Eventos adversos: incidência e impacto econômico em um hospital de grande porte

Abstract

Adverse events are unnecessary damages to an individual’s health caused by professional’s health care. Brazil and other countries suffer from the high costs of health care related to technological incorporation, the increase of health professionals’ workload and the change in the epidemiological profile of the population that provides greater longevity and multiple chronic diseases. Concerns arises regarding the quality of care, technical and professional training, and the efficiency of health organizations. The main objective was to estimate the costs related to the treatment of damages caused by adverse events within one year in the institution, comparing two units: Integrated Practices Unit of Internal Medicine and Functional Structure Unit besides in order to measure the incidence and describe the factors related to the occurrence of adverse event. The study population was patients hospitalized for clinical treatment. This was a retrospective, observational, sectional design, using individual data and quantitative approach comparing two clinical practice sectors of a hospital to test the hypothesis that there is no difference in the adverse events’ amount between these two units. Besides that a study of Cost of Illness using direct costs as analytical category was done. Inclusion criteria were: patients over 18 years of age hospitalized for clinical treatment by Brasilian Health system: Sistema Único de Saúde, with length of stay longer than 24 hours and hospital discharge over 30 days. Exclusion criteria were: inpatients for psychiatric treatment. The method of adverse events’ detection was the Global Trigger Tool developed by the Institution of Health Improvement (IHI). In 96 hospitalizations (20.0%) at least one (1) adverse event was detected and 144 adverse events representing an average of 1.5 events per affected patients. Thirty-one adverse events (21.5%) were present in Admission and 125 (86.8%) were considered preventable. The characteristics related to clinical and surgical procedures had more significant odds ratio: being submitted to surgery increased the chance of AD occurring in approximately 8-fold (OR 7.93) and the hospital’s length of stay greater than or equal to 3 days increased the chance of adverse event in 4 times (OR 4.03). The admission to a Functional Structure Unit represented a two and a half times greater chance of suffering an adverse event compared to patients who were hospitalized in Integrated Practices Unit. It was observed that hospitalizations with adverse event costs of 98.83% to the institution if compared to hospitalizations without adverse event. In the Integrated Practices Unit adverse event represented an increase of 131.2% while in the Functional Structure Unit the costs of adverse event exceeded 76.4. The incidence of adverse event increased around 55% the amount SUS should pay the health service deliver. This average cost was 61.5% in Integrated Practices Unit and 36.9% in Functional Structure Unit. The study have shown that adverse events are very frequent in this sample and represent an excessive expenditure for the institution and the Unified Health System.