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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-23082020-145925
Document
Author
Full name
Frederica Montanari Lourençato
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Pazin Filho, Antonio (President)
Borges, Marcos de Carvalho
Dalri, Maria Celia Barcellos
Title in Portuguese
Implantação de serviço de cuidados paliativos no Serviço Hospitalar de Emergência de um hospital público universitário
Keywords in Portuguese
Cuidados paliativos
Hospitais para doentes terminais
Serviço hospitalar de emergência
Sistema Único de Saúde
Abstract in Portuguese
Objetivos: Descrever o processo de implantação do serviço de cuidados paliativos na U.E.- HCFMRP/USP e comparar a estratégia de intervenção de busca ativa em enfermarias com a estratégia no Serviços Hospitalar de Emergência (Sala de Urgência) Métodos: O estudo descreveu o desenvolvimento dos processos e do desenho do plano de trabalho da implantação do Serviço de Cuidados Paliativos da U.E.-HCFMRP/USP e a documentação sistematizada de dados demográficos, clínicos, das intervenções da ECP e dos desfechos para dois períodos distintos, a estratégias de busca ativa de pacientes nas enfermarias comuns e especializadas (Estratégia I) ou no Serviço Hospitalar de Emergência (Estratégia II). Resultados: A implantação do serviço de cuidados paliativos foi incorporada na prática institucional e os profissionais capacitados. Ferramentas foram construídas com processos de trabalho específicos e protocolos de atendimentos e foi realizada capacitação com os profissionais da RUE da DRS XIII. O estudo contou com 1203 pacientes, Estratégia I (587; 48,8%) e Estratégia II (616; 51,2%). Nas duas Estratégias foram prevalentes pacientes do sexo masculino e idosos. A maioria estava na clínica médica I (39,3%) e II (57,9%). As condições clínicas gerais foram mais prevalentes nas duas estratégias com mais de 40%, após ficando a Oncologia na I (27,7%) e II (32,4%). Houve redução dos pacientes que estavam no CTI/UCO da I (20,9%) para II (9,2%) - p<0.01, queda na enfermaria da I (60,8%) para a II (42,5%) - p<0.01 - e aumento significativo da I (18,2%) para a II (48,2%) na sala de urgência - p<0.01. A percepção reduziu de 10,9 dias para 9,1 dias, o seguimento se manteve em 12 dias e a duração da internação teve queda de 24,3 para 20,7 dias - p<0.01 . A maior demanda foi a definição de prognóstico (56,7%). Acima de 70% de todos os pacientes tinham PPS 10 e acima de 85% ECOG 4. A condição oncológica é a que apresenta maior risco para o óbito e o PPS tem efeito inverso, apresentando menor impacto (Razão de Chances; IC95%). Conclusão: O serviço de cuidados paliativos no SHE foi estruturado pela ECP e incorporado à prática e cultura institucional e a Estratégia II foi a mais efetiva pois diminuiu a o tempo de reconhecimento dos pacientes no SHE e consequentemente a duração da internação.
Title in English
Implementation of a palliative care service in the Emergency Hospital Service of a public university hospital
Keywords in English
Department emergency
Hospice
Palliative
Unified Health System
Abstract in English
Objectives: To describe the process of implementing the palliative care service in the Emergency Unity (UE-HCFMRP / USP) and to compare the intervention strategy of active search in wards with the strategy in the Emergency Hospital Services (Emergency Room). Methods: The study described the development of processes and the design of the work plan for the implementation of the Palliative Care Service in the UE-HCFMRP / USP and the systematized documentation of demographic and clinical data, ECP interventions and outcomes for two different periods, active patient search strategies in common and specialized wards (Strategy I) or in the Emergency Hospital Service (Strategy II). Results: The implementation of the Palliative Care service was incorporated into the institutional practice and the professionals were trained. Tools were built with specific work processes and service protocols and the professionals of RUE of DRS XIII were also trained. The study included 1203 patients, Strategy I (587; 48.8%) and Strategy II (616; 51.2%). In both Strategies, male and elderly patients were prevalent. Most were in medical clinic I (39.3%) and II (57.9%). General clinical conditions were more prevalent in the two strategies, with more than 40%, after were Oncology remained in I (27.7%) and II (32.4%). There was a reduction in patients who were in the ICU / CCU from I (20.9%) to II (9.2%) - p <0.01, reduction in the ward from I (60.8%) to II (42.5%) - p <0.01 - and significant increase from I (18.2%) to II (48.2%) in the emergency room - p <0.01. The perception decreased from 10.9 days to 9.1 days, the follow-up continued for 12 days and the duration of hospitalization dropped from 24.3 to 20.7 days - p <0.01. The major demand was the definition of prognosis (56.7%). Over 70% of all patients had PPS 10 and ECOG 4 above 85%. The oncological condition is the one with the highest risk of death and the PPS has the opposite effect, representing less impact (Chance Ratio; 95% CI). Conclusion: The Palliative Care service in the SHE was structured by the ECP and incorporated into the institutional practice and culture and Strategy II was the most effective because it reduced the time of recognition of patients in the SHE and consequently the duration of hospitalization.
 
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Publishing Date
2020-10-20
 
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