Analysis of the organizational aspects of a clinical emergency department: a study in a General Hospital in Ribeirao Preto, SP, Brazil.

Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10%), on Mondays (16%), from 12pm to 12am (67.1%). The main reason for discharge from the unit was hospitalization (63.8%) and the predominant length of stay in the unit was less than six hours (39.8%). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

[Hospitalizations at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, 1996-2003]. / Produção de internações no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USE, 1996-2003.

Hospitalizations represent an important share of healthcare, due to both the complexity of actions and the financial volume applied. This descriptive-exploratory investigation had the purpose to identify and describing the physical and financial production of hospitalizations performed in a school hospital in the state of São Paulo, from 1996 to 2003, focusing the specialties of surgical clinic, medical clinic, pediatrics and obstetrics. Data collection was performed by searching the official databanks of the studied institution. In that period, a global 8.5% reduction in the frequency of admittances and a 78.4% increase in the financial resources were observed. Surgical clinic, with more expensive procedures, increased its admittances; the production in obstetrics showed the lowest variation. The increasing incorporation of technology, the demands from regional users and the migration of users from the supplementary system to the SUS may justify the variation of production in the different specialties.

Explanatory factors for the variation in hospitalizations.

In the implementation/consolidation process of the Brazilian Single Health System (SUS), hospitalization deserves special attention from the local management. This descriptive study identifies, through qualitative data, factors that explain variations in the number of hospitalizations processed and paid by the Municipal Health Department of Ribeirão Preto, Brazil. Data were collected through interviews with people who produce/use information regarding hospitalizations and then analyzed according to Bardin's (1979) thematic content analysis. As the major explanatory factors for the variation in hospitalizations, interviewees indicated changes in the demographic structure, low problem solving ability in basic care services, introduction of hospitals in the health system, technological incorporation, and the administrator's role in the local health system. It is the responsibility of the administrator, by using scientific instruments associated to human interaction, to regulate, control, and evaluate hospitalizations, planning health care according to the users' needs and organizing the system so as to reach satisfactory results.

Quality assessment of the wound dressing procedure in patients at a university hospital.

This observational and sectional study analyzed the quality of the wound dressing procedure performed on hospitalized patients at a medical surgical unit of a University Hospital, based on their classification according to the degree of care dependency and activity performance phases. Using a check list, 168 wound dressings were observed between October and December 2005. Procedure quality was analyzed based on the Positivity Index (IP) and values >70% were considered satisfactory. For the preparation, the IP was 68%, 63%, 73% and 75% for patients with degrees I, II, III and IV, respectively; for execution, 70%, 69%, 71% and 75% and, for unit organization, it was >70% for all degrees. However, the items: validity time frame checking, respect for aseptic principles and maintenance of logical sequence of procedures were compromised. Rigorous execution of procedures allows for risk decrease and assures beneficial results for patients, conferring quality to nursing actions.

[Absenteeism of nursing workers in a school hospital]. / Ausência dos trabalhadores de enfermagem em um hospital escola.

Absenteeism in the nursing team worries the institutions' managers, because they reflect on the human resources quantitative aspects, interfering in the quality of healthcare provided to the clientele. This descriptive, retrospective study identified the percentage and the types of expected and non-expected absences of nursing workers in a school hospital, between April, 2001 and March, 2002. Data were collected by consultating the schedules and the monthly attendance reports in the Human Resources Center. Expected absences reached 40% for weekly days off, 3.9% for holidays and 9% for vacations. The percentage of non-expected absences for the nursing category varied from 0 to 46.3%, predominantly due to maternity leaves and occupational accidents. For nursing technicians and auxiliaries, percentages varied from 0.5% to 11.6%. In this case, the absences were due to sick and medical leaves approved by the National Institute of Social Security.

[Quality of procedures delivered by nursing assistants]. / Qualidade no desempenho de técnicas dos trabalhadores de enfermagem de nível médio.

OBJECTIVE: To assess the quality of nursing care provided in inhalation, peripheral venipuncture, and administration of intra-muscular medication procedures in the context of professional training of nursing assistants. METHODS: A cross-sectional study was carried out in two phases among nursing staff (nurse assistants as well as unlicensed nursing personnel), in three hospitals in the state of Bahia, Northeastern Brazil, in October and December 2001 and 2002. Data was collected by means of direct observation of task performance and analysis of the median values of performance. A convenience sample was stratified according to professional category and work unit. RESULTS: There was a quality improvement or maintenance while performing the procedure of inhalation, with an overall median score equal to or above 70%. Median scores were reduced for peripheral venipuncture and administration of intra-muscular medication. Analysis of the differences in the procedures indicated that performance improved regarding basic procedural steps but worsened regarding the interaction with the patient. As to the nursing teams, those in Hospital 1, where there were better working conditions, had the best performance, and those in Hospital 2, where there were the worst working conditions, showed the worst performance. CONCLUSIONS: Educational processes among nurse assistants implemented per se in poor working conditions are not able to bring about quality improvement of professional performance.

[Nursing staff turnover rate in hospitals of Uberaba, Minas Gerais]. / Rotatividade dos trabalhadores de enfermagem nos hospitais do município de uberaba, minas gerais.

This article measures and describes nursing staff turnover in eleven hospitals located in the city of Uberaba, Minas Gerais, Brazil, in 2003. The entire hospital network hired 327 nursing professionals and dismissed 276. Therefore, employment rate was higher than dismissal rate, with the exception of nursing assistants. Net replacement rate was of 24.3%. Entire nursing staff would be completely replaced in approximately 3.6 years. The indexes used indicated higher stability and lower staff turnover rate in public hospitals as compared to private hospitals.

[Production of hospital admissions through the Unified Health System in the municipality of Ribeirão Preto, SP]. / Produção de internações hospitalares pelo Sistema Unico de Saúde no município de Ribeirão Preto, SP.

Municipal managers need to dedicate special attention to hospitalizations, due to the financial volume they consume and to the possibility of reorganizing the local health system. This descriptive and cross-sectional study characterizes the production of hospitalizations, in physical and financial terms, between 1996 and 2003, in Ribeirão Preto, SP, Brazil. Data were obtained from a secondary data source, the Datasus database, and showed an increase of 56% in hospitalizations, and 156.3% in financial resources during this period. The largest growth occurred in the clinical surgery area (72.4%), which concentrates more complex and technological procedures, implying higher financial remuneration than in other specialties.

[Interdisciplinary home hospitalization program of Marília-SP: material resource costs]. / Programa interdisciplinar de internação domiciliar de Marília-SP: custos de recursos materiais consumidos.

This study estimated the mean total direct cost of some production factors (material resources), including consumption materials, diets, medication and solutions used by two patient groups during hospitalization in the Interdisciplinary Home Hospitalization Program (PROIID) of Marília-SP, Brazil. The sample consisted of 27 patients with a diagnosis of cerebral vascular accident (CVA) and 18 with Neoplasm. Data were collected from the moment of hospitalization until the patients left the program. The mean total direct cost amounted to R$ 52.72 for each patient with CVA and of R$ 65.13 for those with Neoplasm. For both patient groups, the sub-category of material--diets accounted for the highest percentage of costs.

[Nursing staff downsizing at a university hospital]. / Dimensionamento de pessoal de enfermagem em um hospital universitário.

The developed investigation in this type of case study, had as main goal to measure the nursing personnel at a university hospital. The adopted methodology comprizes the identification of some specific variables, among them the patient classification according to the nursing care category and the index of the predicted and not predicted absences. The medical clinic admission and surgical units were studied. Results demonstrated that the current nursing personnel corresponds to 50% of what was expected, whereas the nursing aides personnel has shown an overage of 29.2%. The redefinition of the nurses quantitative in the hospital will create possibilities to reorganize the work with the minimization of the working load, in such a way to assure the quality of delivered nursing care.

[Characterization of inpatients at the medical and surgical units of the University of São Paulo at Ribeirão Preto Medical School Hospital, according to the level of dependence on nursing care]. / Caracterização dos pacientes internados nas unidades médicas e cirúrgicas do HCFMRP-USP, segundo grau de dependência em relação ao cuidado de enfermagem.

This study characterized inpatients' level of dependence on nursing care at the medical and surgical hospitalization units of the University of São Paulo at Ribeirão Preto Medical School Hospital, Brazil, from April to June 2002. It also identified the mean bed occupation rate in the units under study. Perroca's Patient Classification System (2000) was used. Nine thousand, seven hundred and nineteen patients/day were classified at the medical units and 8,667 at the surgical units. In both the medical and surgical hospitalization units, there was a predominance of patients classified under the minimum level of nursing care with 70.3% and 66.9%, respectively. The mean bed occupation rate varied from 54.3 to 93.1% at the medical units and from 43.4 to 60.2% at the surgical units. The study allowed for the acquisition of knowledge about the clients with respect to the demand for nursing care with a view to the further development of nursing staff dimensioning.

[The "To Live in Cascavel" project: analysis of the information flow]. / Projeto "viver em cascavel": análise do fluxo de informações.

This study estimated and evaluated the time period (in days) concerning the flow of Live Birth Declarations (DNV) for high-risk newborns assisted by the Project "Living in Cascavel"-Paraná, Brazil, from 1996 to 1998, according to organization sites (hospital, epidemiological surveiliance service, basic health unit). Three hundred and three declarations were analyzed, and in order to analyze the flow time of the DNVs, 95% confidence intervals were constructed for the medium population times (in days). Results showed that the DNVs took 25 to 30 days to flow from the hospital until the moment when the home visit occurred. The care to high-risk newborns must take place in the shortest possible time; therefore, the flow time of DNVs found in this study, from birth until the home visit, may hinder the achievement of one of the objectives proposed by the project in question, which is the reduction of infant morbi-mortality in the municipality.

[Survival of patients treated with hemodialysis and estimated expenses in the municipality of Ribeirao Preto - SP]. / Estudo da sobrevida de pacientes submetidos a hemodiálise e estimativa de gastos no município de Ribeirão Preto-SP.

Using Life Table Method the present study estimated the survival of patients gone under hemodialysis, according to age group, from 1997 to 2000, in the Ribeirão Preto County. Based in probability of survival it was also estimated the expenses referred to the sessions of hemodialysis for patients that are beginning treatment. Nearly 60% of patients followed were alive after four years of study, show high survival. The results of this study show that the high expenditure with hemodialysis refers to the increase of survival of patients and not specifically the increase of demand of the therapy.

[The nursing work process: the gap between planning and care delivery]. / O processo de trabalho de enfermagem: a cisão entre planejamento e execução do cuidado.

This article aims at characterizing nurse's and nursing assistant's work process, as well as at analyzing contradictions present in nursing work. Studies on the nursing and health work process, and the communicative action theory were used as its theoretical framework. Based on qualitative research methodology, the empirical material was collected by means of semi-structured interviews with nurses, nursing assistants and physicians on the same work team in a school hospital. Analysis was conducted through the impregnation technique and the identification of thematic units, which were interpreted on basis of analytical categories from the theoretical framework. Results showed contradictions such as the separation between planning and care delivery and the absence of appropriation of nursing knowledge by the agents who are in charge of delivering care.

[Nursing auxiliaries and nursing technicians: different professional categories and equivalent jobs]. / O auxiliar e o técnico de enfermagem: categorias profissionais diferentes e trabalhos equivalentes.

This is a qualitative study with the purpose of identifying and analyzing the differences between the work developed by nursing auxiliaries and nursing technicians. It relies on the theoretical framework concerning health care and nursing work and the Theory of Communicative Action. Information was collected by means of interviews in three hospitals and involved nursing auxiliaries, nursing technicians, nurses and physicians, totaling 32 statements. Results showed that auxiliaries and technicians perform a wide range of actions, including those which are usual for such categories, patient evaluation activities and complex procedures. All the statements indicated that there was no difference between the work done by nursing auxiliaries and that performed by nursing technicians, which allows for questioning the appropriateness of such work division.

Errors in the administration of intravenous medication in Brazilian hospitals.

AIM: To verify the frequency of errors in the preparation and administration of intravenous medication in three Brazilian hospitals in the State of Bahia. BACKGROUND: The administration of intravenous medications constitutes a central activity in Brazilian nursing. Errors in performing this activity may result in irreparable damage to patients and may compromise the quality of care. DESIGN: Cross-sectional study, conducted in three hospitals in the State of Bahia, Brazil. METHODS: Direct observation of the nursing staff (nurse technicians, auxiliary nurses and nurse attendants), preparing and administering intravenous medication. RESULTS: When preparing medication, wrong patient error did not occur in any of the three hospitals, whereas omission dose was the most frequent error in all study sites. When administering medication, the most frequent errors in the three hospitals were wrong dose and omission dose. CONCLUSIONS: The rates of error found are considered low compared with similar studies. The most frequent types of errors were wrong dose and omission dose. The hospitals studied showed different results with the smallest rates of errors occurring in hospital 1 that presented the best working conditions. Relevance to clinical practice. Studies such as this one have the potential to improve the quality of care.

Analysis of the Organizational Aspects of a Clinical Emergency Department: A Study in a General Hospital in Ribeirao Preto, SP, Brazil / Análise dos aspectos organizacionais de um serviço de urgências clínicas: estudo em um hospital geral do município de Ribeirão Preto, SP, Brasil / Análisis de los aspectos de organización de un servicio de urgencias clínicas: estudio realizado en un hospital general del municipio de Ribeirao Preto, SP, Brasil

Demand for the Emergency Department (ED) has increased, making the organization of work difficult. This quantitative, descriptive and documental study identifies and analyzes the characteristics of clinical care in the ED of a General Hospital in Ribeirão Preto, SP, in 2007, according to organizational variables. The study population included all clinical care consultations registered in the Hospital Management Information System. Data were analyzed through descriptive statistics and discussed considering the theoretical framework of the Single Health System (SUS). A total of 5,285 consultations were registered in the period, which were more frequent in patients from the city itself, in January (10 percent), on Mondays (16 percent), from 12pm to 12am (67.1 percent). The main reason for discharge from the unit was hospitalization (63.8 percent) and the predominant length of stay in the unit was less than six hours (39.8 percent). The results support the management of human resources, materials and equipment, indicating the desirability of reorganizing emergency care in the hospital.

A demanda por serviços de urgência e emergência tem aumentado, dificultado a organização do trabalho. Com o objetivo de identificar e analisar características dos atendimentos de clínica médica, no serviço de urgência de hospital geral em Ribeirão Preto, 2007, segundo variáveis organizacionais, foi realizado estudo quantitativo, descritivo, utilizando dados documentais. A população de estudo foi representada por todos os atendimentos clínicos, registrados no Sistema de Informação Gestão Hospitalar. Os dados foram analisados segundo estatística descritiva e discutidos considerando o referencial teórico de reorganização do SUS. No período, ocorreram 5285 atendimentos, que foram mais frequentes em pacientes procedentes do próprio município, no mês de janeiro (10 por cento), às segundas-feiras (16 por cento), horário das 12 às 24h (67,1 por cento), principal motivo de alta da internação hospitalar (63,8 por cento) e o tempo de permanência na unidade, predominante, foi inferior a seis horas (39,8 por cento). Os resultados subsidiam gerenciamento de recursos humanos, materiais e equipamentos, favorecendo reorganização do microespaço de atenção à urgência no hospital.

La demanda por servicios de urgencia y emergencia ha aumentado, dificultado la organización del trabajo. Con el objetivo de identificar y analizar las características de las atenciones de clínica médica, en el Servicio de Urgencia del Hospital General en Ribeirao Preto, 2007, según las variables de organización fue realizado este estudio cuantitativo y descriptivo, utilizando datos documentales. La población de estudio fueron todas las atenciones clínicas, registrados en el Sistema de Información de Gestión Hospitalaria. Los datos fueron analizados según la estadística descriptiva y discutidos considerando el referencial teórico de reorganización del SUS. En el período ocurrieron 5.285 atenciones, que fueron más frecuentes en pacientes procedentes del propio municipio (63,8 por ciento), en el mes de enero (10 por ciento), los días lunes (16 por ciento), en el horario de la 12 a las 24h (67,1 por ciento), y el tiempo predominante de permanencia en la unidad fue inferior a seis horas (39,8 por ciento). Los resultados ofrecen subsidios para mejorar la gestión de recursos humanos, materiales y equipamientos, favoreciendo la reorganización del micro espacio de atención de urgencia en el hospital.

Incidência de úlcera por pressão e ações de enfermagem / Incidencia de úlcera por presión y acciones de enfermería / Incidence of pressure ulcer and nursing interventions

OBJETIVOS: Estimar a incidência cumulativa (ICup) e a densidade de incidência (DIup) de úlcera por pressão (UP) e descrever a ocorrência de ações de enfermagem em dois hospitais do Estado da Bahia, antes (fase 1) e durante (fase 2) intervenção educativa. MÉTODOS: Estudo de coortes prospectivo com pacientes médico-cirúrgicos, utilizando avaliação da integridade cutânea, consulta a registros no prontuário, e entrevista com paciente, família e equipe. RESULTADOS: ICup, fase 1 e fase 2 foi, respectivamente, no hospital 1 de 31,4 por cento e 13,6 por cento, e no hospital 2, de 21,4 por cento e 15 por cento; DIup aponta tempo médio de exposição para aparecimento de UP no hospital 1 de 14,3 dias na fase 1 e de 43,5 na fase 2; no hospital 2, de 31,3 dias na fase 1 e 37 na fase 2. CONCLUSÃO: Redução estatisticamente significante da DIup no hospital 1; cuidados de enfermagem preventivos para UP comprometidos em ambos os hospitais nas duas fases.

OBJECTIVES: To estimate the cumulative incidence (ICup) and density incidence (DIup) of pressure ulcer (PU) and to describe the implementation of nursing interventions in two hospitals in the State of Bahia before (phase 1) and during an educational intervention (phase 2). METHODS: A prospective design was used. The sample consisted of inpatients of medical/surgical units. Data were collected through skin integrity assessment, reviewing of medical records, interviewing patients, family members, and health care team. RESULTS: The cumulative incidence before and during the educational intervention was 31.4 percent and 13.6 percent in hospital 1, and 21.4 percent and 15 percent in hospital 2, respectively. The density incidence in hospital 1 before and during the educational intervention was 14.3 days and 43.5 days, respectively. The density incidence in hospital 2 before and during the educational intervention was 31.3 days and 37 days, respectively. CONCLUSION: There was a statistically significant reduction of density incidence in hospital 1. Preventive nursing interventions were effective in both before and during the educational intervention in both hospitals.

OBJETIVOS: Estimar la incidencia acumulativa (ICup) y la densidad de incidencia (DIup) de úlcera por presión (UP) y describir la ocurrencia de acciones de enfermería en dos hospitales del Estado de la Bahia, antes (fase 1) y durante (fase 2) la intervención educativa. MÉTODOS: Se trata de un estudio de cohortes prospectivo realizado con pacientes médico-quirúrgicos, utilizando una evaluación de la integridad cutánea, consulta a registros en la historia clínica, y entrevista con el paciente, la familia y el equipo. RESULTADOS: ICup, fase 1 y fase 2 fue, respectivamente, en el hospital 1 de 31,4 por ciento y 13,6 por ciento, y en el hospital 2, de 21,4 por ciento y 15 por ciento; DIup apunta un tiempo medio de exposición para la aparición de UP en el hospital 1 de 14,3 días en la fase 1 y de 43,5 en la fase 2; en el hospital 2, de 31,3 días en la fase 1 y 37 en la fase 2. CONCLUSIÓN: Reducción estadísticamente significativa de la DIup en el hospital 1; cuidados de enfermería preventivos para UP comprometidos en ambos hospitales en las dos fases.

Produção de internações no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, 1996-2003 / Hospitalizations at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP, 1996-2003 / Producción de internaciones en el Hospital de las Clínicas de la Facultad de Medicina de Ribeirão Preto, USP, 1996-2003

A produção de internações hospitalares representa importante parcela da atenção à saúde tanto pela complexidade de ações quanto pelo volume financeiro empregado. Esta investigação, de cunho descritivo-exploratório, teve como objetivo identificar e descrever a produção física e financeira de internações hospitalares realizadas em um hospital-escola do interior paulista, no período 1996-2003, nas especialidades de clínica cirúrgica, clínica médica, pediatria e obstetrícia. Os dados foram coletados a partir de consulta a banco de dados oficiais da instituição estudada. No período, houve redução global de 8,5% na freqüência de internações e crescimento de 78,4%, nos recursos financeiros percebidos. A clínica cirúrgica, com procedimentos de maior remuneração, apresentou incremento nas internações; na obstetrícia houve menor variação na produção. A crescente incorporação tecnológica, demanda de usuários da região, migração de usuários do sistema de saúde suplementar para o SUS, podem justificar a variação de produção nas diferentes especialidades.

Hospitalizations represent an important share of healthcare, due to both the complexity of actions and the financial volume applied. This descriptive-exploratory investigation had the purpose to identify and describing the physical and financial production of hospitalizations performed in a school hospital in the state of São Paulo, from 1996 to 2003, focusing the specialties of surgical clinic, medical clinic, pediatrics and obstetrics. Data collection was performed by searching the official databanks of the studied institution. In that period, a global 8.5% reduction in the frequency of admittances and a 78.4% increase in the financial resources were observed. Surgical clinic, with more expensive procedures, increased its admittances; the production in obstetrics showed the lowest variation. The increasing incorporation of technology, the demands from regional users and the migration of users from the supplementary system to the SUS may justify the variation of production in the different specialties.

La producción de internaciones hospitalarias representa una importante índice de la atención prestada a la salud, tanto por la complejidad de acciones como por el volumen financiero empleado en ella. Esta investigación descriptiva y exploratoria, tuvo como objetivo identificar y describir la producción física y financiera de internaciones hospitalarias realizadas en un hospital escuela del interior paulista, en el período de 1996 a 2003, en las especialidades de clínica quirúrgica, clínica médica, pediatría y obstetricia. Los datos fueron recolectados a partir de consultas al banco de datos oficial de la institución estudiada. En el período, hubo una reducción global de 8,5% en la frecuencia de internaciones y un crecimiento de 78,4% en los recursos financieros recibidos. La clínica quirúrgica, con procedimientos de mayor remuneración, presentó un incremento en las internaciones; en la obstetricia hubo una menor variación en la producción. La creciente incorporación tecnológica, la demanda de usuarios de la región y, la migración de usuarios del sistema de salud suplementar para el SUS, pueden justificar la variación de producción en las diferentes especialidades.

Produção física e financeira dos procedimentos cirúrgicos em hospitais sob gestão minicipal em Ribeirão Preto-SP / Producción física y financiera de los procedimientos quirúrgicos realizados en los hospitales municipales de ciudad de Ribeirão Preto-SP / Physical and financial terms of the surgical procedures carried out in municipally managed hospitals in Ribeirão Preto-SP, Brazil

Estudo exploratório com objetivo descrever a produção física e financeira dos procedimentos cirúrgicos, nas internações hospitalares remuneradas pela Secretaria Municipal de Saúde de Ribeirão Preto, segundo prestador, período 1996-2003. A coleta de dados utilizou a pesquisa documental em banco de dados oficiais da Secretaria Municipal de Saúde sobre internações em cinco hospitais conveniados ao Sistema Único de Saúde. No período houve incremento de 73,1 por cento na produção física e de 121,6 por cento nos recursos financeiros, concentrados nas subespecialidades de ortopedia/traumatologia, gastroenterologia e cirurgias do sistema cardiovascular/linfático. Constatamos a especialização de hospitais em algumas subespecialidades cirúrgicas. A variação na produção evidencia que subespecialidades de maior incorporação tecnológica e melhor remuneração apresentam incremento. O estudo não apresenta estimativas para os anos subseqüentes, o comportamento das diferentes subespecialidades ou diferentes prestadores hospitalares do município, entretanto incremento na produção física e financeira dos procedimentos cirúrgicos, no município estudado, justifica uma análise crítica do gestor do sistema.

This exploratory study aimed to describe the physical and financial terms of surgical procedures in hospitalizations from 1996 to 2003 covered by the Municipal Health Secretary in Ribeirão Preto, São Paulo, Brazil, according to providers. Data collection used documental research in official Municipal Health Secretary databases about hospitalizations in five hospitals associated to the Brazilian Federal Health Care System. During the period there was a 73.1 percent increase in procedure production and a 121.6 percent increase in financial resources, mostly in orthopedics/trauma, gastroenterology, and cardiovascular/lymphatic system surgeries. We note hospital specialization in some surgical sub-specializations. Variation among production evidences increases in sub-specializations involving higher use of technologies and better remuneration. This study does not present estimates for subsequent years, behavior of the different subspecialties, or the different hospital service providers in the city. However, the significant increase in the physical and financial terms of surgical procedures justifies critical analysis from the system manager.

Este estudio exploratorio tuvo como objetivo describir la producción material y financiera de los procedimientos quirúrgicos realizados en las hospitalizaciones remuneradas por la Secretaría Municipal de Salud de Ribeirão Preto, según un prestador de servicios, de 1996 a 2003. Para la recolección de los datos se utilizó la investigación documental en bases de datos oficiales de la Secretaría Municipal de Salud sobre hospitalizaciones en cinco hospitales con convenio con el Sistema Único de Salud. En el período estudiado hubo un aumento del 73,1 por ciento en el número de hospitalizaciones y 121,6 por ciento en los recursos financieros, especialmente en las subespecializaciones de ortopedia/traumatología, gastroenterología y cirugías del sistema cardiovascular y linfático. Se constató la especialización de hospitales en subespecialidades quirúrgicas. La variación en la producción evidencia un incremento en las subespecialidades con mayor incorporación tecnológica y mejor remuneración. El estudio no presenta estimaciones para los años siguientes, ni para el comportamiento de las diferentes subespecialidades o diferentes prestadores de servicios hospitalarios en el municipio, sin embargo, el aumento en la producción financiera y de los procedimientos quirúrgicos en el municipio estudiado, justifica el análisis crítico por el gestor del sistema.