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Variação na mortalidade e na demora média do internamento por dia de admissão e de alta
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Autores
Orientador(es)
Resumo(s)
RESUMO - Não existem indicadores de rotina ou mesmo relatórios/
estudos sobre a organização do processo produtivo hospitalar,
neste caso particular sobre o internamento, mas academicamente
é admissível que existam diferenças no número
de profissionais de saúde durante as 24 horas do dia, ou
entre os diferentes dias da semana. As alterações esperadas
a este nível durante o fim-de-semana tornam imperativa a
necessidade de estudar o seu impacte sobre os resultados da
prestação quer ao nível da saúde dos doentes, quer ao nível
da sua eficiência.
Este artigo visa ser um estudo exploratório acerca da produção
e de dois resultados em saúde relevantes para os
doentes, a mortalidade e a duração de internamento, em
função dos dias de admissão ou de alta, embora a distribuição
e a intensidade do trabalho não sejam analisadas e
discutidas.
Foram analisados todos os episódios de internamento nos
hospitais públicos do Continente em 2006. Apurou-se o
número de admissões em cada dia da semana, bem como a
taxa de mortalidade e a demora média observadas para
esses doentes. Os valores observados foram comparados
com os esperados, estimados com base na probabilidade de
morte ou duração do internamento previstas pelo Disease
Staging e recalibradas aos dados portugueses. Para a análise
do dia de alta procedeu-se da mesma forma.
Os resultados indicam que se registou um excesso de 483
óbitos face ao esperado para os doentes admitidos entre 6ª
feira e domingo. Na análise do dia da alta, constatou-se que
6712 óbitos que ocorreram ao sábado e domingo não eram
esperados. No que se refere à demora média, os doentes
com alta à segunda-feira registaram um excesso de 57 160
dias de internamento.
O mais interessante de evidenciar é que o principal efeito
do «período fim-de-semana» é encontrado na mortalidade
e, neste particular, com especial intensidade na alta dos
doentes, mesmo após o ajustamento pelo risco. A importância
da mortalidade e da demora média para os diversos
agentes envolvidos na prestação de cuidados e, em certos
casos, a magnitude das diferenças encontradas tornam premente
o aprofundamento do estudo da variação da actividade
hospitalar ao longo da semana.
ABSTRACT - To date, there is no routine data or reports on the organization of hospital activities, particularly in the inpatient department. However, it is academically possible to expect differences in the availability of human resources during the 24 hours of the day or during the week. The changes expected during the weekend recommend the study of their impact on the outcomes of treatment as well as on its efficiency. This article aims to be a preliminary investigation about the output and about two relevant issues for patients: mortality and length of stay by day of admission or discharge, even though the distribution and intensity of workload are not considered. All inpatient admissions in Portuguese public hospitals during 2006 were considered. The number of admissions, mortality rate and length of stay were calculated by day of admission. Observed values were compared with expected values obtained from Disease Staging’s probability of death or expected length of stay recalibrated to Portuguese data. The same methods were used for day of discharge. Our results indicate that there were 483 more deaths than expected in patients admitted between Friday and Sunday. By day of discharge, 6712 deaths that occurred on Saturday and Sunday were not expected. For patients discharged on Monday, there were 57.160 days over the expected. The highest «weekend effect» was found on mortality and by day of discharge, even after risk adjustment. The relevance of the mortality and of the average length of stay for those involved in the healthcare delivery and, in some cases, the relevance of the differences found point to the need for further research on this subject.
ABSTRACT - To date, there is no routine data or reports on the organization of hospital activities, particularly in the inpatient department. However, it is academically possible to expect differences in the availability of human resources during the 24 hours of the day or during the week. The changes expected during the weekend recommend the study of their impact on the outcomes of treatment as well as on its efficiency. This article aims to be a preliminary investigation about the output and about two relevant issues for patients: mortality and length of stay by day of admission or discharge, even though the distribution and intensity of workload are not considered. All inpatient admissions in Portuguese public hospitals during 2006 were considered. The number of admissions, mortality rate and length of stay were calculated by day of admission. Observed values were compared with expected values obtained from Disease Staging’s probability of death or expected length of stay recalibrated to Portuguese data. The same methods were used for day of discharge. Our results indicate that there were 483 more deaths than expected in patients admitted between Friday and Sunday. By day of discharge, 6712 deaths that occurred on Saturday and Sunday were not expected. For patients discharged on Monday, there were 57.160 days over the expected. The highest «weekend effect» was found on mortality and by day of discharge, even after risk adjustment. The relevance of the mortality and of the average length of stay for those involved in the healthcare delivery and, in some cases, the relevance of the differences found point to the need for further research on this subject.
Descrição
Palavras-chave
Mortalidade Demora média Dia de admissão Dia de alta Mortality Length of stay Admission day Discharge day
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública