Efeito da implantação de ciclo de melhoria da qualidade nos registros de saúde de um serviço pré-hospitalar móvel de urgência

Abstract

Introduction: The improvement cycles can be used to strengthen management functions, contributing to the detection of problems or opportunities for improvement, with a view to solving and / or upgrade them. Objective: to measure the effect of the implementation of a quality improvement program in filling in the records of occurrences of the Mobile Emergency Service (SAMU), in Patos, Paraíba (PB). Method: this is a quasi-experimental study of time series without control group, divided in six stages according to the norms of SQUIRE 2.0 adapted (2018): identification and prioritization of improvement; analysis of the opportunity for improvement; construction and validation of quality criteria; quality level assessment; intervention; revaluation. Three evaluations were made in the biennium 2016-2018, with a simple random sampling of 100 cases in each evaluation, based on seven criteria: identification; clinical evaluation; pathological background; standardization with documented record; readable-correct-accurate record; professional accountability; Systematization of Nursing Assistance (SNA). The complete analysis in the first evaluation showed a failure in all the criteria with emphasis on SNA. Interventions were made in a multifaceted way, grouped by related areas, directed to the quality criteria of worse conformity in the evaluations until a new characterization was achieved, with a completeness favorable to quality. However, the need for new interventions was maintained, since in two of the established criteria did not achieve improvements, nor was there any statistical significance. Therefore, new actions were planned and implemented for the continuity of the process with revaluation under the same criteria. Results: for the established criteria, the statistically significant difference was accepted with Z values of significance <0.001 in 87% of the criteria. In absolute data, it is verified that all seven criteria showed improvements between the evaluations and it is observed that the non-compliance decreased from 95 cases in the first evaluation to 8 cases in the third evaluation. Conclusion: the representation of the joint results between the three evaluations could highlight progressive advance in the compliments of each criterion, emphasizing the decrease of the defects (not compliments) found. Considering the limitations of the study, we evaluated as successful the effect of the implementation of the service improvement program, by providing greater integration of professionals and showing the reduction of the defects of the evaluated problem.