Technological arrangements for healthcare management at an emergency care hospital

Abstract

Emergency hospital services (EHS) are the points of attention in Healthcare Systems where most commonly excessive demand phenomena take place, such as overcrowding, and the complaints regarding healthcare quality, marked by the most varied dimensions of human suffering. The EHS end up with the responsibility of taking in the demand constraint generated at other points of attention in the system. Such fact results in major dissatisfaction among the users, whether because of the long time they have to wait to get the service, or because of unavailability of inpatient hospital beds, resulting in a large number of patients remaining in gurneys at hospital corridors for long periods of time. One of these situations consequences is the expressive increase in sickening levels of emergency work teams, as a result of stressful work environments and processes. Experimentation of new technological arrangements for healthcare acquire major importance, whether by enhancing the capacity to take in and identify risks of individuals seeking hospital care, improving the manner how the patient is admitted at the hospital, or "generating ways out" of EHS which are more articulated with other points of attention, which is of the essence to guarantee continued healthcare. Two technological arrangements have been used aiming at improving the flows at the hospital that will be the research field: Manchester Risk Classification and Kanban. The first one is a scientific methodology that provides risk classification for patients seeking healthcare at an emergency care unit. The Risk Classification System is provided with 52 entries, which are understood as flows or algorithms for classification of severity, which assessment is color-coded. Each classification color determines the maximum delay for the patient's care. "Kanban" is a hospital bed managing device which combines clinical priority management practices, by means of visual tools that allow qualification of care coordination, and prioritization and enhancement of clinical decision making and use of the bed resource. By conforming the multi-professional team's work, it aims at widening the responsibility of the parties involved in healthcare, and producing operating answers, for instance, between observation beds and hospital inpatient units, whether for intensive care or not. Kanban's operation has been boosted by the implementation of the hospital physician's activity, which is understood as the daily or more frequent attendance at the unit, as well as the implementation of multidisciplinary visits, implementation of clinical hospital protocols, which guide clinical decisions and the best practices for safe and effective healthcare, based on scientific evidence. Study objectives To study operation of the Manchester Risk Classification and Kanban at an EHS on the perspective of the workers and that of its users. Methodology. Qualitative study, which will employ multiple techniques to deliver data: 1. documental review 2. collective EHS managers interview 3. participating observation of the daily life of teams operating the Manchester Risk Classification, and the Kanban 4. participating observation of the hospital's waiting room 5. gathering of life histories of users of both arrangements. The study will involve the institutional actors in all research phases, providing regular meetings ("shared seminars") with the teams that operate the devices already in the course of the investigation process. The project will be developed by a research group from Escola Paulista de Medicina and from Lisbon University Institute, a partner institution, already consolidated from preceding studies, and researchers from Secretaria de Saúde de São Bernardo do Campo. As in the preceding projects carried out by the group, fortnightly seminars are scheduled for discussion and follow up of field works. (AU)