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Barreiras e fatores facilitadores na implementação de Sistemas de Alerta Precoce: uma revisão sistemática da literatura de estudos qualitativos
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RESUMO - A ocorrência de eventos adversos nos cuidados de saúde constitui um grave problema de segurança do doente e da qualidade em saúde, sendo um importante problema para a saúde das populações e logo para a Saúde Pública.
Muitos doentes encontram-se em processo de deterioração clínica nas unidades de internamento, acabando por ser identificados tardiamente, pelo que se criaram sistemas de deteção precoce de deterioração clínica dos doentes, chamados de sistemas de alerta precoce. Apesar de amplamente divulgados, coexistem relatos de barreiras e fatores facilitadores à sua implementação. Identificar quais são estas barreiras e fatores facilitadores é o objetivo deste trabalho.
Foi realizada uma revisão sistemática da literatura. Foram pesquisados estudos primários na PUBMED e CHINAL, publicados entre 2011 e 2021, conduzidos em hospitais e referentes a relatos e experiências dos profissionais de saúde envolvidos sobre barreiras e fatores facilitadores que impedem a implementação destes sistemas. Os achados foram extraídos e categorizados numa estrutura organizadora de dados por temas e subtemas.
Foram identificados 84 artigos, dos quais treze foram incluídos. As evidências encontradas sugerem uma maior incidência de relatos relacionados com interações complexas e multifatoriais associados a comunicação, a educação e o treino, e as relações inter-equipa que funcionam como barreiras ou fatores facilitadores dependendo do contexto cultural da organização.
Um foco nos fatores facilitadores identificados direciona para soluções focadas nas interações entre as pessoas, ambiente de cuidados e ambiente organizacional como promotores de uma implementação favorável à segurança do doente e qualidade assistencial.
ABSTRACT - The occurrence of adverse events in healthcare is a severe problem of patient safety and quality of health, being a major problem for the population's health and, therefore, for public health. Many patients are at risk of clinical deterioration while they stay in medical wards and end up being identified too late, so early detection systems for clinical deterioration of patients, called early warning systems, were created. Although widely disseminated, there are reports of barriers and facilitators to their implementation. The aim of this paper is to identify these barriers and facilitating factors. A systematic review of the literature was conducted. Primary studies were searched in PUBMED and CHINAL, published between 2011 and 2021, conducted in hospitals and referring to reports and experiences of the healthcare professionals regarding barriers and facilitators of the implementation of these systems. The findings were extracted and categorized into a data structure organized by themes and subthemes. Eighty-four articles were identified, thirteen of which were included. The evidence found suggests a higher incidence of reports related to complex and multifactorial interactions associated with communication, education and training, and inter-team relationships that function as barriers or facilitating factors depending on the cultural context of the organization. A focus on the facilitating factors identified suggests solutions focused on the interactions between people, care environment, and organizational environment as promoters of a favorable implementation of patient safety and quality of care.
ABSTRACT - The occurrence of adverse events in healthcare is a severe problem of patient safety and quality of health, being a major problem for the population's health and, therefore, for public health. Many patients are at risk of clinical deterioration while they stay in medical wards and end up being identified too late, so early detection systems for clinical deterioration of patients, called early warning systems, were created. Although widely disseminated, there are reports of barriers and facilitators to their implementation. The aim of this paper is to identify these barriers and facilitating factors. A systematic review of the literature was conducted. Primary studies were searched in PUBMED and CHINAL, published between 2011 and 2021, conducted in hospitals and referring to reports and experiences of the healthcare professionals regarding barriers and facilitators of the implementation of these systems. The findings were extracted and categorized into a data structure organized by themes and subthemes. Eighty-four articles were identified, thirteen of which were included. The evidence found suggests a higher incidence of reports related to complex and multifactorial interactions associated with communication, education and training, and inter-team relationships that function as barriers or facilitating factors depending on the cultural context of the organization. A focus on the facilitating factors identified suggests solutions focused on the interactions between people, care environment, and organizational environment as promoters of a favorable implementation of patient safety and quality of care.
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Early warning systems Track and trigger systems Rapid response systems - afferent limb Barriers Facilitators Implementation Hospital Sistemas de alerta precoce