Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Impacto de intervenção educativa sobre segurança do paciente no conhecimento e atitude de estudantes de medicina / Impact of educational intervention about patient safety on the knowledge and attitudes of medical students

Introdução: a segurança é considerada um pilar da qualidade dos cuidados à saúde e seu sucesso depende do comprometimento individual e coletivo, porém, seu ensino é incipiente nas faculdades de medicina brasileiras. Objetivo: avaliar o impacto de intervenção sobre segurança do paciente no conhecimento e atitude dos alunos de medicina. Metodologia: conduziu-se o estudo do tipo pré-pós intervenção de janeiro a novembro de 2017. Todos os estudantes de graduação de medicina do 6° ano que realizaram estágio no hospital sob estudo foram incluídos. A intervenção compreendeu acolhimento, aula expositiva, estágio e aplicação de questionário para avaliar conhecimento e atitude sobre erro humano e segurança do paciente, que foi aplicado em 3 momentos: antes da aula e do estágio, imediatamente após a aula e após 15 dias da aula e término do estágio. As notificações de incidentes foram analisadas. Resultados: participaram 98 (100%) estudantes, dos quais 62% eram do sexo masculino, com média de idade de 25,8 anos. Após a intervenção, observou-se melhora significativa no conhecimento sobre a inevitabilidade do erro em saúde e a caracterização do profissional envolvido no incidente. As atitudes autorreferidas melhoraram significativamente em relação à necessidade de apoio institucional, abordagem sistêmica e adoção de práticas seguras para prevenção de erros; comunicação sobre riscos e erros para superiores, paciente e familiares e que apenas os médicos podem analisar os incidentes. Conclusão: a intervenção foi efetiva para aumentar o conhecimento dos estudantes sobre cultura de segurança, porém limitou-se na mudança de atitude, pois não evidenciou a notificação de incidentes em saúde.

Background: safety is considered a pillar of the quality of health care and its success depends on individual and collective commitment. However, in Brazilian medical schools there are fewer approaches to teaching this subject. Objective: To evaluate the impact of educational intervention about patient safety on the knowledge and attitude of medical students. Methodology: a pre-post intervention study was conducted from January to November 2017. All 6th year medical students who underwent an internship at the hospital under study were included. The intervention comprised reception, lecture, internship and application of a questionnaire to assess knowledge and attitude about human error and patient safety, which was applied in 3 moments: before class and internship, immediately after class and before of internship and in the end of the internship. Adverse drug reports were assessed. Results: 98 (100%) students participated, of which 62% were male, with an average age of 25.8 years. After intervention, there was a significant improvement in knowledge about the inevitability of health errors and the characterization of the professional involved in the incident. Self-reported attitudes have significantly improved in relation to the need for institutional support, a systemic approach and the adoption of safe practices to prevent errors; communication about risks and errors to superiors, patient and family and that only doctors can analyze the incidents. Conclusion: the intervention was effective in increasing students' knowledge of safety culture, but was limited to changing attitudes, as it did not show the notification of health incidents.

Impacto da gestão do consumo de água no Hospital Estadual Américo Brasiliense: um estudo piloto / Impact of water consumption management at the Brazilian American state hospital: a pilot study

Objetivos: Avaliar a redução da extração de água no poço artesiano após a instalação de medidores de vazão em pontos de distribuição hídrica num hospital. Métodos: Conduziu-se estudo piloto de intervenção do tipo antes e depois no Hospital Estadual Américo Brasiliense, localizado no interior do estado de São Paulo. A gestão da água iniciou-se em 2010 e realizou-se por meio do monitoramento de sete hidrômetros pré-equipados para sistema de telemetria, com relojoaria mecânica e sistema de turbinas, dos quais quatro foram instalados em 2016. Em março de 2017, foram instalados chuveiros e torneiras para limpeza com redutores de vazão em todo o hospital e arejadores em todas as torneiras para higienização das mãos. Analisou-se o impacto dos acessórios comparando-se a captação de água (m3) do poço artesiano. Estimou-se o retorno financeiro após a implantação das medidas. Resultados: Observou-se redução entre 21% e 42% (600 e 1.444 m³) do total do consumo hídrico e em 8.000 m3 de água por ano na extração do aquífero. Com a economia entre 800 e 1.000 m3 /mês de água, obteve-se retorno dos investimentos em 13 dias da implantação dos acessórios, pois o montante investido para compra e instalação dos equipamentos foi de 10.955 mil reais e a economia advinda da redução do consumo hídrico foi de 24.302 mil reais. Conclusão: A instalação de medidores de vazão é custo-efetiva para economia de água e financeira em hospitais. As melhorias contribuem para aumentar a credibilidade do desenvolvimento de projetos sustentáveis e a viabilidade de investimentos em ações ambientais

Objectives: Assess the reduction of water extraction in the artesian well after installation of flow restrictors in points of hydric distribution in a hospital. Methods: A pilot pre-post interventional study was carried out in Américo Brasiliense Hospital State, localized in the province of São Paulo (Brazil). Water management began in 2010. The monitoring was performed with seven water flow meters with telemetry system, with watchmaking and turbines of which four were installed in 2016. March 2017, flow restrictors on cleaning sinks and showers were installed, as well as aerators for hand basins. The impact of accessories was assessed comparing the water capitation (m3) in artesian well before and after interventions. Financial payback was estimated after implementation of the accessories. Results: Total hydric consumption decrease by 21% a 42% (600 a 1,444 m³) and reduced the extraction of aquifer in 8,000 m3 of water/year. With the aid of approximately 1,000 m3/month of water economy, the hospital had payback thirteen days after the implementation of the accessories, since the valor invested buy and install of the equipment was R$ 10.955,00 reais and the save regarding the decrease of hydric consume was R$ 24.302,00 reais. Conclusion: Flow restrictors installation in critical points of hydric distribution is cost-effective to reduce water consumption and costs in hospitals. Improvements performed contribute to raise the credibility of sustainability projects and the viability of investment in environmental actions.