DEVELOPMENT OF PATIENT SAFETY INDICATORS FOR MONITORING SURGICAL CARE IN THE UNIQUE HEALTH SYSTEM
Quality of health care; Quality Indicators, Health Care; Patient Safety; Surgical Procedures, Operative.
Monitoring healthcare is an essential activity for any continuous quality improvement activity. However, the Unified Health System (SUS) does not have a set of indicators to monitor the quality of surgical care, making health care management fragile and difficult, given the lack of information to carry out quality improvement cycles . This gap justifies the research carried out, which aims to validate a set of indicators for monitoring the quality of surgical procedures within the SUS. The methodological study of validation of quality indicators developed in 4 stages was used as method: 1) Literature review; 2) Selection of indicators for consensus; 3) Validation of the content of the indicators by the RAND/UCLA consensus method; and 4) Pilot study to analyze reliability and identify quality indicators that can be monitored via official information systems. From the literature review, 217 surgical quality indicators were identified. Indicators considered based on scientific evidence inferior to 1A, similar, specific indicators that corresponded to sentinel events and those that did not apply to the SUS context were excluded. Twenty-six indicators with a high level of scientific evidence were taken to the consensus of experts. After using the RAND/UCLA Consensus Method, 14 process indicators and 8 outcome indicators were validated. Six process indicators were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p<0.05) and 2 had almost perfect reliability (Kappa coefficient> 0.8, p<0.05) when analyzed the inter-rater agreement. It was possible to measure and establish a tabulation mechanism for 7 result indicators. The study contributes to the development of a set of quality indicators in the surgical field that translates into an effective mechanism for measuring the performance and quality of services offered by the network of hospital services in the State of Rio Grande do Norte and in Brazil.