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Quality of Emergency Rooms and Urgent Care Services: User Satisfaction Qualidade Dos Prontos-Socorros E Prontos-Atendimentos: a Satisfação Dos Usuários

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Quality of Emergency Rooms and Urgent Care Services: User Satisfaction Qualidade Dos Prontos-Socorros E Prontos-Atendimentos: a Satisfação Dos Usuários HEALTH ECONOMICS AND MANAGEMENT Quality of emergency rooms and urgent care services: user satisfaction Qualidade dos prontos-socorros e prontos-atendimentos: a satisfação dos usuários Cássio de Almeida Lima1, Bruna Tatiane Prates dos Santos2, Dina Luciana Batista Andrade2, Francielle Alves Barbosa2, Fernanda Marques da Costa1, Jair Almeida Carneiro1 ABSTRACT à queixa aguda, limpeza e conforto do ambiente. Conclusão: A Objective: To evaluate the quality of emergency rooms and urgent acessibilidade, o acolhimento e a infraestrutura foram fatores care services according to the satisfaction of their users. Methods: considerados mais relevantes para a satisfação do paciente do que a A cross-sectional descriptive study with a quantitative approach. cura propriamente dita. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using Descritores: Satisfação do paciente; Assistência ao paciente; Qualidade a structured questionnaire. Results: Participants were mostly male da assistência à saúde; Avaliação em saúde; Serviços médicos de (64.7%) aged less than 30 years (55.8%), and the predominant level emergência; Questionários of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of INTRODUCTION care, and the reason for seeking care related to acute complaints, The worldwide phenomenon of overcrowding that occurs cleanliness, and comfortable environment. Conclusion: Accessibility, hospitality, and infrastructure were considered more relevant factors in hospital emergency services is also a Brazilian reality. for patient satisfaction than the cure itself. Several factors are involved in the genesis of this problem, and the most expressive are increased urban Keywords: Patient satisfaction; Patient care; Quality of health care; violence, greater incidence of problems with external Health evaluation; Emergency medical services; Questionnaires causes, and aging population, which influence the increase in prevalence of chronic degenerative diseases. This demand for emergency hospital services implies RESUMO delays in care and an overworked healthcare team, Objetivo: Avaliar a qualidade dos prontos-socorros e prontos leading to low quality care.(1,2) atendimentos, de acordo com a satisfação dos usuários desses serviços. Métodos: Estudo descritivo transversal com abordagem This difficulty in the urgency and emergency quantitativa. A amostra foi constituída aleatoriamente por 136 healthcare services exists from the level of Primary usuários. A coleta de dados ocorreu no período de outubro Care, due to the scarcity of specialized professionals, in e novembro de 2012 por meio de questionário estruturado. parallel with the low rate of resolution and the reduced Resultados: Os participantes eram na maioria do sexo masculino health promotion strategies, which lead the user to (64,7%), com idade inferior aos 30 anos (55,8%) e a escolaridade seek the emergency room that is open 24-hours a day. predominante foi o ensino médio (54,4%). Entre os itens avaliados, os que se associaram estatisticamente com os níveis de satisfação com Therefore the emergency room receives a high demand o atendimento foram: tempo de espera, confiança do serviço, modelo of patients, which interferes in the care given to the do atendimento e motivo da procura do atendimento relacionado clientele that needs real emergency care, and hinders 1 Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil. 2 Faculdade de Saúde Ibituruna, Montes Claros, MG, Brazil. Corresponding author: Cássio de Almeida Lima – Avenida Rui Braga, s/n – Vila Mauricéia – Zip code: 39401-089 – Montes Claros, MG, Brazil – Phone: (55 38) 9246-0602 E-mail: [email protected] Received on: Mar 10, 2015 – Accepted on: June 8, 2015 Conflict of interest: none. DOI: 10.1590/S1679-45082015GS3347 This content is licensed under a Creative Commons Attribution 4.0 International License. einstein. 2015;13(4):587-93 588 Lima CA, Santos BT, Andrade DL, Barbosa FA, Costa FM, Carneiro JA those sent from the primary care centers, making the client urgency and emergency services, besides subsidizing more go through refusals, long waiting lines, sluggishness, discussions on the subject. and delay in being seen.(3,4) Despite the processes in evolution within the Unified Healthcare System (Sistema Único de Saúde - SUS), for OBJECTIVE the national health system, the constitutional principles To evaluate the quality of the emergency rooms and should be respected and pursued. Likewise, the various urgent care services according to satisfaction of their aspects that compromise hospital care, such as those users. related to human resources and the organization of the Healthcare Networks, which should be integrated, deserve to be the object of evaluations and effective METHODS interventions.(5) In this scenario, the assessment of care This was a cross-sectional descriptive study, with a from the user’s viewpoint becomes extremely relevant, quantitative approach. The following hospitals from that is, the user’s satisfaction as to the quality of this care. the city of Montes Claros (MG) were included: Hospital In Brazil, user satisfaction surveys have received special Universitário Clemente de Faria (HUCF), Fundação attention as of the 1990’s, due to re-democratization Hospitalar de Montes Claros – Hospital Aroldo Tourinho of the country and the appearance of movements for (HAT), Irmandade Nossa Senhora das Mercês de Montes social rights, especially those of access to healthcare Claros (Santa Casa), and Fundação de Saúde Dilson de services.(2) Quadros Godinho (FDQG). In this way, the user is given the opportunity to The focus of the study was the emergency rooms and give opinion about the public policies and identify the urgent care services of these hospitals which represented determining factors of his/her satisfaction, along with the hospital universe of the city of Montes Claros (MG). the recommendation of the World Health Organization We point out that all these services were the entrance way (WHO) that managers take into consideration the for users, with no requirement for a recommendation expectations of the citizens in decision-making processes. in order to be seen. It is worth mentioning that some For this, patient satisfaction has been adopted by particularities of the services, namely: only the HUCF healthcare institutions as a strategy for obtaining a set was an emergency room that cares exclusively for of perceptions related to the quality of care received, patients from the SUS. In this emergency room, there were 36 beds for observation or intermediate care service with which one acquires information that will benefit for those who awaited hospital admission. For each 12- the service organization.(6-9) hour work shift, the service counted on one internal Since then, literature has become very ample on this medicine physician, one pediatrician, one surgeon, and theme. However, more specific studies are needed that one orthopedic surgeon, besides two nurses, one of point out aspects directly related to the quality of the them responsible for triage and the other, for care; it service and the satisfaction of the users, underlining the also had six nurse technicians. The other organizations factors related to the client, the healthcare professionals, (10-13) render services to patients from the SUS, from health and to the quality of the facilities. Since the goal insurance companies and private patients. of patient care is the patient, it is more than justified HAT, Santa Casa, and HUCF had emergency to seek quality in their expectations, aiming at their rooms open for 24 hours. FDQG only had an urgent satisfaction as a determining aspect for judging quality. care service. The emergency room at HAT had 25 beds; In this sense, in search of a better quality of for each 12-hour work shift, there was one internal healthcare in which urgency and emergency services medicine physician, one pediatrician, one surgeon, stand out, an increased quantity of evaluations by the one orthopedic surgeon, and one neurologist, besides organizations is observed at national and international two nurses and four nurse technicians. At the Santa levels. This is because researching on patients’ Casa, the emergency room had 40 beds and had the satisfaction makes possible their participation in following team: two internal medicine physicians, two the evaluation and decision-making process, which pediatricians, one surgeon, one orthopedic surgeon, promotes effective and appropriate improvements for one cardiologist, and one neurologist, in addition to two the clientele seen. These are in agreement with the nurses and eight nurse technicians. As to FDQG, in the current WHO recommendations and the assumptions urgent care service, there were 12 beds, besides a staff of social participation of the SUS. Thus, it is believed team composed of one internal medicine physician, one that this study should guarantee useful information pediatrician, one surgeon, two nurses, and three nurse to managers and professionals who deliver care in technicians. einstein. 2015;13(4):587-93 Quality of emergency rooms and urgent care services 589 To define the size of the sample, the 20% cut-off The questionnaire used to collect data was structured point was used for all the subjects seen in one day of and validated by the Ministry of Health, by means
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