Adverse obstetric outcomes in two Brazilian maternity hospitals.

PURPOSE: Obstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals. DESIGN/METHODOLOGY/APPROACH: A one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index. FINDINGS: A significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year. ORIGINALITY/VALUE: High AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

Improving the quality of radiological examinations: effectiveness of an internal participatory approach.

QUALITY PROBLEM OR ISSUE: To assess the quality of radiological examinations (REs) and to evaluate the effectiveness of a participatory continuous improvement approach to ensure best practices in a Portuguese hospital imaging department. INITIAL ASSESSMENT: At baseline, we found 232 (10.2%) non-compliances, mostly related to the criteria image centering and framing in chest radiography (CXR), proper use of radiological protection equipment in other conventional RE (CR) and X-ray beam collimation (CXR/CR). CHOICE OF SOLUTION: A baseline and three consecutive evaluations of the RE quality were conducted. Each assessment was followed by participatory focused interventions for improvement. IMPLEMENTATION: For each evaluation, we selected a random sample (n = 60) of cases for four types of examination (total n = 240 for each assessment, and 960 for the whole project). Both the building of quality criteria and the design of interventions for improvement were participatory, involving the radiology technicians. Estimates of criteria compliance were calculated with 95% confidence intervals. The statistical significance of absolute and relative improvements was tested using one-tail z-tests. EVALUATION: After the intervention, non-compliances decreased to 48 (2.1%). Compliance estimates improved in 25 of 38 criteria assessed, with statistical significance for 5 criteria in CXR and 3 in CR and digestive examination. LESSONS LEARNED: The internal participatory approach enabled the identification of existing quality problems and, by focusing on the more frequent quality defects, was effective in improving the quality of RE.

Implementation of the WHO Safe Childbirth Checklist: a scoping review protocol.

INTRODUCTION: The WHO Safe Childbirth Checklist (WHO SCC) was developed to accelerate adoption of essential practices that prevent maternal and neonatal morbidity and mortality during childbirth. This study aims to summarise the current landscape of organisations and facilities that have implemented the WHO SCC and compare the published strategies used to implement the WHO SCC implementation in both successful and unsuccessful efforts. METHODS AND ANALYSIS: This scoping review protocol follows the guidelines of the Joanna Briggs Institute. Data will be collected and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews report. The search strategy will include publications from the databases Scopus, PubMed, Embase, CINAHL and Web of Science, in addition to a search in grey literature in The National Library of Australia's Trobe, DART-Europe E-Theses Portal, Electronic Theses Online Service, Theses Canada, Google Scholar and Theses and dissertations from Latin America. Data extraction will include data on general information, study characteristics, organisations involved, sociodemographic context, implementation strategies, indicators of implementation process, frameworks used to design or evaluate the strategy, implementation outcomes and final considerations. Critical analysis of implementation strategies and outcomes will be performed with researchers with experience implementing the WHO SCC. ETHICS AND DISSEMINATION: The study does not require an ethical review due to its design as a scoping review of the literature. The results will be submitted for publication to a scientific journal and all relevant data from this study will be made available in Dataverse. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/RWY27.

Instruments for assessing quality policies and strategies in health systems: a scoping review protocol.

INTRODUCTION: The World Organization recommends to implement National Quality Policies and Strategies in health systems, but few instruments have been proposed to assess and monitor these quality interventions at the system level. This study will map and compare instruments for the assessment of quality policies and strategies in health systems around the world. METHODS AND ANALYSIS: This is a scoping review protocol developed according to the Joanna Briggs Institute's manual and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The search for articles will be performed in the following Embase, Medline/Pubmed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature. Searches will also be conducted on Google Scholar and grey literature (www.opengrey.eu). A descriptive analysis of studies mapped by analysis categories will be performed. The results will be presented through a narrative summary of the mapped findings to verify how the results correlate with the objective and research question of the review. ETHICS AND DISSEMINATION: The study does not require an ethical review due to its nature. The submission of results for publication in a peer-reviewed journal and presentation at a scientific conference is expected. LINK TO THE PROTOCOL RECORD IN THE OPEN SCIENCE FRAMEWORK OSF: https://DOI.org/10.17605/OSF.IO/2KMTS.

Quality of prescription writing in Brazilian primary health care.

OBJECTIVE: To evaluate the quality of prescription writing in the context of public primary health care. BACKGROUND: Prescription errors are one of the leading patient safety problems in primary care and can be caused by errors in therapeutic decisions or in the quality of prescription writing. METHODS: Cross-sectional observational study conducted in a municipality in Northeastern Brazil. The assessment instrument (including 13 indicators and one composite indicator) was applied to a representative sample of drug prescriptions from the 24 Family Health Teams providing Primary Health Care in the municipality, dispensed in January 2021. Estimates of compliance and their 95% confidence intervals and graphical analysis of frequencies are assessed globally and stratified by dispensing units and prescribers. FINDINGS: The average composite prescription writing quality on a 0-100 scale was 60.2 (95% CI 57.8-62.6). No quality criteria had 100% compliance. The highest compliance rates were found for 'frequency of administration' (98.9%) and 'identification of the prescriber' (98.9%). On the other hand, 'recorded information on allergy' (0.0%), 'patient's date of birth' (1.7%), 'nonpharmacological recommendations' (1.7%), and 'guidance on the use of the drug' (25%) were the indicators with lower compliance, contributing to 69% of the noncompliances found. The type and frequency of the errors in the quality of prescription writing uncovered in this study confirm the continuing need to tackle this problem to improve patient safety. The results identify priority aspects for interventions and further studies on the quality of prescription writing in the context of Primary Health Care in Brazil.

Validation of surgical care quality indicators in the Brazilian Unified Health System.

OBJECTIVE: To validate a set of indicators for monitoring the quality of surgical procedures in the Brazilian Unified Health System (SUS). METHODS: Validation study developed in 5 stages: 1) literature review; 2) prioritization of indicators; 3) content validation of indicators by RAND/UCLA consensus method; 4) pilot study for reliability analysis; and 5) development of instruction for tabulation of outcome indicators for monitoring via official information systems. RESULTS: From the literature review, 217 indicators of surgical quality were identified. The excluded indicators were: those based on scientific evidence lower than 1A, similar, specific, which corresponded to sentinel events; and those that did not apply to the SUS context. Twenty-six indicators with a high level of scientific evidence were submitted to expert consensus. Twenty-two indicators were validated, of which 14 process indicators and 8 outcome indicators with content validation index ≥80%. Of the validated process indicators, 6 were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p < 0.05) and 2 had almost perfect reliability (Kappa coefficient > 0.8, p < 0.05), when the inter-rater agreement was analyzed. One could measure and establish tabulation mechanism for TabWin for 7 outcome indicators. CONCLUSION: The study contributes to the development of a set of potentially effective surgical indicators for monitoring the quality of care and patient safety in SUS hospital services.

Effects of home healthcare for adults with chronic respiratory diseases and post-COVID-19 syndrome on hospital bed turnover rate: a protocol of systematic review with meta-analysis.

INTRODUCTION: Chronic respiratory diseases (CRDs) have a high prevalence, morbidity and mortality worldwide. After the COVID-19 pandemic, the number of patients readmitted after hospital discharge increased. For some populations, early hospital discharge and home healthcare may reduce health costs in patients treated at home when compared with those hospitalised. This study aims to systematically review the effectiveness of home healthcare for patients with CRDs and post-COVID-19 syndrome. METHODS AND ANALYSIS: We will search on MEDLINE, CENTRAL, Embase and PsycINFO. We will include randomised controlled trials (RCTs) and non-RCT studies reported in full text and abstracts. No language restriction will be applied. We will include studies related to adults with a diagnosis of CRDs or post-COVID-19 syndrome that compared in-patient hospital care with any home healthcare. We will exclude studies with participants with neurological, mental diseases, cancer or pregnant women. Two review authors will screen abstracts and select the eligible studies. To investigate the risk of bias, we will use the Cochrane 'Risk of Bias' tool for RCT, and the Risk of Bias In Non-randomised Studies-of Interventions for non-RCT. We will use the five Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) considerations to assess the quality of the evidence. Patients and the public will be involved in the preparation, execution and implementation phases of the review. ETHICS AND DISSEMINATION: No ethical approval is required because only published data will be analysed. The publication of the results in peer-reviewed journals and at relevant conferences will guide the direction of future research in the field and healthcare practice. The results will also be disseminated in plain language on social media to disseminate the knowledge to society and the public interested in the topic.

Improvement project to reduce surgical site infections: a retrospective cohort study.

INTRODUCTION: Surgical site infections are one of the main problems related to health care. In Brazil, they are responsible for 14 to 16% of infections related to health care. This study sought to analyze the effect of implementing a package of measures to reduce surgical site infections (SSI) in heart surgeries, kidney transplants and herniorrhaphies and to evaluate adherence to the safe surgery checklist in a university hospital. METHODS: this is a retrospective cohort study with data collection in a time series for the period from 2018 to 2020. RESULTS: we analyzed 222 medical records referring to the surgeries under study performed in the year 2020, in which data were collected from the patients and the care package prevention measures. SSI data and adherence to the safe surgery checklist were analyzed in the years 2018, 2019 and 2020, totaling 268, 300 and 222 procedures analyzed, respectively. CONCLUSION: the study showed a significant reduction in the SSI rate with greater adherence to the protocol, which was not maintained and was influenced by the COVID-19 pandemic. Thus, the sustainability of this action represents a challenge to be overcome, in order to establish a safer environment for the patient and a better quality of service.

Framework for health care quality and evidence-based practice in radiology departments: A regional study on radiographer's perceptions.

INTRODUCTION: The main goals of this study were to describe, in an integrated and multidimensional way, the conditions related to the quality of care in radiology departments from Algarve (Portugal), to assess the perspective of radiographers on the use of scientific evidence in clinical practice and to validate a model that characterizes the conditions for continuous improvement. METHODS: A cross sectional study was performed in four radiology departments from public and private healthcare facilities from Algarve region (Portugal). A paper-based survey was sent to all radiographers to assess the quality systems implemented in their radiology departments and their perspective on the use of scientific evidence in clinical practice. RESULTS: In total, 62 radiographers (61.4%) completed the survey. The quality dimensions that obtained the highest degree of compliance were the existence of quality assurance and improvement activities (43.0%), existence of standards in clinical practice of radiographers (42.7%) and the existence of special provisions (37.6%). The quality dimension related to patient's involvement was the one with the lowest level of compliance. Moreover, from the radiographers perspective, positive responses were obtained related to evidence-based actions (83.0%), sources of evidence (76.0%) and the significance of research activities (74.0%). CONCLUSION: These findings suggest that a new framework based on four factors (Support for Information; Organizational Capability to Technical Quality of Care; Patient Involvement and Evidence-Based Radiology), should be considered in the establishment of strategic policies that better define the provision of diagnostic procedures and professional practices in radiology departments from Algarve region, based on quality improvement systems and better patient safety. IMPLICATIONS FOR PRACTICE: There is a need to include patients in the decision-making process, to involve radiographers in quality assurance and improvement activities and to implement quality monitoring mechanisms within radiology departments under study.

Impact of the implementation of the WHO Safe Childbirth Checklist on essential birth practices and adverse events in two Brazilian hospitals: a before and after study.

OBJECTIVE: The WHO Safe Childbirth Checklist (SCC) is a promising initiative for safety in childbirth care, but the evidence about its impact on clinical outcomes is limited. This study analysed the impact of SCC on essential birth practices (EBPs), obstetric complications and adverse events (AEs) in hospitals of different profiles. DESIGN: Quasi-experimental, time-series study and pre/post intervention. SETTING: Two hospitals in North-East Brazil, one at a tertiary level (H1) and another at a secondary level (H2). PARTICIPANTS: 1440 women and their newborns, excluding those with congenital malformations. INTERVENTIONS: The implementation of the SCC involved its cross-cultural adaptation, raising awareness with videos and posters, learning sessions about the SCC and auditing and feedback on adherence indicators. PRIMARY AND SECONDARY OUTCOME MEASURES: Simple and composite indicators related to seven EBPs, 3 complications and 10 AEs were monitored for 1 year, every 2 weeks, totalling 1440 observed deliveries. RESULTS: The checklist was adopted in 83.3% (n=300) of deliveries in H1 and in 33.6% (n=121) in H2. The hospital with the highest adoption rate for SCC (H1) showed greater adherence to EBPs (improvement of 50.9%;p<0.001) and greater reduction in clinical outcome indicators compared with its baseline: percentage of deliveries with severe complications (reduction of 30.8%;p=0.005); Adverse Outcome Index (reduction of 25.6%;p=0.049); Weighted Adverse Outcome Score (reduction of 39.5%;p<0.001); Severity Index (reduction of 18.4%;p<0.001). In H2, whose adherence to the SCC was lower, there was an improvement of 24.7% compared with before SCC implementation in the composite indicator of EBPs (p=0.002) and a reduction of 49.2% in severe complications (p=0.027), but there was no significant reduction in AEs. CONCLUSIONS: A multifaceted SCC-based intervention can be effective in improving adherence to EBPs and clinical outcomes in childbirth. The context and adherence to the SCC seem to modulate its impact, working better in a hospital of higher complexity.

Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro.

OBJECTIVE: To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS: This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS: After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION: The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.

Implementation of an improvement cycle in the care of a primary health care.

OBJECTIVES: to evaluate the effectiveness of a quality improvement cycle applied to the care of spontaneous demand in a primary care center. METHODS: quasi-experimental before and after study, with a quantitative approach and no control group. An improvement cycle was carried out in a primary care center in the city of Guarabira/PB using five quality criteria. An evaluation, an intervention focused on the most problematic criterion and a reassessment were carried out. The samples were random (n = 60). The percentages and confidence intervals of compliance with each criterion were verified. Statistical significance was calculated using the Z test. RESULTS: after the intervention, there was a significant improvement in two quality criteria of the care of spontaneous demand users (the user must be heard by a professional and go through the risk classification). CONCLUSIONS: the improvement cycle was an effective quality management method.

AGRASS Questionnaire: Assessment of Risk Management in Health Care.

OBJECTIVE: This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS). METHODS: This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median < 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach's alpha. RESULTS: The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ≤ 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (α = 0.94) and process dimension (α = 0.93), and adequate for the structural dimension (α = 0.70). CONCLUSIONS: The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain.

This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Multicentre cross-sectional study on adverse events and good practices in maternity wards in Brazil and Mexico: same problems, different magnitude.

OBJECTIVE: To evaluate the quality of delivery care in maternity wards in Brazil and Mexico based on good practices (GP) and adverse events (AE), in order to identify priorities for improvement. DESIGN: A multicentre cross-sectional study with data collection from medical records between 2015 and 2016 to compare indicators of maternal and neonatal GP and EA based on the Safe Childbirth Checklist and standardised obstetric quality indicators. Two Brazilian and five Mexican maternity wards participated in the study. Descriptive statistics and χ2 tests were performed to assess performance and significant differences between the hospitals investigated. SAMPLING: We analysed 720 births in Brazil and 2707 in Mexico, which were selected using a systematic random sampling of 30 medical records every fortnight for 12 2-week periods in Brazil and 18 2-week periods in Mexico. We included women and their newborns, excluding those with congenital malformations. RESULTS: The Mexican hospitals showed greater adherence to GP (58.2%) and a lower incidence of AE (12.9%) than the participating institutions in Brazil (26.8% compliance with GP and 16.0% AE). In spite of these differences, the relative importance of particular quality problems and type of AE are similar in both countries. Tertiary hospitals, caring for women at higher risk, have significantly (p<0.001) higher rates of AE (27.2% in Brazil and 29.6% in Mexico) than institutions attending women at lower risk, where the frequency of AE ranges from 4.7% to 11.2%. Differences were significant (p<0.001) for most indicators of GP and AE. CONCLUSION: Data from outcome and process measures revealed similar types of failures in the quality of childbirth care in both countries and indicate the need of rationalising the use of antibiotics for the mother and episiotomy, encouraging greater adherence to partograph and to the use of magnesium sulfate for the treatment of severe preeclampsia/eclampsia.

[Patient safety culture in three Brazilian hospitals with different types of management]. / Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão.

The scope of the study was to evaluate patient safety culture and associated factors in Brazilian hospitals with different types of management, namely federal, state and private hospitals. The design was cross-sectional and observational. A survey of 1576 professionals at three hospitals of Rio Grande do Norte state was performed using the Hospital Survey on Patient Safety Culture adapted for Brazil, which measures 12 dimensions of safety culture. Perceptions are described by attributing a general result (Range 0-10) and the percentage of positive responses to estimate their strengths and weaknesses. The response rate was 13.6% (n= 215). The patient safety coefficient was between 7 and 10 for 78.1% of the respondents, whereby the highest average grade was attributed to the private hospital (8.32). It has been estimated that the type of hospital management, unit service, position and number of adverse event notifications are associated with the overall patient safety grade (p <0.001). Only the private hospital had strengths in the dimensions analyzed, while the weaknesses appeared in all the hospitals.

O objetivo do estudo foi avaliar a cultura de segurança do paciente e fatores associados em hospitais brasileiros com diferentes tipos de gestão: federal, estadual e privado. O desenho foi observacional transversal. Enviaram-se 1576 questionários aos profissionais de três hospitais do estado do Rio Grande do Norte, utilizando o Hospital Survey on Patient Safety Culture, adaptado para o Brasil, que mede 12 dimensões da cultura de segurança. As percepções são descritas através de uma nota geral (0 a 10) e dos percentuais de respostas positivas para estimar fortalezas e fragilidades em cada dimensão. A taxa de resposta foi de13,6% (n = 215). A segurança do paciente teve nota entre 7 e 10, para 78,1% dos respondentes, sendo a maior média das notas apresentada pelo hospital privado (8,32). O tipo de gestão hospitalar, unidade de serviço, cargo e quantidade de notificação de eventos adversos estiveram associados à nota geral da segurança do paciente (p < 0,001). Apenas o hospital privado apresentou fortalezas nas dimensões analisadas, enquanto que as fragilidades apareceram em todos os hospitais.

Validation of surgical care quality indicators in the Brazilian Unified Health System / Validação de indicadores de qualidade do cuidado cirúrgico no Sistema Único de Saúde

ABSTRACT OBJECTIVE To validate a set of indicators for monitoring the quality of surgical procedures in the Brazilian Unified Health System (SUS). METHODS Validation study developed in 5 stages: 1) literature review; 2) prioritization of indicators; 3) content validation of indicators by RAND/UCLA consensus method; 4) pilot study for reliability analysis; and 5) development of instruction for tabulation of outcome indicators for monitoring via official information systems. RESULTS From the literature review, 217 indicators of surgical quality were identified. The excluded indicators were: those based on scientific evidence lower than 1A, similar, specific, which corresponded to sentinel events; and those that did not apply to the SUS context. Twenty-six indicators with a high level of scientific evidence were submitted to expert consensus. Twenty-two indicators were validated, of which 14 process indicators and 8 outcome indicators with content validation index ≥80%. Of the validated process indicators, 6 were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p < 0.05) and 2 had almost perfect reliability (Kappa coefficient > 0.8, p < 0.05), when the inter-rater agreement was analyzed. One could measure and establish tabulation mechanism for TabWin for 7 outcome indicators. CONCLUSION The study contributes to the development of a set of potentially effective surgical indicators for monitoring the quality of care and patient safety in SUS hospital services.

RESUMO OBJETIVO Validar um conjunto de indicadores para monitoramento da qualidade dos procedimentos cirúrgicos no Sistema Único de Saúde (SUS). MÉTODOS Estudo de validação desenvolvido em 5 etapas: 1) revisão de literatura; 2) priorização de indicadores; 3) validação de conteúdo dos indicadores por método de consenso RAND/UCLA; 4) estudo piloto para análise da confiabilidade; e 5) desenvolvimento de instrutivo para tabulação dos indicadores de resultado para monitoramento via sistemas de informações oficiais. RESULTADOS A partir da revisão de literatura, foram identificados 217 indicadores de qualidade cirúrgica. Os indicadores excluídos foram: indicadores baseados em evidências científicas inferiores a 1A, similares, específicos, que correspondiam a eventos sentinelas; e aqueles que não se aplicavam ao contexto do SUS. Foram submetidos ao consenso de especialistas 26 indicadores com alto nível de evidência científica. Foram validados 22 indicadores, dos quais 14 indicadores de processo e 8 indicadores de resultado com índice de validação de conteúdo ≥80%. Dos indicadores de processo validados, 6 foram considerados confiáveis substancialmente (Coeficiente de Kappa entre 0,6 e 0,8; p < 0,05) e 2 tiveram confiabilidade quase perfeita (coeficiente de Kappa > 0,8, p < 0,05), quando analisada a concordância interavaliador. Foi possível mensurar e estabelecer mecanismo de tabulação para TabWin para 7 indicadores de resultado. CONCLUSÃO O estudo contribui com o desenvolvimento de um conjunto de indicadores cirúrgicos potencialmente eficazes para o monitoramento da qualidade do cuidado e segurança do paciente nos serviços hospitalares do SUS.

Improvement project to reduce surgical site infections: a retrospective cohort study / Projeto de melhoria para redução de infecções de sítio cirúrgico: um estudo de coorte retrospectivo

ABSTRACT Introduction: Surgical site infections are one of the main problems related to health care. In Brazil, they are responsible for 14 to 16% of infections related to health care. This study sought to analyze the effect of implementing a package of measures to reduce surgical site infections (SSI) in heart surgeries, kidney transplants and herniorrhaphies and to evaluate adherence to the safe surgery checklist in a university hospital. Methods: this is a retrospective cohort study with data collection in a time series for the period from 2018 to 2020. Results: we analyzed 222 medical records referring to the surgeries under study performed in the year 2020, in which data were collected from the patients and the care package prevention measures. SSI data and adherence to the safe surgery checklist were analyzed in the years 2018, 2019 and 2020, totaling 268, 300 and 222 procedures analyzed, respectively. Conclusion: the study showed a significant reduction in the SSI rate with greater adherence to the protocol, which was not maintained and was influenced by the COVID-19 pandemic. Thus, the sustainability of this action represents a challenge to be overcome, in order to establish a safer environment for the patient and a better quality of service.

RESUMO Introdução: as infecções do sítio cirúrgico são um dos principais agravos relacionados à assistência à saúde. No Brasil, são responsáveis por 14 a 16% das infecções relacionadas à assistência à saúde. Esse estudo buscou analisar o efeito da implementação de um pacote de medidas para redução de infecções de sítio cirúrgico (ISC) em cirurgias cardíacas, transplantes renais e herniorrafias e avaliar adesão ao checklist de cirurgia segura em um hospital universitário. Métodos: trata-se de um estudo de coorte retrospectivo com coleta de dados em série temporal relativo ao período de 2018 a 2020. Resultados: foram analisados 222 prontuários referentes às cirurgias em estudo realizadas no ano de 2020, nos quais foram coletados dados dos pacientes e do pacote de medidas de prevenção. Dados de ISC e adesão ao checklist de cirurgia segura foram analisados nos anos de 2018, 2019 e 2020, totalizando 268, 300 e 222 procedimentos analisados, respectivamente. Conclusão: o estudo evidenciou uma redução significativa da taxa de ISC com a maior adesão ao protocolo, a qual não foi mantida e sofreu influência da pandemia de COVID-19. Assim, a sustentabilidade dessa ação representa um desafio a ser contornado, a fim de estabelecer um ambiente mais seguro para o paciente e uma melhor qualidade do serviço.

Factors associated with access to physical rehabilitation for victims of traffic accidents.

OBJECTIVE: Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors. METHODS: A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables. RESULTS: Among the 155 respondents, the majority were adolescents and adults between 15-29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7-59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term - family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management - written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10). CONCLUSIONS: This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan). OBJETIVO: Avaliar o nível de acesso à reabilitação física para sobreviventes de acidentes de trânsito e seus fatores associados. MÉTODOS: Estudo transversal realizado em Natal, Nordeste do Brasil, com inquérito telefônico a 155 vítimas de acidentes de trânsito atendidos no hospital de emergência, entre janeiro e agosto de 2013, com diagnóstico de fratura, traumatismo cranioencefálico ou amputação. Os participantes foram identificados no banco de dados do hospital referência para atendimentos de acidentes de trânsito. Calculou-se a estimativa pontual e o intervalo de confiança (IC95%) da porcentagem de acesso e tempo para acesso, além de análise multivariada (regressão logística) entre o acesso (variável dependente) e as variáveis sociodemográficas, clínicas e assistenciais. RESULTADOS: Entre os 155 entrevistados, predominaram jovens e adultos de 15-29 anos (47,7%), sexo masculino (82,6%), escolaridade até o ensino médio (92,3%), renda de até dois salários mínimos (78,0%) e motociclistas (75,5%). Embora 85,8% dos sobreviventes de acidentes de trânsito tivessem relatado a necessidade de reabilitação física, houve baixo acesso geral (51,6%; IC95% 43,7-59,4) e demora para início da reabilitação física (média = 67 dias). Os fatores associados ao acesso à reabilitação física classificaram-se em: (i) individuais não modificáveis em curto prazo - renda familiar maior que dois salários mínimos (OR = 3,7), ser trabalhador informal (OR = 0,11) ou desempregado (OR = 0,15) e ter plano privado de saúde (OR = 0,07); e (ii) assistenciais modificáveis pela gestão do serviço - encaminhamento escrito para reabilitação física (OR = 27,5) e necessidade percebida de reabilitação física (OR = 10). CONCLUSÕES: Este estudo encontrou um baixo e demorado acesso à reabilitação física para indivíduos potencialmente necessitados. Os fatores associados foram os processos organizativos dos cuidados em saúde (encaminhamento e informação em saúde) e os determinantes sociais (renda, ocupação e plano privado de saúde).

Confiabilidade da autoavaliação das práticas de segurança do paciente instituídas pelo Sistema Nacional de Vigilância Sanitária: um estudo piloto / Reliability of patient safety self-assessment practices established by the National Health Surveillance System: a pilot study

Resumo Introdução: A Autoavaliação das Práticas de Segurança do Paciente é um ato regulatório para melhoria da qualidade do cuidado. Porém, há dúvidas sobre a validade das suas informações. O objetivo deste estudo foi analisar a sua confiabilidade. Método: Estudo piloto de análise da confiabilidade de 21 indicadores simples e um composto da autoavaliação como forma de embasar uma amostra nacional em estudos futuros. Participaram hospitais com leitos de terapia intensiva e comparou dados da Autoavaliação (AA) e Autoavaliação Revisada (AR) pela vigilância sanitária (Visa) com a Inspeção Presencial (IP). A análise incluiu os coeficientes Kappa e de correlação intraclasse. Resultados: Comparando com a IP, a concordância foi aceitável (Kappa≥0,4) em 12 indicadores da AA e em 18 da AR. Os indicadores menos confiáveis são relativos a protocolos de prevenção de infecções. Quanto ao indicador composto do nível de adesão, a confiabilidade melhorou com revisão da Visa (AA=0,89 e AR=0,94), embora a concordância da classificação de alta conformidade tenha sido baixa. Conclusões: A AR se mostrou essencial para melhorar a confiabilidade da Autoavaliação. Ademais, identificou-se necessidade de revisar alguns indicadores e o instrumento de verificação pela Visa.

Abstract Introduction: The Patient Safety Self-Assessment Practices is a regulatory action to enhance quality of care. However, validation of its information requires attention. This study aimed to analyze reliability of the Patient Safety Self-Assessment Practices. Methods: Pilot study analyzing the reliability of 21 simple indicators and 1 composite of self-assessment to provide a national sample in future studies. Hospitals with intensive unit care beds participated in the study, and data from self-assessment (SA) and revised self-assessment (RSA) by the health surveillance (HS) were compared with on-site inspection (OSI). Analyses included Kappa and intraclass correlation coefficients. Results: Concordance was satisfactory (Kappa ≥ 0.4) in 12 indicators of SA and 18 indicators of RSA compared with OSI. The least reliable indicators were related to infection prevention protocols. Reliability of the adherence level composite indicator improved with HS revision (SA = 0.89 and RSA = 0.94), despite the low concordance of the high compliance classification. Conclusion: RSA was essential to improve reliability of SA. In addition, some indicators and assessment tools of the HS need revision.