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Skip to content A segurança assistencial da rede hospitalar brasileira apresenta inúmeras oportunidades de melhoria que poderão diminuir mortes, sequelas aos usuários, sofrimentos aos profissionais de saúde, além de reduzir custos assistenciais liberando recursos para novos investimentos em segurança do paciente. Comparações de resultados dos achados do SUS e da Saúde suplementar neste estudo: o desenho metodológico deste estudo impossibilita comparações de resultados entre os dois sistemas de saúde.
Evoluções do segundo anuário de segurança assistencial hospitalar. O anuário de 2018 aumentou em 36,8% o numero de hospitais participantes e em 85,6% a amostra estudada Para o anuário de 2017 foram acompanhados 240.128 pacientes que tiveram alta de 133 hospitais no período de 12 meses. As condições adquiridas ocorreram em 7,2% desta população. No anuário 2018 foram acompanhados 445.671 pacientes de 182 hospitais e as condições adquiridas ocorreram em 7,0% desta população. A expectativa dos autores é de que esta tendência de crescimento da amostra e da abrangência se mantenha permitindo resultados cada vez mais representativos da assistência hospitalar no Brasil a cada nova edição.
As estimativas nacionais de mortes o anuário de 2017 foram baseadas em estudos nacionais que avaliaram a mortalidade nos pacientes com eventos adversos assistenciais (DAIBERT, 2015; MENDES et al., 2009; MARTINS et al., 2011) e foi constatado que ocorreram de 170.778 a 432.301 óbitos no Brasil determinados pelos eventos adversos , em 2016. Esta variabilidade foi atribuída as diferenças dos hospitais de cada estudo sendo o de Daibert realizado em hospitais acreditados e certificados e o de Mendes em Hospitais do SUS. Os impactos econômicos foram baseados na literatura internacional sendo estimado na saúde suplementar em R$ 15,57 bilhões sendo R$ 10,9 bilhões prevenível (PORTER; TEISBERG, 2006) (NIHCM, 2007).
No anuário de 2018 a mortalidade relacionada, determinada e previnivel dos eventos adversos graves foi estabelecida na população estudada . Os dados do presente anuários mostram uma mortalidade associada aos eventos adversos de 235.127 brasileiros um numero que se situa entre as estimativas de 2017
Para comparar o anuário de 2017 e 2018 seria necessário um estudo com desenho metodológico para contolar os fatores determinantes dos eventos adversos a saber estrutura, processos, complexidade dos pacientes e não fez parte do escopo deste trabalho.
DIRETRIZES PARA A CONSTRUÇÃO DE UMA REDE HOSPITALAR MAIS SEGURA NO BRASIL PROPOSTA PELO INSTITUTO DE ESTUDOS DE SAÚDE COMPLEMENTAR – IESS Estas diretrizes estão baseadas nos achados deste estudo e a maioria delas encontra-se em consonância com as de outros países do mundo e com o Programa Nacional de Segurança do Paciente
Número de internações (Brasil, 2017) 19.432.818Pacientes com eventos adversos relacionados a assistência hospitalar 1.299.540Pacientes com eventos adversos graves relacionados a assistência hospitalar 329.338Mortalidade associada aos eventos adversos de qualquer natureza relacionados a assistência hospitalar 235.127Mortalidade associada aos eventos adversos graves relacionados a assistência hospitalar 112.697Mortalidade atribuível ao evento adverso grave prevenível entre os pacientes com óbito associado a estes eventos (FAP) 36.174Aumento de tempo de internação associado aos eventos adversos de qualquer natureza relacionados a assistência hospitalar (em dias) 14.265.412Aumento de tempo de internação associado aos eventos adversos graves relacionados a assistência hospitalar (em dias) 4.742.230Oportunidade de aumento de acesso à internação hospitalar pela redução dos eventos adversos graves 929.972Custos estimados relacionados aos eventos adversos gerais na saúde suplementar 10,61 bilhõesCustos estimados relacionados a eventos adversos graves na saúde suplementar 1,11 bilhões
Proposição de meta nacional de segurança assistencial hospitalar Diminuir 36.174 óbitos hospitalares em 10 anos pela prevenção dos eventos adversos graves. Para o alcance da meta devemos: a. construir um acordo nacional tendo como alvo a centralidade da saúde das pessoas e como prioridade a segurança assistencial e sustentabilidade do sistema de saúde através da qualidade assistencial b. os líderes da sociedade brasileira devem estabelecer uma cultura de segurança assistencial, não punitiva, que transforme as experiências com as falhas em oportunidades de melhoria; c. o governo e iniciativa privada devem corrigir as deficiências de estrutura e processo da rede hospitalar brasileira. Os recursos a serem utilizados nesta ação podem se originar do controle do desperdício da ociosidade, 41,8% dos leitos disponíveis no Brasil, da redução dos eventos adversos graves, 15% dos custos da saúde suplementar e do aumento da eficiência/produtividade no uso do leito hospitalar; d. A agencia nacional de saúde deve disponibilizar arcabouço legal que permita as operadoras concentrarem o atendimento de sua redes de assistência hospitalar e selecionarem prestadores mais seguros. e. o SUS e as operadoras de saúde suplementar brasileira devem mudar seu modelo de rede hospitalar concentrando sua assistência em um número menor de organizações hospitalares, de grande porte e alto volume assistencial, aumentando a segurança dos pacientes, diminuindo o desperdício da ociosidade e auxiliando na sustentabilidade dos hospitais pelo aumento de escala assistencial que dilui o custo fixo; f. o SUS e as operadoras de Saúde suplementar brasileira devem mudar seu modelo de pagamento de hospitais trocando o fee-for-service por modelos que incentivem a qualidade, segurança e aumento da eficiência / produtividade do leito hospitalar; g. o SUS, as operadoras de saúde suplementar e hospitais devem aumentar o nível de transparência e acesso ao usuário da informação de qualificação e resultados assistenciais hospitalares por meio de um conjunto comum de indicadores e requisitos de segurança de alta relevância; h. o estado deve aumentar sua capacidade de fiscalização da aplicação da legislação na rede hospitalar; i. o sistema de saúde deve capacitar sua força de trabalho e ofertar condições de estrutura e processos que atendam a legislação e os requisitos de segurança.
As prioridades para gestão de risco assistencial hospitalar no Brasil Os cinco alvos populacionais: a. pacientes de alta complexidade determinada por sua doença de base; b. pacientes em terapia intensiva; c. pacientes submetidos a procedimentos cirúrgicos de maior porte; d. pacientes em uso de procedimentos invasivos (CVC, VM, SVD*); e. pacientes nos extremos de idade: recém-nascidos prematuros e idosos acima de 65 anos. * Cateter venosos Central (CVC), ventilação mecânica (VM), sonda vesical de demora (SVD)
Os quatro alvos de prevenção de infecção relacionada à assistência à saúde Programas: a. septicemia, associada ou não aos dispositivos intravasculares; b. pneumonia, associada ou não à VM; c. infecção do trato urinário, associada ou não ao cateterismo vesical; d. infecção de sítio cirúrgico.
Os sete alvos de prevenção de eventos adversos não infecciosos Programas: 1. úlcera por pressão; 2. insuficiência respiratória aguda; 3. aspiração pulmonar; 4. insuficiência renal aguda; 5. hemorragia pós-operatórias; 6. parada cardiorrespiratória prevenível; 7. erro no uso de medicamentos.
O sucesso destas ações depende do envolvimento de todas as partes interessadas: o estado, líderes, agências reguladoras de governo, parcerias público-privadas, organizações de saúde (provedoras e prestadoras), pesquisadores, associações profissionais e de clientes, educadores, a força de trabalho, os pacientes e as famílias (NPSF, 2015).
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