Estratégias de gestão para redução da aglomeração e superlotação no pronto socorro adulto de um hospital terciário da zona norte da cidade de São Paulo - SP

Abstract

Introduction: Overcrowding in Hospital Emergency Services (HES) is a worldwide phenomenon and is characterized when all beds are occupied, there are patients bedridden in the corridors, the waiting time for care is over one hour, there is high tension in the team assistance and great pressure for new assistance. Overcrowding in the HES indicates poor performance of the health system and induces low quality of care. It can pose a threat to human rights for both users and workers. The length of hospital stay is the main indicator of agglomeration. Once the problem of overcrowding, overcrowding and agglomeration in the adult emergency room of a tertiary hospital in the northern zone is recognized and the implications that these problems cause for the patient, the care team and the hospital, it is necessary to analyse this problem and propose possible interventions . Objectives: To identify possible causes related to overcrowding and overcrowding in the HES as well as their consequences; describe the profile of patients using the Manchester risk classification; address the moments of intervention in the prehospital period, in the hospital and at the time of hospital discharge; analyse the effects of interventions; compare the two moments, before and after the application of the measures, using the average length of stay in the HES and hospital as indicators; and analyse the results with the implementation of several strategic measures to combat overcrowding and overcrowding in the HES. Methodology: This is a descriptive, longitudinal and quantitative case study evaluating two periods (2018 and 2019), using indicators that were statistically analysed by means of central tendency (mean) and dispersion measure (standard deviation), comparing both the evaluation moments using the Student test to assess the inherent impacts of the proposed strategic management measures. Research Results: The average length of stay in general in both periods did not show a statistically significant difference, but there was a statistically significant decrease in the average stay in the Emergency Room. Still, the average number of hospitalizations in 2019 was significantly lower than in 2018, as well as the average number of hospitalizations. There was a decrease in the number of employees in the P S and in the institution as a whole, which may have contributed to the ineffectiveness of the measures implemented. Final Considerations: The overcrowding and overcrowding in HES are a complex problem. The emergency hospital service is a critical point in public hospitals and is sometimes used as a door and entrance for SUS users. This study demonstrated the inappropriate use of emergency services by users. Probably the demand for health services and the reduction in the number of employees contributed so that the measures implemented in the CHM were not efficient in reducing the hospital's length of stay. One of the greatest contributions of this study is that it is necessary to make careful use of health resources and avoid the reduction of employees.