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Master's Dissertation
DOI
10.11606/D.17.2017.tde-06012017-110651
Document
Author
Full name
Heloisa Botto Dompieri Oliveira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2016
Supervisor
Committee
Sá, Marcos Felipe Silva de (President)
Clé, Diego Villa
Maciel, Benedito Carlos
Title in Portuguese
Resultados de exames laboratoriais não acessados pelos médicos em um hospital de ensino
Keywords in Portuguese
análise de custo em saúde
testes desnecessários
testes diagnóstico
Abstract in Portuguese
Introdução: A cada ano, cresce o número de exames solicitados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP (HCFMRP-USP), devido, principalmente, ao aumento da demanda de exames complementares, com a alegação de que se trata de um hospital de ensino. Entretanto, dúvidas são levantadas sobre a real necessidade de muitos exames solicitados por razões acadêmicas no binômio atendimento/ensino, sem, contudo, contribuírem efetivamente para a tomada de decisão em face de um problema clínico do paciente. Por outro lado,as dificuldades orçamentárias enfrentadas pelas instituições públicas de saúde, particularmente nestes últimos anos, em virtude da crise econômica que assola o país, com reflexos importantes em nosso meio. Desta forma, avaliar a utilização racional dos pedidos de exames laboratoriais é medida fundamental para identificar o uso indiscriminado dessas ferramentas de diagnóstico e conduta clínica em um hospital de grande porte. Objetivo: Este trabalho teve por objetivo quantificar e apresentar o custo dos exames totais solicitados nos anos de 2012 a 2014 nos laboratórios do HCRP de acordo com o local de atendimento: enfermaria, ambulatório e unidades de terapia intensiva (UTI); verificar, dentre os dez exames mais solicitados, o percentual daqueles cujos resultados não acessados pelos médicos; e estimar o custo dos exames não acessados. Metodologia: Estudo de corte transversal, retrospectivo, realizado no período de 2012 a 2014 no HCFMRP-USP, unidade Campus. Foram avaliados exames realizados em dezessete laboratórios, solicitados pelas enfermarias, ambulatórios e UTIs. Resultados: Verificou-se um aumento de 9,19% na solicitação de exames de 2012 a 2014. Com relação aos exames não acessados no mesmo período, houve uma redução de 18,52% nas UTIs, porém um aumento de 16,60% nas enfermarias e de 68,94% nos ambulatórios.O gasto total dos dez exames mais solicitados e não acessados nos três locais solicitantes foi de R$ 270 241,21 de 2012 a 2014. Os dados demonstram que novas estratégias devem ser realizadas para evitar ou ao menos reduzir esse desperdício financeiro. Implantação de protocolos clínicos, educação continuada aos médicos e revisão do rol de exames disponíveis são ações que podem contribuir para o uso racional dos exames complementares.
Title in English
Laboratory test results not checked by physicians in a university hospital
Keywords in English
costs analysis in health
diagnostic test
unnecessary testing
Abstract in English
Introduction: Every year, the number of laboratorial tests performed at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP (HCFMRP-USP)) increases, mainly due to the increment in the demand for complementary tests, with the argument that the institution is a university hospital. However, questions have been raised about the real necessity of ordering so many tests for academic (assistance / teaching) purposes, without effectively contributing to the clinical decision making. On the other hand, it is well known that public health institutions have been facing budget problems in light of the economic crisis hitting the country, with serious consequences to health. Therefore, the assessment of the rational use of laboratory test orders is essential to detect an indiscriminate use of these diagnostic and therapeutic tools in a large hospital. Aim: This study aimed to quantify all laboratory tests ordered to the laboratories of the GH-USPMS from 2012 to 2014, by three locations: wards, outpatient department, and intensive care units (ICUs); to determine among the ten most ordered exams, the percentage of test results that were not checked by the physicians; and to estimate the costs of these tests. Methods: This was a retrospective, crosssectional studied, carried out at the GH-USPMS, Campus, from 2012 to 2014. Tests performed at the seventeen laboratories of this institution, ordered by the wards, outpatient department and ICUs were assessed. Results: There was a 9.19% increase in the number of laboratory tests ordered from 2012 to 2014. Regarding the number of test results not accessed by the physicians during the same period, there was a decrease by 18.52% at the ICUs, but an increase by 16.60% in the wards and 68.94% in the outpatient department. The total cost of the ten most ordered tests whose results were not checked by the physicians was 270,241.21 BRL from 2012 to 2014. These findings show that new strategies to prevent, or at least reduce financial waste should be employed. In addition, the implementation of clinical protocols, continuing education for physicians, and the revision of the menu of tests available may contribute to the rational use of complementary tests.
 
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Publishing Date
2017-02-15
 
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