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Patient Satisfaction According to the Form of Hospital Stay at a Teaching Hospital Karine Lorenzen Molina1 Gisela Maria Schibella Souto De Moura1

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Patient Satisfaction According to the Form of Hospital Stay at a Teaching Hospital Karine Lorenzen Molina1 Gisela Maria Schibella Souto De Moura1 Artigo Original A satisfação dos pacientes segundo a forma de internação em hospital universitário Patient satisfaction according to the form of hospital stay at a teaching hospital Karine Lorenzen Molina1 Gisela Maria Schibella Souto de Moura1 Descritores Resumo Satisfação do paciente; Health care Objetivo: Analisar a satisfação dos pacientes de acordo com a forma de internação em hospital universitário. evaluation mechanisms; Serviço Métodos: Estudo transversal realizado com 366 pacientes com mais de 18 anos, internados em unidades hospitalar de Enfermagem; Auditoria de clínicas e cirúrgicas no período de janeiro a junho de 2014, cujo desfecho tenha sido a alta entre 15 e 30 dias. Enfermagem; Qualidade da assistência Teste Mann-Whitney foi realizado para analisar amostras independentes para comparação entre os grupos. à saúde Resultados: Estiveram satisfeitos e muito satisfeitos com o atendimento recebido 99,4% dos pacientes internados pela emergência e 98,4% dos internados pela admissão, apresentando médias de satisfação de Keywords 5,66 e 5,55, respectivamente. A média de satisfação foi mais elevada em todos os atributos para o grupo Patient satisfaction; Mecanismos de da emergência. A comparação entre grupos dos atributos da equipe de Enfermagem e satisfação geral não avaliação da assistência a saúde; demonstrou significância estatística. Nursing service, hospital; Nursing audit; Conclusão: O elevado nível de satisfação dos pacientes com o serviço de saúde evidenciou a qualidade Quality of health care assistencial prestada no hospital universitário, na perspectiva do paciente. Destacou-se igual e elevada avaliação da satisfação com enfermagem entre os grupos. Submetido Abstract 14 de Outubro de 2015 Objective: To analyze the patients’ satisfaction according to the form of hospital stay at a teaching hospital. Aceito Methods: Cross-sectional study involving 366 patients over 18 years of age, hospitalized at clinical and 14 de Dezembro de 2015 surgical wards between January and June 2014, whose outcome was discharge within 15 and 30 days. The Mann-Whitney test was applied to analyze independent samples for intergroup comparison. Results: In total, 99.4% of the patients hospitalized through the emergency service and 98.4% of the inpatients were satisfied and highly satisfied, with mean satisfaction rates of 5.66 and 5.55, respectively. The Autor correspondente mean satisfaction score was higher on all attributes for the emergency group. The intergroup comparison of Karine Lorenzen Molina the Nursing team attributes and general satisfaction did not demonstrate statistical significance. Rua São Manoel, 963, 90620-110 Conclusion: The patients’ high level of satisfaction with the health service evidenced the quality of care at the Porto Alegre, RS, Brasil. teaching hospital from the patient’s perspective. The same high assessment of the satisfaction with nursing [email protected] was found between the groups. DOI http://dx.doi.org/10.1590/1982- 0194201600004 1Universidade Federal do Rio grande do Sul, Porto Alegre, RS, Brasil. Conflitos de interesse: não há conflitos de interesse a declarar. Acta Paul Enferm. 2016; 29(1):17-25. 17 A satisfação dos pacientes segundo a forma de internação em hospital universitário Introdução disponibilidade de leito. Estas áreas hospitalares são caracterizadas por terem número definido de leitos A crescente expectativa de vida da população e o e cuja ocupação não ultrapassa sua capacidade ins- aumento da morbidade e da mortalidade por doen- talada. Possuem um quadro de pessoal de enferma- ças cerebrovasculares e coronarianas, por exemplo, gem pré-estabelecido e dimensionado para favorecer são fatores que têm contribuído para o aumento dos uma adequada proporção de pacientes por profis- índices de procura por atendimento nos serviços de sional visando a qualidade do cuidado. As unidades saúde.(1) Com isso, a qualidade dos serviços de saú- atendem, também, pacientes estáveis oriundos de de tem sido uma preocupação constante na área de internações eletivas e que ingressaram no hospital gestão em saúde, fomentando a discussão sobre a através do setor de admissão, caracterizando um necessidade da adoção de novos modelos de aten- processo de ingresso no sistema por meio de um ção, que visam à prestação de cuidados mais com- atendimento planejado e programado previamente. plexos e prolongados.(2) Este contexto configura, então, que numa unidade Existem diversos problemas no sistema de saú- de internação haverá pacientes oriundos de duas di- de que necessitam ser repensados, sendo um deles ferentes formas de ingresso hospitalar e desperta a a porta de entrada dos pacientes para internação indagação de que talvez a forma de ingresso possa hospitalar. As emergências superlotadas e o longo influenciar a percepção de qualidade do serviço. tempo de espera para as internações eletivas no setor A definição de qualidade inclui nível de excelên- de admissão são evidências desse problema. Diante cia profissional, uso eficiente de recursos e alto grau disso, por meio da experiência profissional em En- de satisfação dos pacientes.(4) A satisfação do pacien- fermagem em unidade hospitalar, são relevantes o te é definida como a reação de um indivíduo sobre conhecimento do perfil dos pacientes e que os ser- os aspectos mais salientes de seu atendimento hos- viços comprovem a qualidade assistencial prestada pitalar. É uma resposta comportamental que ocorre a eles, contemplando a satisfação do paciente como quando a avaliação cognitiva de um indivíduo, com um dos critérios de avaliação. relação a aspectos dos cuidados, atende ou excede A emergência é caracterizada por ser o “gargalo” as normas subjetivas pessoais.(5) Vale ressaltar que a do sistema de saúde brasileiro, pelo atendimento gestão hospitalar já reconhece que a má qualidade de pacientes em situação aguda de saúde e/ou ris- dos serviços de saúde prestados está intimamente co iminente de morte, mas também porque atende relacionada com os baixos índices de satisfação e, pacientes com baixa complexidade. Este setor tem, consequentemente, com o aumento nos custos da frequentemente, sua capacidade instalada ultrapas- instituição.(6) sada devido os pacientes permanecerem aguardando Alguns estudos corroboram que o principal vín- leito, abarcando em número elevado de pacientes culo entre o usuário e o hospital ocorre por meio por profissionais de saúde. Estudo internacional di- do serviço de Enfermagem, por se constituir como ferenciou o setor de emergência com unidades de o maior grupo de profissionais de saúde, o qual atendimento rápido para que pacientes em situação mantém um contato ininterrupto com o paciente, aguda de saúde não ficassem aguardando para aten- promovendo a manutenção, a recuperação e a rea- dimento. Além disso, enfatizaram que possuir pro- bilitação da saúde por meio do cuidado.(7,8) Os en- fissionais médicos e enfermeiros especialistas é um fermeiros são profissionais ideais como informantes ótimo modelo para a qualidade do cuidado. Des- de características das organizações onde trabalham, ta forma, eles aumentaram a qualidade de cuidado devido à sua proximidade com os usuários.(7) oferecido para os pacientes.(3) Essa avaliação favorece um melhor planejamen- No hospital campo do presente estudo, uma vez to da assistência, identificando os atributos que concluído o atendimento na emergência, os pacien- contribuem ou não para a satisfação do paciente.(7) tes que necessitam de internação, são encaminha- Os atendimentos nas unidades de internação pos- dos para unidades clínicas ou cirúrgicas, conforme suem atributos que se destacam durante a hospita- 18 Acta Paul Enferm. 2016; 29(1):17-25. Molina KL, Moura GM lização por meio do setor de admissão, das equipes público: um compromisso social com o usuário. O con- médicas, de Enfermagem, de nutrição, da limpeza e tato com os usuários foi feito quando estes já não da alta hospitalar. O enfermeiro, articulando o en- estavam mais no hospital. cadeamento das ações desses diversos profissionais, O estudo foi realizado no Hospital de Clínicas naturalmente assume a responsabilidade pela admi- de Porto Alegre, que é um hospital universitário, nistração do funcionamento adequado dos serviços. público, geral e vinculado ao Sistema Único de No Brasil, a partir de 1990, o sistema de saúde Saúde (SUS). Este foi o primeiro hospital univer- destacou-se pela proposição de abrir as portas das sitário público no país a receber o selo de acredi- instituições para que todos os cidadãos (ou indiví- tação internacional pela Joint Commission Interna- duos) fossem atendidos sem nenhum tipo de dis- tional (JCI).(13) criminação.(9) As pesquisas sobre qualidade desen- A emergência do Hospital de Clínicas de Porto volveram-se com o advento do sistema de saúde, Alegre tinha capacidade para acomodar 49 pacientes contemplando a participação da comunidade nos adultos e 9 pediátricos, mas trabalhava diariamente processos de avaliação e planejamento.(8,9) Apesar com sua capacidade extrapolada, com quase 120 pa- dessa participação não estar formalmente estrutura- cientes em atendimento. O Serviço de Emergência da nas instituições hospitalares, a pesquisa de satis- prestava atendimento a mais de 5 mil pacientes por fação dos pacientes é utilizada como um importante mês, oriundos de diversas localidades do Rio Gran- indicador. Além disso, a ouvidoria, setor que media de do Sul e de outros Estados. situações entre os usuários e a instituição de saúde, As unidades de internação clínica e cirúrgica in- também pode representar uma estratégia
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