Adesão e efeito do checklist de cirurgia segura na incidência de eventos adversos entre pacientes cirúrgicos

Abstract

Damage associated with surgical care (adverse events) is potentially serious and can cause significant damage and even death. Given the magnitude of adverse events (AE) in health care, the World Health Organization (WHO) launched in 2004 the World Alliance for Patient Safety. Regarding surgical care, WHO strongly recommended the use of a Safe Surgery Checklist (CL) to reduce complications and deaths associated with surgical care. In this context, the research aimed to verify adherence to Safe Surgery CL and its effect on the incidence of AE in surgical patients. This is a retrospective and documentary research, performed through the review of medical records. The study had as scenario a referral general hospital located in the city of Juiz de Fora, MG. The study population consisted of all patients who underwent surgery in 2012 (before CL implantation in the institution) and 2015 (after CL implantation), from which a representative sample of 851 medical records was calculated. all specialties, being 428 for 2012 and 423 for 2015. Exclusion criteria were: age below 18 years, hospitalization less than 24 hours, patients undergoing non-surgical invasive procedures, interventional cardiology and normal delivery. The review of medical records for identification of AE was guided by the Global Trigger Tool (GTT) method developed by the Institute for Healthcare Improvement (IHI). To evaluate CL adherence, the medical records referring to the year 2015 (after the implementation of the instrument) were considered. Adherence was estimated considering the existence of CL in the medical records and the completeness of the check items. Incidences of AE in surgical patients before and after CL use were estimated and compared. Factors associated with CL adherence and the occurrence of AE were identified by simple Logistic Regression models. Data were processed in a database using the Statistical Package for Social Sciences software (SPSS, version 20.0 for Windows). CL was present in 95% of the analyzed medical records. However, only 67.4% of them were completely filled. The presence of CL in the medical chart was significantly associated with the anesthetic risk of the patient. The incidence of patients who suffered at least one AS was 12.7%. More than half of the events were related to complications at the surgery site. Prolonged hospitalization time, surgery duration greater than 4 hours, and procedures classified as contaminated showed a significant association with the occurrence of AS. Regarding the effect of CL, it was observed that the difference between the proportions of deaths referring to the periods before and after CL implantation was significant (p = 0.007). Multivariate analysis showed no significant association between the presence of CL in the medical record and the occurrence of AE. Although CL did not guarantee the expected effect on the occurrence of AE, the reduction in the proportion of deaths before and after implantation of the instrument suggests improvements in the quality of surgical care. The incompleteness of the instrument, as well as the issues related to its implementation process may have influenced the results found.