Avaliação de qualidade em Medicina Intensiva

Autores

  • Rui Moreno Assistente Hospitalar de Medicina Interna, Hospital de Santo António dos Capuchos, Lisboa
  • Ricardo Matos Assistente Hospitalar de Medicina Interna, Hospital de Santo António dos Capuchos, Lisboa
  • João Paulo Caixinha Interno do Internato Complementar de Medicina Interna, Hospital Condes de Castro Guimarães, Cascais
  • Teresa Fevereiro Internodo Internato Complementar de Medicina Interna, Hospital de Santo António dos Capuchos, Lisboa
  • Eduardo Almeida Assistente Hospitalar Graduado de Medicina lnterna, Hospital de Garcia de Orta, Abnada

Palavras-chave:

avaliação de qualidade, melho­ria de qualidade, Medicina Intensiva

Resumo

As técnicas de avaliação e de melhoria de qua­ lidade não são um conceito recente no mundo empresarial A sua aplicação à Medicina tem, no entanto, sido feita com algum atraso e ama­ dorismo por parte dos profissionais e das es­ truturas envolvidas.

A avaliação das nossas atitudes, processos e resultados, quando visamos obter uma melhor qualidade dos cuidados que prestamos, tem sido muitas vezes imprecisa, pontual e intuitiva. Ela pode e deve ser exacta, sistemática e rigorosa. Para tal é necessária a utilização de uma termi­nologia comum, que pressupõe o conhecimento profundo de um conjunto de definições ligadas a este tema.

Os autores apresentam a terminologia mais utilizada neste contexto, reflectindo sobre os processos de avaliação e melhoria da qualida­ de em Medicina, salientando os seus alvos e atri­butos. Finalmente, discutem a aplicabilidade desta abordagem global ao contexto da Medicina In­tensiva nos anos 90.

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Referências

Reis Miranda D, Gyldmark M. Evaluating aned understanding of costs in the intensive care unit. ln: Ryan DW, ed. Current practice in critical illness. London: Charman & Hall, 1996:129-149.

Thijs LG, Memhers of the Task Force of the Eurorean Society of Intensive Care Medicine. Continuous quality imrpovement in the ICU: general guidelines. lntensive Care Med 1997;23:125-127.

American Medical Association Council of Medical Service. Qua­lity of care. JAMA 1984;256:1032-1034.

Lohr KN. Medicare: a strategy for quality assurance. Washing­ton, D.C.: National Academy Press, 1990

Lomas J. Quality assurance and effectiveness in health care: an overview. Qual Assur Health Care 1990;2:5-12.

New York State Department of Health. Coronary artery hyrass surgery in New York State, 1990-1992. Albany: New York State Department of Health, 1993.

Chassin MR. Improving the quality of care. N Engl J Med 1996;335:1060-1063.

Blumenthal D. Origins of the quality-of-care debate. N Engl J Med 1996;335:1146-1149.

Cook D, Ellrodt G. The potential role of clinical practice guide­lines in the ICU. Curr Opin Crit Care 1996;2:326-330.

Donahedian A. Continuity and change in the quest of quality. Clin Perform Qual Health Care 1993;1:9-16.

Organization anel management of Intensive Care: a prospecti­ve study in 12 European countries. Reis Miranda D, Ryan DW, Schaufeli WB, Fidl:r V, eds. Berlin Heidelberg: Sprin­ger-Verlag, 1997.

Carlet J. Quality assessment of intensive care units. Curr Opin Crit Care 1992:319-325.

Brook RH, McGlynn EA, Cleary PD. Measuring quality of care. N Engl J Med 19%;335:966-970.

Donahedian A. The seven pillars of quality. Arch Pathol Lab Med 1990;114:1115-1118.

Con ors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ili patients. JAMA 1996;276:889-897.

Kalh PE, Miller DH. Utilization strategies for intensive care unit . JAMA 1989;261:2389-2395.

Rogers RM, Weiler C, Ruppenthal B. Impact of the respiratory intensive care unit in survival of patients with acute respira­tory failure. Chest 1972;62:94-97.

Skidmore FD. A review of 460 patients admitted to the intensi­ve therapy unit in a general hospital. Br J Surg 1973;60:1-16.

Feller I, Tholen D, Cornell RG. Improvements in bum care. JAMA 1980;244:2074-2078.

Griner PF. Treatment of acute pulmonary edema: conventio­nal or intensive care? Ann Intern Med 1972;77:501-506.

Piper KW, Griner PF. Suicide attempts with dmg overdose: ou­ comes of intensive care vs. conventional floor care. Arch Intern Med 1974;134:703-706.

Hook EW, Horton CA, Schaberg DR. Failure of intensive care unit support to influence mortality from pneumococcal bac­teremia. JAMA 1983;249:1055-1057.

Knaus WA, Draper EA, Wagner DP, ZimmermanJE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.

Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS li) based on a European / North American multicenter study. JAMA 1993;270:2957-2%3.

Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993;9:543-554.

Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J. Interpreting hospital data: the role of clinical risk adjustment.

Predicting hospital mortality for Medicare patients: a me­thod for patients with stroke, pneumonia, myocardial in­ farction, and congestive hearth failure. JAMA 1988;260:3617- 3624.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evalua­tion of outcome from intensive care in major medical cen­ters. Ann lntern Med 1986;104:410-418.

Berwick D. Continuous improvement as an ideal in health care. N Engl J Med 1989;320:53-56.

Suter P, Armagandis A, Beaufils F, et al. Predicting outcome in ICU patients: consensus conference organized by the ESI­ CM and the SRLF. Intensive Care Med 1994;20:390-397.

8lumenthal D. Quality of care - what is it? N Eng! J Med 1996:335:891-894.

Fowkes FGR. Medical audit cycle. A review of methods and research in clinicai practice. Med Educ 1982;16:228-338.

Moreno R, Reis Miranda D, lapichino G. Variations in the utili­ sation of nursing manpower according to European areas. Intensive Care Med 1996;22:5304.

Moreno R, Reis Miranda D, Iapichino G. The efficiency of nur­sing manpower use in Europe. Intensive Care Med 1996:22:S304.

Wagner DP, Knaus WA, Draper EA. Identification of Iow-risk monitor admissions to medical-surgical ICUs. Chest 1987:92:423-428.

McClish DK, Powell SH. How well can physicians estimate mor­tality in a medical intensive care unit? Med Decis Making l989;9:125-132.

Wagner DP, Knaus WA, Draper EA, et al. Identification of Iow­ risk monitor patient within a medical-surgical !CU. Med Care 1983;21:425-433.

Zimmerman JE, Wagner DP, Knaus WA, Williams JF, Kolako­wski D, Draper EA. The use of risk predactors to identify candidates for intermediate care unit . Implications for in­ tensive care unit utilization. Chest 1995;108:490-499.

ZimmermanJE, Wagner DP, Sun X, Knaus WA, Draper EA. Plan­ning patient services for intermediate care units: insight based on care for intensive care unit Iow-risk monitor ad­missions. Crit Care Med 1996;24:1626-1632.

Strauss MJ, LoGerfo JP, Yeltatzie JA, Temkin N, Hudson LO. Rationing of intensive care unit services. An everyday oc­currence. JAMA 1986;255:1143-1146.

Zimmerman JE, Wagner DP, Draper EA, Knaus WA. Improving intensive care unit discharge decisions: supplementary phy­sician judgment with predictions of next day risk for life support. Crit Care Med 1994;22:1373-1384.

Civetta JM, Hudson-Civetta JA, Nelson LD. Evaluation of APA­CHE II for cost containment and quality assurance. Ann Surg 1990;212:266-276.

Atkinson·S, Bihari D, Smithies M, Daly K, Mason R, McColl I. Identification of futility in intensive care. Lancet 1994;344:1203-1206.

Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in post-operative surgi­cal patients. Arch Surg 1990 ;125:519-522.

Rapoport J, Teres D, Lemeshow S, AvruninJ S, Haber R. Explai­ning variability of cost using a severity of illness measure for ICU patient . Med Care 1990; 28:338-348.

Oye RK, Bellamy PF. Patterns of resource consumption in medical intensive care. Chest 1991;99:695-689.

Jacobs S, Arnold A, Clyburn PA, Willis BA. Toe Riyadh intensive care program applied to a mortality analysis of a teaching hospital intensive care unit. Anaesthesia 1992;47:775-780.

Murray L', Teasdale GM, Murray GD, et al. Does prediction of outcome alter patient management ? Lancet 1993;341:1487- 1491.

Veloso AB. Qualidade em medicina. Boletim Clinico Hospitais Civis de Lisboa 1996;50:13-15.

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Publicado

31-12-1997

Como Citar

1.
Moreno R, Matos R, Caixinha JP, Fevereiro T, Almeida E. Avaliação de qualidade em Medicina Intensiva. RPMI [Internet]. 31 de Dezembro de 1997 [citado 18 de Dezembro de 2024];4(4):274-80. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/2253

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