GestÃo por processo : o protocolo como ferramenta para a melhoria da qualidade e de reduÃÃo dos custos nos hospitais universitÃrios

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

This research paper analyzes if the use of a health care protocol in a university hospital can promote an increase in the quality of the care provided while also promoting cost reduction in the standardized surgical procedure itself and in the inpatient units directly related to it. During the years of 2004 and 2005, a quasi-experimental study was made in the Orthopedic Unit of the Clinical Hospital of the Federal University of Pernambuco (UOT/HC/UFPE), by means of the establishment of two groups: a study group formed by patients undergoing a standardized procedure for total arthoplasty of the knee and a control group composed of patients undergoing the normally performed arthroplasty of the hip. Data were analyzed on quality indicators, direct costs of the surgery itself and of the inpatient stay for 89 patients of the experimental study group and 22 patients of the control group. Three hypotheses were tested: Hypothesis 1: the utilization of a standardized care protocol in the orthopedics inpatient unit of the Clinical Hospital of the Federal University of Pernambuco (UOT/HC/UFPE) helped to increase the quality of care of the medical-hospital services provided to the patients subjected to a total arthroplasty of the knee. Hypothesis 2: the utilization of a standardized care protocol in the UOT/HC/UFPE helped reduce the direct variable costs of the total arthroplasties of the knee performed in this Unit. Hypothesis 3: the utilization of a standardized care protocol in the orthopedics inpatient unit of the UOT/HC/UFPE helped reduce the direct variable costs associated with the inpatient length of stay (LOS) for the patients submitted to total arthroplasty of the knee admitted to this Unit. The results obtained confirmed hypothesis 1 for the indicators related to the hospital length of stay and hospital infection, partially confirmed the indicators related to problem solving, the surgery in itself and the Operating Room and did not confirm the indicators for the completion of medical records and information recording. The indicator related to the incidence of repeated exams was not tested due to the lack of occurrences. Hypothesis 2 was not confirmed with regards to the global analysis of the costs related to the surgery. A more segmented analysis of the costs involved, however, showed that the hypothesis was not true only for disposable items and other material costs used for the surgery and for anesthesia, but was true for personnel cost items related to the surgical team, to medicinal gases and equipment depreciation. Their cost values were reduced after the implementation of the standardized care protocol for arthroplasty of the knee. Hypothesis 3 was confirmed for the variable costs of the inpatient length of stay not only in a global context, but in all specific cost items considered

ASSUNTO(S)

gestÃo por processos indicadores de qualidade hospitalar custos hospitalares administracao protocolos de atendimento

ACESSO AO ARTIGO

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