Melhoria da qualidade nos processos do circuito cirúrgico

Abstract

Introduction: Surgical procedures may be responsible for improving the quality of life of thousands of Brazilians who need this intervention to solve their health problems. However, until it can be performed, a series of obstacles arise on the way through a virtual queue, which involves different stages, many trips to and from the health unit that will be responsible for carrying out the procedure, waiting, anguish, hope, annoyance and mismatches. Many of the problems are caused by the difficulty in establishing an assertive communication process in the surgical circuit, both between professionals and patients, as well as between the various areas involved. Objective: To improve the processes that make up the Surgical Circuit at a university hospital. Methodology: A complete improvement cycle was carried out on the surgical circuit processes, encompassing Identification and prioritization of the opportunity for improvement, Analysis of the quality problem, Construction of quality assessment criteria, Design of a quality level study or hypothetical causes, Analysis and presentation of the assessment data, Design of interventions for improvement, Implementation of the designed intervention, Re-evaluation and documentation of the improvement achieved. Two evaluations of four criteria were carried out, before and after the interventions: 1. the patient must be registered in the AGHU with their SUS card details; 2. the doctor must request pre-operative tests at the first gynaecological consultation of the surgical circuit; 3. specialist doctors (cardiologist and anaesthesiologist) must record the results of all the patient's tests in the electronic medical record; 4. the medical board must provide the AIH, the ICF, the prioritization (according to risk) and record all the information in the electronic medical record. The interventions carried out were: process mapping, construction of the risk matrix, construction of the Surgical Circuit Protocol, panel of indicators related to the performance and suspension of surgeries, as well as training, with the improvement team as a partner throughout the process. In addition, he had to hold daily talks with doctors and residents during the implementation phase of the interventions, seeking guidance on the opportunities for improvement found in the surgical circuit process. The work followed ethical and legal principles and was previously submitted for authorization by the hospital, having received a Letter of Institutional Consent, as well as being forwarded to the CEP and obtaining the Consubstantiated Opinion. Results: It was observed that, in absolute numbers, there were 44 non-compliances in the first evaluation, versus 19 in the second evaluation, accounting for a reduction of 25 "quality defects". This represented an absolute improvement of 56.81% through the improvement cycle. Conclusion: The application of the process improvement cycle in the Surgical Circuit proved to be a useful and effective quality tool, highly recommended for healthcare services. The significant improvement achieved in most of the quality criteria led to the inclusion of good practices in the recording of information in the electronic medical record, minimizing existing risks that could delay the steps in the Circuit, avoiding further delays in resolving the patients' health problems.