Avaliação de intervenções de Gestão da Clínica na qualificação do cuidado e na oferta de leitos em um hospital público de grande porte

Abstract

*** Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital ***AIMS: To describe the results achieved in hospital performance indicators and supply of beds, with the strategy of incorporating clinical management into the care process of the backup unit of the Nossa Senhora da Conceição Hospital.METHODS: The study was carried out in the backup unit of the Nossa Senhora da Conceição Hospital, in Porto Alegre, Rio Grande do Sul, Brazil. The backup unit is an inpatient hospital with beds intended for hospital emergency patients characterized by short stay (less than 10 days of hospitalization) and in the study period it had 27 beds. As clinic management tools we implemented multidisciplinary reference teams and multidisciplinary rounds, established a Kanban system to monitor mean length of stay, and introduced the unique therapeutic project at the hospital entrance (emergency room) and management of beds by the Internal Regulation Center. We monitored the hospital indicators number of hospitalizations, mean length of stay, resolvability, mortality rate and turnover rate over a period of 12 months (2016, after implementation of the strategy) and made comparisons with the same period of the previous year. RESULTS: After the introduction of Clinic Management, there was an increase in the number of hospitalizations from 1395 to 1537/year. There were 1240 discharges to home (an average of 104 a month), showing an increase of 101.9% in relation to the previous period. There was also a decrease in the number of internal transfers (between the back unit and other sectors of the hospital), an increase in the turnover rate from 51.6 to 56.9, decrease in the mean stay time of 7.2 days to 6.6 days and a significant decrease in the mortality rate from 3.5 to 0.7 (p <0.05).CONCLUSIONS: The implementation of clinical management in the context of care work in the hospital's backup bed unit fostered improvements in care processes, as well as ensuring greater supply of beds to users.