Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital
DOI:
https://doi.org/10.15448/1980-6108.2017.2.26575Keywords:
clinical management, clinical governance, health services management, interdisciplinary health team, interprofessional relations, health quality management, Kanban System.Abstract
*** Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital ***
AIMS: To describe the results achieved in hospital performance indicators and supply of beds, with the strategy of incorporating clinical management into the care process of the backup unit of the Nossa Senhora da Conceição Hospital.
METHODS: The study was carried out in the backup unit of the Nossa Senhora da Conceição Hospital, in Porto Alegre, Rio Grande do Sul, Brazil. The backup unit is an inpatient hospital with beds intended for hospital emergency patients characterized by short stay (less than 10 days of hospitalization) and in the study period it had 27 beds. As clinic management tools we implemented multidisciplinary reference teams and multidisciplinary rounds, established a Kanban system to monitor mean length of stay, and introduced the unique therapeutic project at the hospital entrance (emergency room) and management of beds by the Internal Regulation Center. We monitored the hospital indicators number of hospitalizations, mean length of stay, resolvability, mortality rate and turnover rate over a period of 12 months (2016, after implementation of the strategy) and made comparisons with the same period of the previous year.
RESULTS: After the introduction of Clinic Management, there was an increase in the number of hospitalizations from 1395 to 1537/year. There were 1240 discharges to home (an average of 104 a month), showing an increase of 101.9% in relation to the previous period. There was also a decrease in the number of internal transfers (between the back unit and other sectors of the hospital), an increase in the turnover rate from 51.6 to 56.9, decrease in the mean stay time of 7.2 days to 6.6 days and a significant decrease in the mortality rate from 3.5 to 0.7 (p <0.05).
CONCLUSIONS: The implementation of clinical management in the context of care work in the hospital's backup bed unit fostered improvements in care processes, as well as ensuring greater supply of beds to users.
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References
- Brasil. Ministério da Saúde. Portaria n. 3.390, de 30 de dezembro de 2013. Institui a Política Nacional de Atenção Hospitalar no âmbito do Sistema Único de Saúde, estabelecendo-se as diretrizes para a organização do componente hospitalar da Rede de Atenção à Saúde. Diário Oficial da República Federativa do Brasil [Internet]. Brasília; 2013 [cited 2016 Dec 16]. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt3390_30_12_2013.html
- Mendes EV. As Redes de Atenção à Saúde. Brasília: Organização Pan-Americana da Saúde; 2011.
- Tang CJ, Chan SW, Zhou WT, Liaw SY. Collaboration between hospital physicians and nurses: an integrated literature review. Int Nurs Rev. 2013;60(3):291-302. https://doi.org/10.1111/inr.12034
- Gonzalo JD, Kuperman E, Lehman E, Haidet P. Bedside interprofessional rounds: perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians. J Hosp Med. 2014;9(10):646-51. https://doi.org/10.1002/jhm.2245
- Lopes dos Reis R. Manual da gestão de Stocks: teoria e prática. Lisboa: Editorial Presença; 2008.
- Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Núcleo Técnico da Política Nacional de Humanização. Clínica ampliada, Equipe de referência e projeto terapêutico singular. 2.ª ed. Brasília: Ministério da Saúde; 2007. (Série B. Textos Básicos de Saúde).
- Rea CM, Thompson GE. Multidisciplinary patient management by means of a high social risk screening tool. Clin Perform Qual Health Care. 1996;4(3):159-63.
- Anschau F, Webster J, Roessler N, de Oliveira Fernandes, Klafke V, Paim da Silva C, Messerschmit G, Ferreira S, Fossari JAJ. Clinic Management as a Tool for Enhancing quality of Care and Guarantee of Hospital Access. BAOJ Med Nursing. 2016;2(5):1-4.
- Zucchi P, Bittar OJN, Haddad N. Produtividade em hospitais de ensino no estado de São Paulo, Brasil. Rev Panam Salud Publica. 1998;4(5):311-6. https://doi.org/10.1590/S1020-49891998001100004
- Travassos C, Noronha J, Martins M. Mortalidade hospitalar como indicador de qualidade: uma revisão. Ciênc Saúde Colet. 1999;4(2):367-81. https://doi.org/10.1590/S1413-81231999000200011
- Machado JP, Martins ACM, Martins MS. Avaliação da qualidade do cuidado hospitalar no Brasil: uma revisão sistemática. Cad Saúde Pública. 2013;29(6):1063-82. https://doi.org/10.1590/S0102-311X2013000600004
- Barros JO. A construção de projetos terapêuticos no campo da saúde mental: apontamentos acerca das novas tecnologias de cuidado [dissertação]. [São Paulo]: Universidade de São Paulo; 2010. 111 p.
- Bonato VL. Gestão de qualidade em saúde: melhorando assistência ao cliente. Mundo Saude. 2011;35(5):319-31.
- Williams H, Edwards A, Hibbert P, Rees P, Prosser Evans H, Panesar S, Carter B, Parry G, Makeham M, Jones A, Avery A, Sheikh A, Donaldson L, Carson-Stevens A. Harms from discharge to primary care: mixed methods analysis of incident reports. Br J Gen Pract. 2015;65(641):e829-37. https://doi.org/10.3399/bjgp15X687877
- Husser J, Guerin O, Bretones D. The incentive effects of DRG's reimbursement rates for health care estabilishments in France: to wards a new allocation of surgical procedures? Int Bus Research. 2012;5(12):31-7. https://doi.org/10.5539/ibr.v5n12p31
- Campos GWS, Amaral MA. A clínica ampliada e compartilhada, a gestão democrática e redes de atenção como referenciais teórico-operacionais para a reforma do hospital. Ciênc Saúde Colet. 2007;12(4) :849-59. https://doi.org/10.1590/S1413-81232007000400007
- Pinto DM, Jorge MSB, Pinto AGA, Vasconcelos MGF, Cavalcante CM, Flores AZT, de Andrade AS. Projeto terapêutico singular na produção do cuidado integral: uma construção coletiva. Texto Contexto Enferm. 2011;20(3):493-502. https://doi.org/10.1590/S0104-07072011000300010
- Yu SY, Ko IS, Lee SM, Park YW, Lee C. A unit-coordinator system: an effective method of reducing inappropriate hospital stays. Int Nurs Rev. 2011;58(1):96-102. https://doi.org/10.1111/j.1466-7657.2010.00850.x
- Sendlhofer G, Brunner G, Tax C, Falzberger G, Smolle J, Leitgeb K, Kober B, Kamolz LP. Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers. Wien Klin Wochenschr. 2015 Jan;127(1-2):1-11. https://doi.org/10.1007/s00508-014-0620-7
- Martins M, Blais R, de Miranda NN. Avaliação do índice de comorbidade de Charlson em internações da região de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica. 2008 Mar;24(3):643-52. https://doi.org/10.1590/S0102-311X2008000300018
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
- Martins HM, Cu-a LM, Freitas P. Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital. Emerg Med J. 2009 Mar;26(3):183-6. https://doi.org/10.1136/emj.2008.060780
- Rafael MS, Portela SL, Sousa P, Fernandes AC. Utilização do serviço de urgência pediátrica: a experiência de um centro português. Sci Med. 2017;27(1):ID24919. https://doi.org/10.15448/1980-6108.2017.1.24919
- Lopes de Figueiredo M, D'Innocenzo M. Dificuldades encontradas pelos gestores de instituição de saúde na utilização da metodologia gestão por processos. RAS. 2011;13(50):45-52.
- Fernandes JCL. A quem interessa a relação médico paciente? Cad Saúde Pública. 1993;9(1):21-7. https://doi.org/10.1590/S0102-311X1993000100003
- Da Silva EP, Pereira de Melo FA, Marques de Souza M, Gouvea RA, Andrade e Tenório A, Cabral AFF, Pacheco MCS, Andrade AFR, Pereira TM. Projeto terapêutico singular como estratégia de prática da multiprofissionalidade nas ações de saúde. R Bras Ci Saúde 2013;17(2):197-202. https://doi.org/10.4034/RBCS.2013.17.02.14
