Ciclo de melhoria para aumentar a adesão ao protocolo de atendimento inicial ao paciente vítima de trauma

Abstract

Introduction: Trauma is the leading cause of death among people aged 15 to 29 years. Due to the complexity of the problem, it is necessary that the service is carried out through protocols that favor the timely, safe and effective reception, providing identification and prompt action to life-threatening situations. Objective: To carry out a cycle of improvement, to increase the adherence of professionals to the Protocol of Initial Assistance to the Patient Victim of Trauma in a reference hospital in the region of Cariri in the Brazilian Northeast. Methodology: This is a quantitative, quasiexperimental, before and after study, carried out from September 2020 to February 2022, based on a quality improvement cycle, following the SQUIRE guidelines, divided into 9 steps: identification and prioritization of improvement; analysis of the causes of the problem; development of quality criteria; quality assessment; analysis and presentation of evaluation data; designing interventions to improve; implementation of the intervention; reassessment and registration; and monitoring. It has an approval opinion in the CEP under n.4,963,590. For the evaluation, seven quality criteria were defined related to the causes of non-adherence to the trauma care protocol. The interventions were planned and implemented in a participatory and multifaceted way, with the aim of increasing adherence to the record of actions in the trauma care protocol, and took place from September 2021 to February 2022. After the interventions, the criteria were reassessed and the analysis was performed from the calculation of point estimates of criteria compliance and absolute and relative improvement. Statistical significance was tested using the one-sided z-value test and presented in a Pareto chart. Results: In the first evaluation, nonconformities were found in 74% of the criteria and in the re-evaluation, a reduction of 60% of this rate was observed, resulting in 71% of compliance. The greatest gains after interventions were related to the registration of Revised Trauma Score data, with a relative improvement of 96%; patient and trauma identification data filled in, achieving an absolute improvement of 41% and a relative improvement of 91%; and initial care based on the ATLS described in the Trauma Protocol form, with an absolute improvement of 62% and a relative improvement of 86%. As additional gains, there was a 59% increase in the number of protocol activations, and a 29% reduction in associated mortality. Conclusions: It is believed that the interventions planned with the help of quality tools provided a more accurate identification of the causes of the problems found, favoring the improvement of the quality of patient care.