Avaliação da adesão e da conformidade ao plano terapêutico na linha de cuidado do paciente com fratura de fêmur

Abstract

Introduction/Justification: In recent years, quality management has gained increasing importance in the hospital process, particularly in the surgical area. In 2007-2008, member countries of the World Health Organization (WHO) launched the second global challenge titled "Safe Surgery Saves Lives," aiming to reduce the number of deaths and complications associated with surgical procedures. The aging population has shown a significant demographic trend in recent years, resulting in an increased incidence of femur fractures in elderly patients in Brazil. In this context, the implementation of a therapeutic plan (TP) for patients with femur fractures can play a crucial role in improving the quality of care and outcomes for these patients. A therapeutic plan is associated with the management of a patient's clinical condition, which, with the involvement of a multidisciplinary team, can improve outcomes for hospitalized patients with femur fractures. Objectives: To evaluate the level of adherence and compliance to the TP in the care line of patients with femur fracture in a reference hospital, before and after an improvement cycle. Materials and Methods: This is an almost experimental study. The study was conducted at the Central Sertão Regional Hospital - HRSC, in Northeast Brazil. Patients admitted and operated at HRSC in the care line of patients with femur fractures from January to December 2023 were included. Reoperations, procedures without surgical incision, and patients requiring arthroplasty were excluded. Data were collected through consultation of safety management spreadsheets, the femur fracture patient care line spreadsheet, and medical records. From the medical records, sociodemographic information of the patients was collected, as well as the following parameters: length of hospital stay and compliance with the TP. Results: A total of 240 medical records were evaluated. The majority of patients were female (67.5%), with a mean age of 72.37±17.34 years. After the improvement cycle, there was a significant increase in adherence to the TP, with improvements in the timely opening rate of the plan and its compliance rate. There was no statistical difference in relation to length of hospital stay. In the Pareto analysis, the main process failures identified before the improvement cycle were related to the lack of timely plan opening and nursing reassessment, representing 61.82% (32.27% and 29.54%, respectively). After the cycle, the main failures were medical reassessment and the inclusion of multidisciplinary team goals, representing 45.65% (23.91% and 21.73%, respectively). Conclusion: The implemented improvement cycle was responsible for adjustments in the processes, resulting in an increase in TP compliance from 11% to 77% of the samples, which was statistically significant. The measures were effective but insufficient to ensure complete compliance with the therapeutic plan and reduce hospital stay.