Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascular

Abstract

Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascularResults of the establishment of an organizational model in a cardiovascular surgery service Abstract Objective: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes.Methods: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra-and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. Results:After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Rev Bras Cir Cardiovasc 2009; 24(2): 116-125 relevance, because they are the base of cardiovascular surgery programs of excellence [5]. Quality control programs aim at adequacy of hospitals units and professionals involved in order to provide the best possible medical care. With this, the influence of organizational factors in the surgical outcomes can be minimized, with only the team human error [6] and individual factors linked to the patient, such as, socioeconomic status, severity of the disease and its comorbidities [7,8].Although the literature is extremely important for the development of medical practice in various specialties, there are few publications aiming at hospital organizational aspect and its quality control. Little evidences correlates integrated measures for care to outcomes after heart surgery [9-11], which encourages broad discussion on the subject, considering the increasing transparency of the outcomes of medical procedures to the lay public [12] and the consequent tendency of payment based on parameters such as quality and performance [13].The aim of this study is to assess the short-term impact of the adoption of an organizational model of cardiovascular surgery service on the surgical outcomes.

Resultados clínicos e metabólicos da abreviação do jejum com carboidratos na revascularização cirúrgica do miocárdio

“…Multimodal protocols belong to the reality of CVS, also being recommended in guideline for CABG [2][3][4][5][6]26]. De Vries et al [6] compared 3760 patients who underwent CVS before implementation of a protocol checklist, with 3820 patients operated after implementation.…”

“…The percentage of patients with complications decreased from 15.4% to 10.6% (P<0.001). In Brazil, reference centers in CVS have been concerned with the creation and deployment of multimodal protocols, with the proposition of risk scores for patients undergoing CABG and maintaining databases in order to assess the results and adoption of impact measures for improvements [2][3][4][5][31][32][33][34]. Atik et al [5] showed that after adoption of the organizational model, there was a reduction in hospital mortality (from 12% to 3.6%, RR=0.3, P=0.003), as well as adverse events combined (22% to 15%, RR=0.68, P=0.011).…”

“…Thus, studies that discuss multimodal protocols of fast-track or ckecklist in surgical patients attempt to define perioperative care to involve themselves with less morbidity, lower costs and accelerate recovery. The implementation of these protocols with quality control in cardiovascular surgery (CVS) does not seem easy, but it is necessary, since the specialty needs to interact with several different areas of medicine and hospital sectors [1][2][3][4][5][6].…”

Production science in nursing: focus on pre-surgical care / Produção científica na enfermagem: enfoque no atendimento pré-cirúrgico

“…mobilizados diante de situação estressante como, medo, dúvida e alterações emocionais (14,15) . (16) . No caso de crianças o uso do brinquedo mostrou-se uma forma adequada para comunicar-se efetivamente com a criança .…”

O trabalho da enfermagem no pós-operatório de cirurgia cardíaca: uma revisão integrativa

“…O desenvolvimento tecnológico na área de Medicina tem permitido que operações cardiovasculares fossem conduzidas com segurança e resultados melhores. Fatores institucionais e pessoais estão envolvidos nesses bons resultados para melhor atendimento na assistência pós-operatória, exigindo dos profissionais atitudes, conhecimentos e habilidades específicas 11,12 .…”