Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016. / Notificações de eventos adversos relacionados com a assistência à saúde que levaram a óbitos no Brasil, 2014-2016.

OBJECTIVE: to describe the adverse events related to health care resulting in death. METHODS: a descriptive study of reports recorded in the Brazilian Health Surveillance Notification System (Notivisa) in Brazil from Jun 2014 to Jun 2016; notifications recorded as 'other' in the 'incident type' were recoded. RESULTS: 417 cases were recorded, mostly in adults and the elderly (85%), with no sex differences; the states of São Paulo (N=92), Paraná (N=75) and Minas Gerais (N=66) were the main reporter; hospitals contributed to 97% of the records, principally in the intensive care and hospitalization sectors; the investigation by the notifying unit occurred in 5% of cases; in the recode of the type of incident, 52 records were recovered; the most common type of incident was 'failures during health care' (50%). CONCLUSION: notifications resulting in death occurred mainly in hospitals; were identified failure to register and need to investigate the large proportion of deaths.

Notificações de eventos adversos relacionados com a assistência à saúde que levaram a óbitos no Brasil, 2014-2016 / Registros de eventos adversos relacionados con la asistencia de salud que resultaron en muertes en Brasil, 2014-2016 / Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016

Objetivo: descrever os eventos adversos relacionados com a assistência à saúde resultantes em óbito. Métodos: estudo descritivo das notificações registradas no Sistema de Notificações para a Vigilância Sanitária (Notivisa) no Brasil, de junho/2014 a junho/2016; notificações registradas como 'outros' em 'tipo de incidente' foram reclassificadas. Resultados: foram registrados 417 óbitos, a maioria em adultos e idosos (85%), sem diferenças entre sexos; os estados de São Paulo (N=92), Paraná (N=75) e Minas Gerais (N=66) foram os maiores notificadores; os hospitais contribuíram com 97% dos registros, com concentração nos setores 'terapia intensiva' e 'internação'; houve investigação pela unidade notificadora em 5% das notificações; na reclassificação do tipo de incidente, recuperaram-se 52 registros; o tipo de incidente mais comum foi 'falhas durante a assistência à saúde' (50%). Conclusão: notificações resultantes em óbito ocorreram principalmente em hospitais; foram identificadas falhas no registro e necessidade de investigação de grande proporção dos óbitos.

Objetivo: describir los eventos adversos relacionados con la asistencia sanitaria que resultaran en muerte. Métodos: estudio descriptivo de las notificaciones registradas en el Sistema de Notificaciones para la Vigilancia Sanitaria (Notivisa) en Brasil entre junio/2014-junio/2016; las notificaciones registradas como 'otros' en la variable 'tipo de incidente' fueron reclasificadas. Resultados: se registraron 417 casos, la mayoría en adultos y ancianos (85%), sin predominio de sexo; los estados de São Paulo (N=92), Paraná (N=75) y Minas Gerais (N=66) fueron los mayores notificantes; los hospitales contribuyeron con el 97% de los registros; la investigación por la unidad notificante se produjo en el 5% de los casos; en la reclasificación, se recuperaron 52 registros; el tipo de incidente más común fue 'fallas durante la asistencia sanitaria' (50%). Conclusión: las notificaciones de eventos resultantes de la muerte son principalmente de hospitales; se identificaron fallas en el registro y necesidad de más investigación de las muertes.

Objective: to describe the adverse events related to health care resulting in death. Methods: a descriptive study of reports recorded in the Brazilian Health Surveillance Notification System (Notivisa) in Brazil from Jun 2014 to Jun 2016; notifications recorded as 'other' in the 'incident type' were recoded. Results: 417 cases were recorded, mostly in adults and the elderly (85%), with no sex differences; the states of São Paulo (N=92), Paraná (N=75) and Minas Gerais (N=66) were the main reporter; hospitals contributed to 97% of the records, principally in the intensive care and hospitalization sectors; the investigation by the notifying unit occurred in 5% of cases; in the recode of the type of incident, 52 records were recovered; the most common type of incident was 'failures during health care' (50%). Conclusion: notifications resulting in death occurred mainly in hospitals; were identified failure to register and need to investigate the large proportion of deaths.

[Perceptions on the quality of services relating to women's healthcare]. / Percepções sobre qualidade de serviços que atendem à saúde da mulher.

The scope of this work is to identify the characteristics relating to the quality of women's healthcare services from the perspective of the sanitary vigilance professionals (Visa) and women's healthcare coordinators (CSM) in the municipalities. It is a study with a qualitative approach that was carried out using semi-structured interviews. Three Brazilian state capitals were selected and three individuals in each capital were interviewed, namely a Visa healthcare service chief, as well as a technician, and a CSM coordinator. The content analysis technique was adopted to organize the data and the answers were grouped into the healthcare service evaluation topics based on Donabedian's model, i.e. structure, processes, and outcomes. Visa workers reported aspects related to the structure of health services, such as equipment and qualified human resources more frequently. The Visa chief mentioned aspects related to structure and processes, such as prioritization in attendance. The CWH coordinator examined all three categories, especially processes. Analysis of interviews points to a potential distortion in evaluation by results. The study highlights the need for joint action between the surveillance and assistance sectors to improve the quality of services.

Percepções sobre qualidade de serviços que atendem à saúde da mulher / Perceptions on the quality of services relating to women's healthcare

O objetivo deste trabalho é identificar as características relacionadas à qualidade em serviços que atendem à saúde da mulher na perspectiva de profissionais de vigilância sanitária (Visa) e de coordenadores de saúde da mulher (CSM) de municípios. Trata-se de um estudo de abordagem qualitativa, efetuado por meio de entrevistas semiestruturadas. Foram selecionadas três capitais brasileiras e entrevistados três sujeitos de cada capital - um responsável e um técnico da área de Visa em serviços de saúde e um CSM. A análise das entrevistas foi realizada pela técnica de análise de conteúdo, organizando as respostas em categorias temáticas baseadas no modelo de avaliação dos serviços de saúde de Donabedian: estrutura, processos e resultados. Os técnicos de Visa relataram com maior frequência aspectos relacionados à estrutura dos serviços de saúde, como equipamentos e recursos humanos qualificados. Os responsáveis pela Visa citaram aspectos relacionados à estrutura e aos processos como priorização no atendimento. Os CSM abordaram as três categorias, com destaque para os processos. As entrevistas apontam para um possível prejuízo na avaliação por resultados. O estudo reforça a necessidade de atuação conjunta entre os setores de vigilância e assistência, a fim de promover a qualidade nos serviços.

The scope of this work is to identify the characteristics relating to the quality of women's healthcare services from the perspective of the sanitary vigilance professionals (Visa) and women's healthcare coordinators (CSM) in the municipalities. It is a study with a qualitative approach that was carried out using semi-structured interviews. Three Brazilian state capitals were selected and three individuals in each capital were interviewed, namely a Visa healthcare service chief, as well as a technician, and a CSM coordinator. The content analysis technique was adopted to organize the data and the answers were grouped into the healthcare service evaluation topics based on Donabedian's model, i.e. structure, processes, and outcomes. Visa workers reported aspects related to the structure of health services, such as equipment and qualified human resources more frequently. The Visa chief mentioned aspects related to structure and processes, such as prioritization in attendance. The CWH coordinator examined all three categories, especially processes. Analysis of interviews points to a potential distortion in evaluation by results. The study highlights the need for joint action between the surveillance and assistance sectors to improve the quality of services.