Regulation of hospital medics: evaluation of time of intervention in cardiac surgery

Name: Morgana Maria Rampe Reis
Type: MSc dissertation
Publication date: 26/02/2018

Namesort descending Role
Eliane de Fátima Almeida Lima Advisor *

Examining board:

Namesort descending Role
Cândida Caniçali Primo Co advisor *
Eliane de Fátima Almeida Lima Advisor *
Fabio Lucio Tavares External Alternate *
Franciéle Marabotti Costa Leite Internal Examiner *
Mirian Fioresi Internal Alternate *
Rita Ines Casagrande da Silva External Examiner *

Summary: Introduction: The average hospitalization time is an important indicator for the assessment of hospital efficiency, efficacy, and effectiveness, being a basis for healthcare planning and management. Among the non-transmissible chronic diseases, cardiovascular diseases are the main causes of hospitalization, and they generate the greater cost for this component of the national healthcare system. In order to meet a demand for institutional improvements in the management of hospital beds in the cardiac surgery. This project is aligned with the research line of organization and evaluation of health care systems, and was developed in partnership with the team of cardiac surgery and bed management of the master student’s institution. Objectives: To describe the socio-demographic and clinical profile of patients submitted to heart surgery; To verify the hospitalization average time distribution according to the socio-demographic and clinical characteristics; To examine the association between the average hospitalization time and the socio-demographic and clinical variables of patients submitted to heart surgery; To elaborate an pre-surgical checklist for the hospitalization of the heart surgery patient. Method: This is a transversal and retrospective epidemiological study done from the analysis of the secondary data of individuals who have been submitted to heart surgery at a university hospital in the South-East region of Brazil. Data was collected from the heart surgery patient’s records in the heart surgery staff records, the surgical center records, and the University Hospitals Management App in the period from May to September 2017. Results: 200 records of patients submitted to heart surgery between August 2015 and April 2017 were analyzed. The greater part of these were of male gender, older than 60 years, and brown. The most prevalent co-morbidities were high blood pressure, dyslipidemia, and diabetes mellitus. The total average hospitalization time was 23 days. A higher median average hospitalization time was that for patients with over 60 years old, male, with previous co-morbidities, especially chronic kidney failure, as well as tobacco smoking, clinical procedure at hospitalization, having been previously hospitalized at the Intensive Care Unit, and surgical suspension. Besides that, the most prolonged hospitalization was the one for individuals who presented post-surgical complications, such as neurological events, cardiac arrhythmias, acute kidney failure, lung complications, and hospital infection (p<0,05). Product: A preoperative checklist was developed for the hospitalization of the heart surgery patient that was implemented at the institution. Conclusion: The study was important to know the profile of patients who underwent heart surgery in the institution and in contributing to the intensification of health educational and prevention actions, giving support to strategies for the adherence to treatment and the control of complications. In addition, the association of clinical and sociodemographic variables with hospitalization time made it possible to identify patients who remained in bed longer, being useful in the development of institucional protocols and flows. The product is relevant to scientific development and it has potential to generate an impact and be applied at the local level to organize the management of cardiac surgery beds. The instrument was sent for use at the institution.

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