Impacto de um ciclo de melhoria na redução da suspensão cirúrgica em um hospital público

Abstract

Introduction: The admission to the surgical procedure, with shorter waiting time, is crucial to guarantee the patient's quality of life and return to his socioeconomic activities. Objective: To carry out an improvement cycle to reduce the rate of surgery suspension in the operating room of a public hospital in Ceará. Methodology: Quantitative quasi-experimental study, before and after, carried out in the 2019/2020 biennium, based on the Saturn improvement cycle and following the SQUIRE guidelines. For the evaluation, four quality criteria related to the causes of surgical suspension and fifteen sub-criteria related to criteria 1 and 2 were defined, to better direct the evaluation and analysis of quality problems. The interventions were planned and implemented in a participatory, multifaceted and data-based manner, with the aim of reducing the causes of surgical suspension related to the quality criteria. After the interventions, the criteria were reassessed to measure the results and distributed on a Pareto chart. The behavior of the surgical suspension rate indicator and the calculation of absolute and relative improvement after the intervention were also analyzed. Statistical significance was tested using the onesided z-value test. Results: The results showed that, in the first evaluation, 88.2% of the scheduled procedures were performed and in the reassessment, after interventions, 93.3% of the scheduled procedures took place, demonstrating an absolute improvement of 5.1% and a relative improvement of 43.2% in the suspension of surgeries. Criteria 2 (comply with the surgical schedule) and 4 (absence of refusal to perform the procedure) showed an improvement in quality, with compliance increasing from 92.5% to 97.3% and from 99.7% to 100% respectively. The rate of surgical suspension decreased from 13% to 8% and then to 3%, following the rules of the Run chart, and has maintained this value ever since. Conclusions: The improvement cycle carried out in this study represents a valuable tool to intensify quality management, as it contributed to a significant reduction in surgical cancellations. Based on the results achieved, the institution can disseminate important contributions to other hospitals in the public health network, by demonstrating that management measures bring gains to the population, which benefits from the increase in the offer of services and to the institution, which makes their most efficient processes.