Transição do cuidado na alta hospitalar: tempo dedicado pela enfermagem e gestão do processo

Abstract

To examine the management of the responsible discharge process according to professionals working in the transition of care in health care institutions. Methods: Mixed sequential exploratory strategy. Stage 1- construction of list of activities to be performed by nurses at discharge from hospital through multiple sources; validation of the activities produced through the Delphi technique (consensus pre-established at 0.80 and calculated content validity index - CVI); Stage 2 - qualitative study approaching the interprofessional actions in the process; individual semi-structured interviews were carried out with 12 professionals working in medical-surgical and palliative care units of a special sized school hospital in the interior of São Paulo state . The reports were submitted to content analysis. Stage 3 - web survey was conducted with public and private school hospitals in the state of São Paulo with good health practices certified by national and international accreditations. A questionnaire was developed from a list of activities validated by experts considering frequency, time at which they occur, professionals involved and estimated time. Data collection was carried between April and August 2020 (Stage 1); from October to November 2020 (Stage 2); and, discontinuously, from February to September 2021 (Stage 3). Results: Fourteen activities were developed. In Delphi 1, the CVI ranged from 0.70 (post discharge contact and home visit scheduling) to 1.0 and in Delphi 2, a range of 0.60 (post discharge telephone contact) to 1.0 was found and 13 of them were validated (Stage 1). Only two activities (telephone follow-up and home visit) were not performed by members of the interprofessional team; "communication and patient/family/caregiver involvement in the discharge plan" was the most signaled activity. Six themes emerged from the interviews: Work overload - care demand and dedicated time; Articulation of interprofessional actions and networking; Advance discharge planning; Guidance to the patient/family/caregiver; Advances and restrictive aspects of interprofessional actions and Repercussions of the actions for continuity of care (Stage 2). Seventy-one nurses linked to 29 care institutions located in nine cities in São Paulo state have participated in the study. Most of the activities was regularly conducted in the first four days of hospitalization. Scheduling home visits, identifying post discharge problems and following-up the patient/family through post discharge telephone contact were never carried out, respectively, by 44(63.7%), 41(58.6%) and 51(71.8%) of the nurses. Telephone contact was considered important 70(98.5%) and feasible 41(57.8%). The nurse, individually, or as part of the team has been performing all activities. The sum of the estimated time for the process represented 257.5 (range 205-410) minutes (Step 3). Conclusion: The validated activities can contribute to improve the management of the discharge process. For more effectiveness, structural and procedural issues have to be improved and post discharge interventions systematized. The key role of nurses was strengthened, identifying the time dedicated, the work force and the necessary actions to qualify the practice, prevent readmissions and unnecessary expenses, mainly by promoting continuity and integrity of care.