMID: 36753244 DOI: 10.15446/rsap.v22n4.54092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/12/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The aim of this study was investígate the reasons for the demand for these services by users rated on two non-urgent emergency care units of a medium-sized municipality of São Paulo. METHODOLOGY Qualitative data were collected through semi-structured interviews with 756 individuals who sought the services of emergency care units and, of these, 417 (55%) users were classified as non-urgent risk and were eligible for the study. RESULTS It was observed six major categories of motives among that seeking care in emergency care units: lack of infrastructure of the nearest health unit; perception of pain and symptoms of emergency; home/work proximity; takes care of scheduling and primary health care; quality of care in the emergency care units; habit of attending services. These categories were grouped into four themes concerning: a) perception of urgency; b) convenience; c) difficulty of access and d) quality of service. CONCLUSION It was concluded from these findings the need to strengthen primary care system in order to ensure facilitated access for users and better resolution of cases that can be seen treated in this level, in conjunction with the entire network of health care.
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Affiliation(s)
- Lidiane Cintia de Souza Amarante
- LA: Enfermeira. M. Sc. Saúde Coletiva. Complexo Hospital de Clínicas da Universidade Federal do Paraná (UFPR). Curitiba/PR, Brasil.
| | - Camila Gonçalo Mialhe
- CM: Cirurgiã-Dentista. Ph. D. Saúde Coletiva. Faculdade de Medicina de Jundiaí. Jundiaí/SP, Brasil.
| | - Luciane Miranda Guerra
- LG: Cirurgiã-Dentista. Ph.D. Saúde Coletiva. Faculdade de Odontologia. Universidade Estadual de Campinas (UNICAMP). Piracicaba/SP, Brasil.
| | | | - Fábio Luiz Mialhe
- FM: Cirurgião-Dentista. Ph.D. Saúde Coletiva. Faculdade de Odontologia. Universidade Estadual de Campinas (UNICAMP). Piracicaba/SP, Brasil.
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Abdulkareem KH, Mohammed MA, Salim A, Arif M, Geman O, Gupta D, Khanna A. Realizing an Effective COVID-19 Diagnosis System Based on Machine Learning and IoT in Smart Hospital Environment. IEEE INTERNET OF THINGS JOURNAL 2021; 8:15919-15928. [PMID: 35782183 PMCID: PMC8769008 DOI: 10.1109/jiot.2021.3050775] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/05/2020] [Accepted: 01/06/2021] [Indexed: 05/18/2023]
Abstract
The aim of this study is to propose a model based on machine learning (ML) and Internet of Things (IoT) to diagnose patients with COVID-19 in smart hospitals. In this sense, it was emphasized that by the representation for the role of ML models and IoT relevant technologies in smart hospital environment. The accuracy rate of diagnosis (classification) based on laboratory findings can be improved via light ML models. Three ML models, namely, naive Bayes (NB), Random Forest (RF), and support vector machine (SVM), were trained and tested on the basis of laboratory datasets. Three main methodological scenarios of COVID-19 diagnoses, such as diagnoses based on original and normalized datasets and those based on feature selection, were presented. Compared with benchmark studies, our proposed SVM model obtained the most substantial diagnosis performance (up to 95%). The proposed model based on ML and IoT can be served as a clinical decision support system. Furthermore, the outcomes could reduce the workload for doctors, tackle the issue of patient overcrowding, and reduce mortality rate during the COVID-19 pandemic.
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Affiliation(s)
| | - Mazin Abed Mohammed
- College of Computer Science and Information TechnologyUniversity of Anbar Anbar 00964 Iraq
| | - Ahmad Salim
- Department of Computer SystemsTechnical Institute of Anbar, Middle Technical University Baghdad 10074 Iraq
| | - Muhammad Arif
- School of Computer ScienceGuangzhou University Guangzhou 510006 China
| | - Oana Geman
- Department of Health and Human DevelopmentUniversitatea Stefan cel Mare din Suceava 720229 Suceava Romania
| | - Deepak Gupta
- Department of Computer Science and EngineeringMaharaja Agrasen Institute of Technology New Delhi 110086 India
| | - Ashish Khanna
- Department of Computer Science and EngineeringMaharaja Agrasen Institute of Technology New Delhi 110086 India
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Cost minimization analysis of outpatient parenteral/oral antibiotic therapy at a trauma hospital: Public health system. Infect Control Hosp Epidemiol 2021; 42:1445-1450. [PMID: 33618784 DOI: 10.1017/ice.2021.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the impact of outpatient parenteral antimicrobial therapy (OPAT) on a public hospital in a middle-income country. DESIGN A retrospective, observational study analyzing the economic data retrieved on the dehospitalization of patients on antibiotic therapy. SETTING Public university trauma hospital. PATIENTS Data were collected from June 2017 to May 2020. Antibiotic cost, hospital length of stay, and risk of multidrug-resistant (MDR) infection or colonization were reviewed, along with the break-even point at which a balance occurs between OPAT antimicrobial costs and all in-hospital costs. A cumulative risk curve was constructed showing the incidence of MDR during the review period. RESULTS In total, 225 patients were studied. The implementation of OPAT resulted in a reduction of $156,681 (49.6%), which is equivalent to an average of $696 per patient, as well as a shortened length of stay, from 33.5 to 15.7 days. OPAT reduces the risk of acquiring infection by MDR bacteria by having the final treatments administered outside of the hospital environment. The breakeven curves, comparing the duration of the OPAT to daily medication costs, allowed for the prediction of the time and dollar costs of antibiotic therapy. CONCLUSIONS OPAT presented a significant cost savings, shortened length of stay, and reduced risk of contamination of patients by MDR.
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Santos TBS, Moreira ALA, Suzart NA, Pinto ICDM. Gestão hospitalar no Sistema Único de Saúde: problemáticas de estudos em política, planejamento e gestão em saúde. CIENCIA & SAUDE COLETIVA 2020; 25:3597-3609. [DOI: 10.1590/1413-81232020259.33962018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/20/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo deste estudo é apresentar o estado da arte sobre gestão hospitalar, do período que antecede o SUS até a publicação da Política Nacional de Atenção Hospitalar. Trata-se de revisão sistemática nacional e internacional com adoção do Protocolo Prisma e levantamento da literatura científica indexada nas bases Lilacs, Scielo e Web of Science. Os 157 artigos incluídos, organizados em três períodos históricos, evidenciaram crescimento da produção científica a partir de 2003. Os achados, dentre outros aspectos, apontam incipiente capacidade de gestão sistêmica antes da criação do SUS. Chama atenção o pouco investimento para readequação do modelo de atenção hospitalar entre a Constituição de 1988 e o Plano de Reforma da Atenção Hospitalar em 2003. No período deste plano governamental e a Política Nacional de Atenção Hospitalar de 2013, um conjunto de problemáticas conduziu estratégias de gestão sistêmica e dos serviços hospitalares, como regionalização, instâncias de governança e adoção de modelos de gestão indireta. A produção científica analisada permitiu identificar importantes dimensões da gestão hospitalar no SUS, na perspectiva da Política, Planejamento e Gestão em Saúde, apontar lacunas e lançar possibilidades para a agenda de pesquisa na área.
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Bittencourt RJ, Stevanato ADM, Bragança CTNM, Gottems LBD, O'Dwyer G. Interventions in overcrowding of emergency departments: an overview of systematic reviews. Rev Saude Publica 2020; 54:66. [PMID: 32638885 PMCID: PMC7319499 DOI: 10.11606/s1518-8787.2020054002342] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments. METHODS Electronic searches for reviews published between 2007 and 2018 were made on PubMed, Cochrane Library, EMBASE, Health Systems Evidence, CINAHL, SciELO, LILACS, Google Scholar and the CAPES periodicals portal. Data of the included studies was extracted into a pre-formatted sheet and their methodological quality was assessed using AMSTAR 2 tool. Eventually, 15 systematic reviews were included for the narrative synthesis. RESULTS The interventions were grouped into four categories: (1) strengthening of the triage service; (2) strengthening of the ED’s team; (3) creation of new care zones; (4) change in ED’s work processes. All studies observed positive effect on patient’s length of stay, expect for one, which had positive effect on other indicators. According to AMSTAR 2 criteria, eight revisions were considered of high or moderate methodological quality and seven, low or critically low quality. There was a clear improvement in the quality of the studies, with an improvement in focus and methodology after two decades of systematic studies on the subject. CONCLUSIONS Despite some limitations, the evidence presented on this overview can be considered the cutting edge of current scientific knowledge on the topic.
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Affiliation(s)
- Roberto José Bittencourt
- Escola Superior de Ciências da Saúde, Fundação de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde do Distrito Federal, Distrito Federal, Brasil
| | - Angelo de Medeiros Stevanato
- Escola Superior de Ciências da Saúde, Fundação de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde do Distrito Federal, Distrito Federal, Brasil
| | - Carolina Thomé N M Bragança
- Escola Superior de Ciências da Saúde, Fundação de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde do Distrito Federal, Distrito Federal, Brasil
| | - Leila Bernarda Donato Gottems
- Escola Superior de Ciências da Saúde, Fundação de Ensino e Pesquisa em Ciências da Saúde, Secretaria de Estado de Saúde do Distrito Federal, Distrito Federal, Brasil
| | - Gisele O'Dwyer
- Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Costa GAPCD, O'Dwyer G, Carvalho YDS, Campos HDS, Rodrigues NCP. Perfil de atendimento de população idosa nas Unidades de Pronto Atendimento do município do Rio de Janeiro. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO No atual contexto de transição epidemiológica, as Unidades de Pronto Atendimento (UPA) passaram a exercer papel fundamental no atendimento à população idosa, com destaque para diagnósticos relacionados com trauma, doenças cardiovasculares e doenças respiratórias. Este trabalho teve como objetivo fazer uma análise do atendimento à população de idosos nas UPA do município do Rio de Janeiro entre os anos 2013 e 2015, levando em conta os diagnósticos mais prevalentes de acordo com a Classificação Internacional de Doenças, as classificações de risco relativas a cada grupo de doenças e os desfechos após o atendimento médico. Detectou-se maior prevalência de atendimentos do sexo feminino, assim como um aumento considerável no número de diagnósticos atendidos em idosos com o passar dos anos. Observou-se que a maioria desses idosos foi classificada como risco Amarelo, e a maior parte dos desfechos foi alta ou encaminhamento a especialistas. A rede de atenção à saúde deve preparar-se para o aumento das demandas desse grupo etário, sendo especialmente necessário um incentivo à procura pela atenção primária em busca da prevenção.
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Costa GAPCD, O'Dwyer G, Carvalho YDS, Campos HDS, Rodrigues NCP. Care profile of the elderly population in Emergency Care Units in the city of Rio de Janeiro. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012509i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO No atual contexto de transição epidemiológica, as Unidades de Pronto Atendimento (UPA) passaram a exercer papel fundamental no atendimento à população idosa, com destaque para diagnósticos relacionados com trauma, doenças cardiovasculares e doenças respiratórias. Este trabalho teve como objetivo fazer uma análise do atendimento à população de idosos nas UPA do município do Rio de Janeiro entre os anos 2013 e 2015, levando em conta os diagnósticos mais prevalentes de acordo com a Classificação Internacional de Doenças, as classificações de risco relativas a cada grupo de doenças e os desfechos após o atendimento médico. Detectou-se maior prevalência de atendimentos do sexo feminino, assim como um aumento considerável no número de diagnósticos atendidos em idosos com o passar dos anos. Observou-se que a maioria desses idosos foi classificada como risco Amarelo, e a maior parte dos desfechos foi alta ou encaminhamento a especialistas. A rede de atenção à saúde deve preparar-se para o aumento das demandas desse grupo etário, sendo especialmente necessário um incentivo à procura pela atenção primária em busca da prevenção.
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Cecilio LCDO, Correia T, Andreazza R, Chioro A, Carapinheiro G, Cruz NLDM, Barros LSD. Os médicos e a gestão do cuidado em serviços hospitalares de emergência: poder profissional ameaçado? CAD SAUDE PUBLICA 2020; 36:e00242918. [DOI: 10.1590/0102-31100242918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/03/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: O Kanban é um arranjo tecnológico de organização do cuidado hospitalar orientado para a gestão de leitos e da clínica, que visa à qualidade e integralidade da assistência, maior rotatividade dos leitos, com consequente redução do tempo de internação e custos hospitalares. O constante e atualizado acompanhamento do paciente, compartilhado pela equipe profissional em reuniões sistemáticas é seu elemento mais marcante e inovador. O objetivo foi caracterizar os prováveis impactos da adoção de tal arranjo no poder profissional (autonomia e autoridade) dos médicos. Estudo qualitativo em hospital de urgência-emergência municipal com uso das seguintes técnicas de produção de dados: etnografia do cotidiano do hospital, com observação e registro em diários de campo, e realização de seminários compartilhados entre pesquisadores e equipes. Os médicos valorizam o trabalho multiprofissional como um qualificador de sua prática, em uma linha auxiliar e complementar. Acresce que o Kanban tende a ser controlado por “híbridos” (médicos que acumulam funções gerenciais e clínicas) que traduzem sinergias entre “gestão clínica” e “gestão de leitos”. Assim, interferências no trabalho dos médicos não são exercidas de fora, e as suas decisões clínicas continuam a condicionar o trabalho dos demais grupos profissionais. Os médicos não percebem sua autoridade e autonomia ameaçadas pelo Kanban, dada a articulação entre a autoridade administrativa e a autoridade profissional. Contudo, aspectos relacionados à hibridização e estratificação interna da profissão médica precisam ser mais convocados para o debate do poder profissional em saúde.
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Cecílio LCDO, Reis AACD, Andreazza R, Spedo SM, Cruz NLDM, Barros LSD, Carapinheiro G, Correia T, Schveitzer MC. Nurses in the Kanban: are there news meanings of professional practice in innovative tools for hospital care management? CIENCIA & SAUDE COLETIVA 2019; 25:283-292. [PMID: 31859876 DOI: 10.1590/1413-81232020251.28362019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
Kanban is a care management tool that values multi-professional work and intensive use of data and has been growingly used in Brazil to address overcrowding in hospital emergency services (HES). The researchers monitored the Kanban for ten months in multiple wards of a municipal HES, and their observations were recorded in field diaries and discussed in biweekly research team meetings. The empirical material was organized from two questions: Are there changes in "traditional attributions" of Kanban-operating nursing? Are Medicine-Nursing interprofessional relationships transformed? A strong nurse adherence to this tool was observed, coupled with greater specialization and fragmentation of their work: nurses working as diarists assume more traditional administrative functions, while those on-call develop more direct assistance to patients. Nurses consider that clinical decisions are still in the doctors' hands, although Kanban provides them with a stronger influence on such decisions. Nurses' role in the management of significant mass of clinical and operational data, central to Kanban's operationalization, strengthens their professional authority.
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Affiliation(s)
- Luiz Carlos de Oliveira Cecílio
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Ademar Arthur Chioro Dos Reis
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Sandra Maria Spedo
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Nelma Lourenço de Matos Cruz
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Luciana Soares de Barros
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
| | - Graça Carapinheiro
- Centro de Investigação e Estudos em Sociologia. Instituto Universitário de Lisboa. Lisboa Portugal
| | - Tiago Correia
- Unidade de Saúde Pública Internacional e Bioestatística. Instituto de Higiene e Medicina Tropical. Universidade Nova de Lisboa. Lisboa Portugal.,Centro de Investigação e Estudos em Sociologia. Instituto Universitário de Lisboa. Lisboa Portugal
| | - Mariana Cabral Schveitzer
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. R. Botucatu 740, Vila Clementino. 04023-062 São Paulo SP Brasil.
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Nishimura F, Carrara AF, Freitas CED. Effect of the Melhor em Casa program on hospital costs. Rev Saude Publica 2019; 53:104. [PMID: 31800915 PMCID: PMC6863111 DOI: 10.11606/s1518-8787.2019053000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/06/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To verify if the Melhor em Casa program can actually reduce hospitalization costs. METHODS We use as an empirical strategy a Regression Discontinuity Design, which reduces endogeneity problems of our model. We also performed tests of heterogeneous responses and robustness. Data on the dependent variable, namely hospitalization costs, were collected in the Department of Informatics of the Unified Health System (DATASUS), using the microdata set from the Hospital Admissions System of the Unified Health System (SUS) from 2010 to 2013, totaling 3,609,384 observations. The covariates or control variables used were age and costs with patients in the intensive care unit, also from DATASUS. RESULTS The results point out that the Melhor em Casa program effectively reduced hospitalization costs by approximately 4.7% in 2011, 5.8% in 2012 and 10.2% in 2013. CONCLUSIONS Based on the analyses, we observed that maintaining the program can effectively improve the management of public resources, since it reduced the hospitalization costs in the three years studied. The program reduced hospitalization costs of risk groups and also in situations that usually increase hospital costs such as lack of equipment and elective hospitalizations. Thus, it can be affirmed that the program can reduce hospitalization costs, especially in risk and more vulnerable groups, showing efficiency as a public policy.
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Affiliation(s)
- Fábio Nishimura
- Universidade Federal de Mato Grosso. Curso de Ciências Econômicas. Programa de Pós-Graduação em Economia. Rondonópolis, MT, Brasil
| | - Aniela Fagundes Carrara
- Universidade Federal de Mato Grosso. Curso de Ciências Econômicas. Programa de Pós-Graduação em Economia. Rondonópolis, MT, Brasil
| | - Carlos Eduardo de Freitas
- Universidade Federal de Mato Grosso. Curso de Ciências Econômicas. Programa de Pós-Graduação em Economia. Rondonópolis, MT, Brasil
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Sacoman TM, Beltrammi DGM, Andrezza R, Cecílio LCDO, Reis AACD. Implantação do Sistema de Classificação de Risco Manchester em uma rede municipal de urgência. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-1104201912105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os serviços de urgência e emergência hospitalares e não hospitalares são habitualmente utilizados como portas de entrada dos sistemas de saúde. A hipótese do excesso de demanda por esses serviços é insuficiente para explicar os desfechos clínicos desfavoráveis que resultam do fenômeno da superlotação, relacionado a aspectos organizativos desses próprios serviços. Diante desse cenário, a reorganização das entradas dos serviços de urgência e emergência tornou-se primordial. O artigo apresenta e analisa a implantação do Sistema de Classificação de Risco de Manchester em uma rede municipal de urgência e emergência da região metropolitana de São Paulo, a maior do hemisfério Sul, e permite compreender como o aprimoramento do uso da classificação de risco, prevista em diversas políticas do Sistema Único de Saúde, pode se constituir em potente tecnologia aplicada à gestão do cuidado e dos serviços de urgência e emergência.
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Rech RS, Hugo FN, Giordani JMDA, Passero LG, Hilgert JB. Contextual and individual factors associated with dissatisfaction with public emergency health services in Brazil, 2011-2012. CAD SAUDE PUBLICA 2018; 34:e00175416. [DOI: 10.1590/0102-311x00175416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/25/2017] [Indexed: 11/22/2022] Open
Abstract
The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman’s office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care’s waiting time and the length needed to resolve the demand.
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O'Dwyer G, Konder MT, Reciputti LP, Lopes MGM, Agostinho DF, Alves GF. The process of implementation of emergency care units in Brazil. Rev Saude Publica 2017; 51:125. [PMID: 29236876 PMCID: PMC5718113 DOI: 10.11606/s1518-8787.2017051000072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/16/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the process of implementation of emergency care units in Brazil. METHODS We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.
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Affiliation(s)
- Gisele O'Dwyer
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil
| | - Mariana Teixeira Konder
- Universidade Estadual do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Clínica Médica. Rio de Janeiro, RJ, Brasil
| | - Luciano Pereira Reciputti
- Fundação Oswaldo Cruz. Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil
| | - Mônica Guimarães Macau Lopes
- Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Brasília, DF, Brasil
| | - Danielle Fernandes Agostinho
- Fundação Oswaldo Cruz. Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil
| | - Gabriel Farias Alves
- Fundação de Apoio à Pesquisa do Estado do Rio de Janeiro Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil
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Soares VS. Analysis of the Internal Bed Regulation Committees from hospitals of a Southern Brazilian city. EINSTEIN-SAO PAULO 2017; 15:339-343. [PMID: 29091157 PMCID: PMC5823049 DOI: 10.1590/s1679-45082017gs3878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 06/27/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the composition of the Internal Regulation Committees created in hospitals of a capital city. Methods A cross-sectional descriptive study assessing the structure, processes and results of each Committee. Results The main reasons for implementing the committees were legal issues and overcrowding in the emergency department. The most monitored indicators were the occupancy rate and the mean length of stay, and the most observed results were reductions in the latter. Institutional protocols were developed in 70% of cases, and the degree of support that the Internal Regulation Committee received from the hospital managers was high, despite being only average the support received from the medical teams. Promoting the efficient use of beds seemed to be the main goal. To achieve it, the Internal Regulation Committee had to control hospital capacity at levels that allowed proper and safe bed turnover for patients. The strategies for this were varied and needed to integrate administrative and care issues. Conclusion The Internal Regulation Committees were a management tool with great potential and promising results in the experiences evaluated.
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O'Dwyer G, Konder MT, Reciputti LP, Macedo C, Lopes MGM. [Implementation of the Mobile Emergency Medical Service in Brazil: action strategies and structural dimension]. CAD SAUDE PUBLICA 2017; 33:e00043716. [PMID: 28792986 DOI: 10.1590/0102-311x00043716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/22/2016] [Indexed: 11/21/2022] Open
Abstract
The Mobile Emergency Medical Service (SAMU) was the first component of the National Policy for Emergency Care implemented in Brazil in the early 2000. The article analyzed the implementation of mobile pre-hospital emergency care in Brazil. The methods included document analysis, interviews with state emergency care coordinators, and an expert panel. The theoretical reference was the strategic conduct analysis from Giddens' Structuration Theory. The results showed uneven implementation of the SAMU between states and regions of Brazil, identifying six patterns of implementation, considering the states' capacity to expand the population coverage and regionalize the service. Structural difficulties included physician retention, poorly equipped dispatch centers, and shortage of ambulances. The North and Northeast were the country's most heavily affected regions. SAMU is formatted as a structuring strategy in the emergency care network, but its performance suffered the impact of limited participation by primary care in the emergency network and especially the lack of hospital beds.
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Affiliation(s)
- Gisele O'Dwyer
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Mariana Teixeira Konder
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Anziliero F, Dal Soler BE, Silva BAD, Tanccini T, Beghetto MG. Manchester System: time spent on risk classification and priority of care at an emergency medical service. Rev Gaucha Enferm 2017; 37:e64753. [PMID: 28273254 DOI: 10.1590/1983-1447.2016.04.64753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 01/05/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the time before and time spent on risk classification, priority of care, and destination of patients within 24 hours after their admission to an emergency medical service. Methods Retrospective cohort study that included adults classified by the Manchester Triage System at the largest emergency medical service in the south of the country in 2012. The data were made available in the form of an electronic sheet and analyzed according to their characteristics and distribution. Results Of the 139,556 admissions, half of the patients arrived at classification within the time recommended (7; IQR: 2-20 minutes), and were classified within two (IQR: 1-3) minutes. Lower priority classifications and hospital discharges (88.4%) were more frequent than hospitalizations (11.4%) and deaths (0.2%). Conclusion The time involved in activities that precede the first medical care remained within the recommendation. The proportion of lower priority classifications and hospital discharges within 24 hours after classification was high.
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Affiliation(s)
- Franciele Anziliero
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Bárbara Elis Dal Soler
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Bárbara Amaral da Silva
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Thaíla Tanccini
- Grupo Hospitalar Conceição (GHC). Porto Alegre, Rio Grande do Sul, Brasil
| | - Mariur Gomes Beghetto
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional (DAOP). Porto Alegre, Rio Grande do Sul, Brasil
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Bonella GF, Fontes AMDS, Jorge MT, Silveira ABMD. Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital. Braz J Infect Dis 2016; 20:462-7. [PMID: 27513531 PMCID: PMC9425537 DOI: 10.1016/j.bjid.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/16/2016] [Accepted: 07/03/2016] [Indexed: 11/16/2022] Open
Abstract
Many interventions demonstrate success in adapting the duration of intravenous antibiotic therapy, but few studies have been conducted in developing countries. The aim of this study was to evaluate the effectiveness of an intervention in the induction of early discontinuation of intravenous antimicrobial therapy and/or its switch to oral therapy. The study employed a before–after intervention design that consisted of displaying a message in the computerized prescription on the third day and suspension of the prescription on the fifth day of intravenous antimicrobial therapy. A total of 465 patients were followed during the control period (CP) and 440 in the intervention period (IP). The intravenous therapy was switched to oral therapy for 11 (2.4%) patients during the CP and 25 (5.7%) in the IP (p = 0.011), and was discontinued for 82 (17.6%) patients during the CP and 106 (24.1%) in the IP (p = 0.017). During the IP there was a significant increase of patients who had their antimicrobial treatment discontinued before the seventh day of intravenous treatment, 37.40% (49/131) in the IP and 16.13% (15/93) in the CP (p = 0.0005). The duration of intravenous antimicrobial therapy decreased by one day, but it was not significant (p = 0.136). It is concluded that the proposed intervention is effective in promoting the early discontinuation of antimicrobial treatment and/or switch to oral therapy. As long as a computerized system for prescription already exists, it is easy and inexpensive to be implemented, especially in hospitals in developing countries.
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Lima CDA, Santos BTPD, Andrade DLB, Barbosa FA, Costa FMD, Carneiro JA. Quality of emergency rooms and urgent care services: user satisfaction. EINSTEIN-SAO PAULO 2015; 13:587-93. [PMID: 26313440 PMCID: PMC4878635 DOI: 10.1590/s1679-45082015gs3347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. Methods A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Results Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Conclusion Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.
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Rodrigues LCR, Juliani CMCM. Impact of implementing an Internal Bed Regulation Committee on administrative and care indicators at a teaching hospital. EINSTEIN-SAO PAULO 2015; 13:96-102. [PMID: 25993075 PMCID: PMC4977596 DOI: 10.1590/s1679-45082015gs3235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/10/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. METHODS It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. RESULTS The indicators improved after implementation of the Internal Bed Regulation Committee. CONCLUSION The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde.
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Oliveira SND, Ramos BJ, Piazza M, Prado MLD, Reibnitz KS, Souza AC. Emergency Care Units (UPA) 24h: the nurses' perception. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003390011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to describe the nurses' perception regarding the Emergency Care Units. It is descriptive research with a qualitative approach. The study participants were 25 nursing professionals from the Emergency Care Unit of a municipality in Santa Catarina who voluntarily accepted to participate in the study. The data were collected through interviews and were submitted to the operative proposal for analysis of qualitative data. The results show the professionals' understanding in relation to the purpose of these units, but indicate the incorrect way that this service is being used by the population; a fact that - added to the lack of materials, standardization of procedures, human resources and training - hinders the work process. It is suggested that continuing education may be used as a means for articulating the team and the search for quality work.
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Versa GLGDS, Vituri DW, Buriola AA, Oliveira CAD, Matsuda LM. Assessment of user embracement with risk rating in emergency hospital services. Rev Gaucha Enferm 2014; 35:21-8. [DOI: 10.1590/1983-1447.2014.03.45475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cross-sectional and quantitative study, conducted in 2013, aiming to evaluate the implementation of User Embracement with Risk Rating (ACCR) in four Emergency Hospital Services. One hundred fifty six nurses participated and answered the questionnaire "User Embracement with Risk Rating". The data were treated through descriptive and inferential statistics, from the Kruskal-Wallis test. The implementation of ACCR was assessed as precarious, mainly due to the lack of referral of low complexity cases to the basic health system, the inadequate physical space for companions and the lack of discussion and periodic assessment of the flow of care in ACCR. The dimension Result of Implementation obtained a slightly higher score and Structure was the dimension with the lowest score. It was concluded that the negative assessments by nursing professionals of the referred dimensions in the investigated sites suggests the need for improvements, especially in the dimension Structure.
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Best AM, Dixon CA, Kelton WD, Lindsell CJ, Ward MJ. Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital. Am J Emerg Med 2014; 32:917-22. [PMID: 24953788 PMCID: PMC4119494 DOI: 10.1016/j.ajem.2014.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country. METHODS We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS). RESULTS The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) LOS decrease. However, when shift start times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI, 94-98), and with the simultaneous combination of staff roles (registration and history taking), there was an overall mean LOS reduction of 152 minutes (95% CI, 150-154). CONCLUSIONS Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute care in resource-limited settings.
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Affiliation(s)
- Allyson M Best
- University of Cincinnati, College of Medicine, Cincinnati, OH 45229
| | - Cinnamon A Dixon
- Division of Emergency Medicine, Center for Global Health, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229
| | - W David Kelton
- Department of Operations, Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH 45221
| | | | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN 37232.
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Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs 2014; 23:47-52. [PMID: 25087059 DOI: 10.1016/j.ienj.2014.06.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/19/2014] [Accepted: 06/14/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The growing number of patients in emergency departments can lead to overcrowding, often adding to organisational problems. Triage aims to predict the severity of disease, with the aim of organising patient flow. The aim of this study was to analyse the efficacy of the Manchester Triage System (MTS) for risk classification of patients. METHODS A systematic review of the literature in Ebscohost, Pubmed and Scielo (2002-2013) was undertaken. Articles were selected independently by two researchers using selection criteria. Twenty-two articles were selected for inclusion in this review. RESULTS The results support the applicability of the MTS, which has proven validity for use in children, adults, patients with coronary syndrome and patients with acute pulmonary embolism. The MTS was found to be inclusive, and to predict emergency department admission and death in the short term. CONCLUSION The majority of studies found that the MTS was useful in triage of patients in emergency departments, but sub-triage and super-triage (i.e. under and over classification of severity, respectively) still occur.
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Marchal B, Hoerée T, da Silveira VC, Van Belle S, Prashanth NS, Kegels G. Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations. BMC Public Health 2014; 14:378. [PMID: 24742181 PMCID: PMC4020604 DOI: 10.1186/1471-2458-14-378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/03/2014] [Indexed: 11/24/2022] Open
Abstract
Background Performance of health care systems is a key concern of policy makers and health service managers all over the world. It is also a major challenge, given its multidimensional nature that easily leads to conceptual and methodological confusion. This is reflected by a scarcity of models that comprehensively analyse health system performance. Discussion In health, one of the most comprehensive performance frameworks was developed by the team of Leggat and Sicotte. Their framework integrates 4 key organisational functions (goal attainment, production, adaptation to the environment, and values and culture) and the tensions between these functions. We modified this framework to better fit the assessment of the performance of health organisations in the public service domain and propose an analytical strategy that takes it into the social complexity of health organisations. The resulting multipolar performance framework (MPF) is a meta-framework that facilitates the analysis of the relations and interactions between the multiple actors that influence the performance of health organisations. Summary Using the MPF in a dynamic reiterative mode not only helps managers to identify the bottlenecks that hamper performance, but also the unintended effects and feedback loops that emerge. Similarly, it helps policymakers and programme managers at central level to better anticipate the potential results and side effects of and required conditions for health policies and programmes and to steer their implementation accordingly.
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Affiliation(s)
- Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Bellucci Júnior JA, Matsuda LM. [Construction and validation of an instrument to assess the Reception with Risk Rating]. Rev Bras Enferm 2014; 65:751-7. [PMID: 23338578 DOI: 10.1590/s0034-71672012000500006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/22/2012] [Indexed: 11/22/2022] Open
Abstract
Methodological study, carried out between April to December 2010, which aimed to describe the criteria for construction, appearance and content validation of an instrument to assess the Reception with Risk Rating (RRR). The strategies of Content Validation through Delphi technique and Appearance Validation were used. The appreciation of the instrument was made by a panel of judges, consisting of ten nurses, teachers with titration of specialists, teachers and/or doctors with experience in RRR. We conclude that the instrument has content and appearance validity to assess the RRR because the indices of reliability and agreement in all three dimensions of health evaluation Donabedian reached values above the established standard, ie 80%.
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Konrad R, DeSotto K, Grocela A, McAuley P, Wang J, Lyons J, Bruin M. Modeling the impact of changing patient flow processes in an emergency department: Insights from a computer simulation study. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.orhc.2013.04.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vituri DW, Inoue KC, Bellucci Júnior JA, de Oliveira CA, Rossi RM, Matsuda LM. Welcoming with risk classification in teaching hospitals: assessment of structure, process and result. Rev Lat Am Enfermagem 2013; 21:1179-87. [PMID: 24142229 DOI: 10.1590/s0104-11692013000500023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 07/15/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess, from the worker's viewpoint, the structure, the process and the results of the Emergency Hospital Services that have taken up the guideline of "Welcoming with Risk Classification" in two teaching hospitals of the state of Paraná. METHOD Quantitative and descriptive research, exploratory and prospective, using random sampling stratified by professional category, comprising a universe of 216 professional people. RESULTS They found some points of agreement regarding the promotion of a welcoming and humane environment; privacy and security; welcome and shelter of the companion and also the sheltering and classification of all patients; however, there was disagreement about the comfort of the environment, reference system and counter-reference, prioritisation of seriously ill patients in post-classification service, communication between the members of the multi-professional team and reassessment of the guideline. CONCLUSION The workers assess the development of the guideline as being precarious, due mainly to the lack of physical structure, due to the lack of physical structure and shortcomings in the service process.
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Salvador RDSP, Silva BADSDA, Lisboa MTL. Estresse da equipe de enfermagem do corpo de bombeiros no Atendimento Pré-Hospitalar Móvel. ESCOLA ANNA NERY 2013. [DOI: 10.1590/s1414-81452013000200022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A pesquisa teve como objeto de estudo o estresse evidenciado no trabalho da equipe de Enfermagem do Corpo de Bombeiros no Atendimento Pré-Hospitalar Móvel. Os objetivos foram: identificar os estressores presentes nessa atividade profissional e analisar a repercussão do estresse na saúde desses profissionais.Caracterizou-se como um estudo qualitativo descritivo-exploratório, envolvendo 10 profissionais. A coleta de dados foi realizada por meio de entrevista gravada eletronicamente, utilizando-se de instrumento semiestruturado. Após transcrição das entrevistas, os aspectos semelhantes e as diferenças encontradas foram agrupados em Categorias de Análise. Confirmou-se que esses profissionais são submetidos a constante estresse, tendo seus hábitos de vida alterados, com repercussão na saúde. Sugere-se que os problemas identificados sejam estudados de maneira a criar estratégias com a finalidade de gerar melhores condições de trabalho para esses profissionais.
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Abstract
OBJECTIVE This study aimed to determine the outcome of children with unclear etiology for acute abdominal pain admitted to the emergency department observation unit (EDOU). METHODS This is a retrospective cohort study of children 18 years or younger who presented with acute abdominal pain to a tertiary pediatric ED and were observed in the EDOU. Children with alternative explanations for abdominal pain were excluded. Patients were classified based on disposition, and data were analyzed using χ tests. RESULTS There were 237 patients included in the study (median age, 9 years; 46% male). Mean length of stay in EDOU was 14.4 hours. Fifty-four percent were evaluated by surgery. Two hundred (84%) were discharged; 37 (16%) were admitted, of whom 22 (9%) underwent surgical intervention (13 appendectomies, 6 ovarian cystectomies, 2 small-bowel obstructions, 1 cholecystectomy). Eight had acute appendicitis on pathology reports. The duration of symptoms, the presence of fever, nausea/vomiting, right-lower-quadrant pain, rebound tenderness, or leukocytosis greater than 10,000 cells/μL did not predict admission. Patients with diarrhea were more likely to be discharged home (P = 0.02). Intravenous hydration (86%) and pain control (63%) were the most common interventions in the EDOU. Abdominal pain not otherwise specified and acute gastroenteritis were the 2 most common discharge diagnoses. Eight (4%) of the 200 discharged patients returned to the ED within 48 hours, and all were discharged home from the ED. CONCLUSIONS The majority of children admitted to the EDOU with abdominal pain have nonsurgical causes of abdominal pain. The EDOU provides a reasonable alternative for monitoring these patients pending disposition.
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O'Dwyer G, Mattos RA. Cuidado integral e atenção às urgências: o serviço de atendimento móvel de urgência do estado do Rio de Janeiro. SAUDE E SOCIEDADE 2013. [DOI: 10.1590/s0104-12902013000100018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O inadequado atendimento às urgências é motivo de insatisfação da população e de aumento de morbidade e mortalidade. Para responder ao problema, o Estado implantou o Serviço de Atendimento Móvel de Urgência (SAMU), o primeiro componente da Política Nacional de Urgências que propõe o atendimento integral às urgências. Com o objetivo de analisar a prática de integralidade no SAMU, analisamos a regulação nos SAMU do Estado do Rio de Janeiro. A metodologia baseou-se na análise da conduta estratégica (Giddens, 1984) relacionando as estratégias de ação dos agentes com as dimensões estruturais. A categorização da análise do resultado destacou: o SAMU bem sucedido, com práticas de integralidade no seu componente individual e de acesso aos serviços; sua função de observatório de rede, que indicou restrição no acesso à atenção básica e ao hospital; a insuficiência de recursos e o uso inadequado de ambulâncias; e demandas não reconhecidas, em que casos foram recusados. O campo confirmou a potência do SAMU como observatório de saúde. Entretanto, a mobilização de recursos autoritativos e alocativos mostrou-se insuficiente para um sistema integrado de atenção às urgências.
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O'Dwyer G, Konder MT, Machado CV, Alves CP, Alves RP. The current scenario of emergency care policies in Brazil. BMC Health Serv Res 2013; 13:70. [PMID: 23425342 PMCID: PMC3598552 DOI: 10.1186/1472-6963-13-70] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 02/14/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The regulation of emergency care has featured prominently in Brazil's federal health agenda since the 2000s. The aim of this study was to review up to the present day the implementation of the National Emergency Care Policy. METHODS The methods employed were documental review, analysis of official data and 11 interviews conducted with federal, state and local managers. The results were analyzed using Giddens' Structuration Theory, relating the cognitive abilities of the agents to their action strategies, in view of the structural dimensions, rules and resources provided by the federal administration. RESULTS Federal policy for emergency care in Brazil can be divided into three stages: from 1998 to 2003, the initial regulation; from 2004 to 2008, the expansion of the Mobile Emergency Medical Services (SAMU, in Brazil); and from 2009 onwards, the implementation of stationary pre-hospital care facilities, known as Emergency Care Units (UPA). The structuration elements identified for the emergency care policy were the public health system guidelines, legislation, standards and federal financing. Significant restrictions were found such as lack of hospital beds and intensive care treatment, gaps in the information system for producing evidence for management, ineffective Management Committees, as well as a low degree of commitment among physicians to the services. CONCLUSION Considering the financial constraints imposed on the SUS (Brazilian Unified Health System), emergency care was identified as a political priority with financial support. The individual actions by emergency care workers and governmental agents typified the first period of the policy, structuring the basis and producing changes in the circumstances of action. Federal strategies can be equated to the rules and resources provided to support the implementation process of the policy.
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Affiliation(s)
- Gisele O'Dwyer
- National School of Public Health / Oswaldo Cruz Foundation (Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz), 1480, Leopoldo Bulhões Avenue, Rio de Janeiro, Postal code 21041-210, Brazil
| | - Mariana Teixeira Konder
- National School of Public Health / Oswaldo Cruz Foundation (Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz), 1480, Leopoldo Bulhões Avenue, Rio de Janeiro, Postal code 21041-210, Brazil
| | - Cristiani Vieira Machado
- National School of Public Health / Oswaldo Cruz Foundation (Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz), 1480, Leopoldo Bulhões Avenue, Rio de Janeiro, Postal code 21041-210, Brazil
| | - Camila Paes Alves
- National School of Public Health / Oswaldo Cruz Foundation (Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz), 1480, Leopoldo Bulhões Avenue, Rio de Janeiro, Postal code 21041-210, Brazil
| | - Renan Paes Alves
- National School of Public Health / Oswaldo Cruz Foundation (Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz), 1480, Leopoldo Bulhões Avenue, Rio de Janeiro, Postal code 21041-210, Brazil
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Assigning Residents of Emergency Medicine to Screen Patients Before Admission: a Strategy to Overcome Overcrowding. Trauma Mon 2012. [DOI: 10.5812/traumamon.2923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bellucci Júnior JA, Matsuda LM. Implantação do sistema acolhimento com Classificação e Avaliação de Risco e uso do Fluxograma Analisador. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000100025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo teve como objetivo relatar o processo de implantação do sistema Acolhimento com Classificação e Avaliação de Risco e o uso do Fluxograma Analisador, no Serviço Hospitalar de Emergência da Santa Casa de Misericórdia de Ourinhos, Estado de São Paulo. A implantação do sistema foi subdividida nas etapas: sensibilização dos profissionais, readequação de recursos, execução do planejamento e avaliação. À organização do fluxo de pacientes, foram utilizados Fluxogramas Funcionais que, depois de alguns ajustes, resultaram em um Fluxograma Analisador. O Fluxograma Analisador resultante proporcionou a visualização gráfica das etapas do atendimento e direcionou todos os portadores de agravos não emergenciais à consulta de enfermagem. Conclui-se que o Fluxograma Analisador foi uma ferramenta essencial ao processo de implantação do Acolhimento com Classificação e Avaliação de Risco porque, ao definir as etapas do fluxo para o atendimento, o serviço se tornou mais organizado, humano e seguro.
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Javadzadeh HR, Davoudi A, Davoudi F, Mahmoodi S, Ghane MR, Goodarzi H, Faraji M. Assigning residents of emergency medicine to screen patients before admission: a strategy to overcome overcrowding. Trauma Mon 2012; 16:191-3. [PMID: 24749100 PMCID: PMC3989572 DOI: 10.5812/kowsar.22517464.2923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 11/05/2011] [Accepted: 11/22/2011] [Indexed: 11/29/2022] Open
Abstract
Background: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. Objectives: This study proposes a strategy to overcome ED overcrowding. Materials and Methods: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. Results: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. Conclusions: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered.
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Affiliation(s)
- Hamid Reza Javadzadeh
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Amir Davoudi
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Amir Davoudi, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98- 9125623495, Fax:+98-81262120, E-mail:
| | - Farnoush Davoudi
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Sadrollah Mahmoodi
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Ghane
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hasan Goodarzi
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mehrdad Faraji
- Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Wiler JL, Griffey RT, Olsen T. Review of modeling approaches for emergency department patient flow and crowding research. Acad Emerg Med 2011; 18:1371-9. [PMID: 22168201 DOI: 10.1111/j.1553-2712.2011.01135.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emergency department (ED) crowding is an international phenomenon that continues to challenge operational efficiency. Many statistical modeling approaches have been offered to describe, and at times predict, ED patient load and crowding. A number of formula-based equations, regression models, time-series analyses, queuing theory-based models, and discrete-event (or process) simulation (DES) models have been proposed. In this review, we compare and contrast these modeling methodologies, describe the fundamental assumptions each makes, and outline the potential applications and limitations for each with regard to usability in ED operations and in ED operations and crowding research.
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Affiliation(s)
- Jennifer L Wiler
- Division of Emergency Medicine, Washington University in St. Louis School of Medicine, MO, USA.
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Bellucci Júnior JA, Matsuda LM. O enfermeiro no gerenciamento à qualidade em serviço hospitalar de emergência: revisão integrativa da literatura. Rev Gaucha Enferm 2011; 32:797-806. [DOI: 10.1590/s1983-14472011000400022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O estudo teve por objetivo analisar publicações relacionadas à atuação de enfermeiros no gerenciamento à qualidade em Serviço Hospitalar de Emergência. Por meio de revisão integrativa da literatura foram identificados 4780 artigos dos quais se selecionou oito, considerando os critérios: artigos completos; publicados no período entre 2000 a 2010; disponíveis no idioma português; indexados nas bases de dados da Biblioteca Virtual em Saúde. Todo o material foi analisado por meio da técnica Análise de Conteúdo. Emanaram-se duas categorias temáticas: Atuando na estruturação da equipe de enfermagem à qualidade do atendimento e Gerenciando as ações de enfermagem à qualidade no atendimento. Conclui-se que a promoção da qualidade do atendimento prestado em Serviço Hospitalar de Emergência é vinculada às ações de humanização do cuidado e do cuidador e que a atuação do enfermeiro no Acolhimento com Classificação de Risco é uma das principais estratégias para o gerenciamento da qualidade nesses serviços.
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Oliveira GN, Silva MDFN, Araujo IEM, Carvalho-Filho MA. Profile of the Population Cared for in a Referral Emergency Unit. Rev Lat Am Enfermagem 2011. [DOI: 10.1590/s0104-11692011000300014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the service’s care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.
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Machado CV, Salvador FGF, O'Dwyer G. Mobile Emergency Care Service: analysis of Brazilian policy. Rev Saude Publica 2011; 45:519-28. [PMID: 21503554 DOI: 10.1590/s0034-89102011005000022] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the configuration of mobile emergency health care policy in Brazil. METHODOLOGICAL PROCEDURES The study was based on public policy analysis. Bibliographic and document review, analysis of official data and interviews with federal administrators related to formulation and implementation of the Mobile Emergency Care Service (SAMU) in Brazil in the 2000s were performed. ANALYSIS OF RESULTS Priority was given to SAMU at the federal level since 2003. During the first years of implementation, municipal level services predominated; in 2008, services with regional scope became more significant. Estimated coverage reached 53.9% of the population in 2009, in 20.5% of Brazilian municipalities. Implementation varied between States, and there were less advanced support ambulances than recommended, both nationally and in several States. CONCLUSIONS SAMU was adopted nationwide since 2003 upon development of federal norms. Implementation of the policy involves challenges, including adequate investment, integration of the service into an established urgent care network, arrangement of appropriate information systems and personnel capacity. Addressing these challenges will allow SAMU to become a key health care strategy in the unified health system.
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O'Dwyer G. A gestão da atenção às urgências e o protagonismo federal. CIENCIA & SAUDE COLETIVA 2010; 15:2395-404. [DOI: 10.1590/s1413-81232010000500014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 05/31/2010] [Indexed: 11/22/2022] Open
Abstract
O atendimento às urgências/emergências tem sido alvo de críticas e o Estado brasileiro, a partir de 2002, assume o esforço de normatizar esse nível de atenção. Este estudo objetivou analisar a política de urgência a partir dos documentos e portarias, baseando-se na teoria da estruturação (Giddens), que relaciona a mobilização de recursos alocativos e autoritários como dimensões da estrutura em interação, o que justificaria a legitimação exercida a partir da sanção das normas. A Política Nacional de Urgência (PNAU) teve como marcos o financiamento federal, a regionalização, a capacitação dos profissionais, a gestão por comitês de urgência e a expansão da rede. Identifiquei a densidade das propostas documentais como a vertente facilitadora do recurso estrutural, inovadora pelas propostas de regionalização e de responsabilização dos diversos atores e pela pretensa centralidade no usuário. O financiamento do SUS, apesar do seu persistente estado de constrangimento, não teve ação coerciva sobre o investimento tecnológico. Na atual gestão, houve uma vigorosa expansão e estruturação da rede, que só foi possível por um forte aporte de recursos federais. A gestão pelos comitês precisa ser investigada e aponta-se como fragilidade a gestão do trabalho.
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Dubeux LS, Freese E, Reis YACD. Avaliação dos serviços de urgência e emergência da rede hospitalar de referência no Nordeste Brasileiro. CAD SAUDE PUBLICA 2010; 26:1508-18. [DOI: 10.1590/s0102-311x2010000800005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 05/03/2010] [Indexed: 11/21/2022] Open
Abstract
Este artigo avalia o grau de implantação de dez serviços de urgência/emergência hospitalar, que compõem a rede de referência macro e microrregional em Pernambuco, Nordeste brasileiro. Aborda critérios relativos à estrutura (física-organizacional, recursos materiais e humanos) e ao processo (atividades de rotina e de referência/contra-referência); classificando os hospitais como satisfatório, aceitável e deficiente. Aponta que a maioria dos hospitais se classifica como deficiente, estando entre estes todas as unidades de referência microrregionais e uma macrorregional. Estas últimas apresentam melhor desempenho quanto ao processo de trabalho; e a dimensão estrutura apresenta-se mais bem implantada nos hospitais microrregionais. Os resultados evidenciam como prioridade a qualificação dos hospitais avaliados, mediante o fortalecimento de políticas descentralizadas de recursos humanos e tecnológicos, direcionados à melhoria das práticas de trabalho consensuais aos contextos regionais do estado.
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Affiliation(s)
- Luciana Santos Dubeux
- Fundação Oswaldo Cruz, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
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