Avaliação e melhoria do processo de cuidado do paciente com sepse em um serviço de emergência

Abstract

Introduction: Sepsis is a serious public health problem with high mortality potential worldwide. Initiatives for quality improvement have sought to change this scenario, however, this tool still needs to be better explored at the level of low- and middle-income countries. Objectives: To evaluate the effect of an improvement cycle for the sepsis care process in the emergency department, to identify the level of quality of care for sepsis and to analyze the effectiveness of a participatory and multifaceted improvement intervention. Methods: It is a cycle of quality improvement of multi-faceted and collaborative characteristics, with before-after quasi-experimental design in the biennium 2017/2018 in the Emergency department of a tertiary hospital located in the interior of northeastern Brazil. For the proposed evaluation, a list was established with ten quality criteria related to septic patient care. The analysis was carried out from the calculation of the one - off estimates of the conformity of the criteria and absolute and relative improvement. Statistical significance was tested using the unilateral z-value test. Results: The initial evaluation showed an absolute frequency of 843 failures, notably related to the reevaluation criteria of the septic patient and reclassification of the severity of the disease. A baseline was drawn and reassessment was conducted. After the intervention, the failures reduced to 506, representing an improvement of 67%. All the indicators evaluated had an increase in conformity in the second evaluation, but the improvement achieved in two of them was not statistically significant, represented by a p-value greater than 0.05. In addition, sepsis-related mortality fell by 10%. Conclusion: Quality improvement cycles are an important management tool to improve care for patients with sepsis, and should be used routinely to achieve continuous improvement.