Avaliação do impacto e da efetividade da implantação da unidade de atendimento ao acidente vascular cerebral agudo do Hospital de Clínicas de Uberlândia

Abstract

Stroke is the second leading cause of death and most responsible for the number of disabled people worldwide. For years, means were developed to improve the care provided to stroke patients and try to minimize their sequelae. Against the exposed context, this research is justified by analyzing a cerebrovascular accident treatment unit, reporting, in an unprecedented way, what its care and clinical impact during a certain period. Objective: Verify the impact and effectiveness of institutionalization of the Stroke Type II in the Clinical Hospital of Uberlândia. Material and methods: This is a retrospective, documentary study, which included 478 patients hospitalized from 2016 to 2019 (cohort A: 01/2016 to 08/2018; cohort P: 10/2018 to 09/2019) , collected in 2020. To analyze the clinical profile of patients, the variables used were: gender, age, presence of comorbidities (hypertension, diabetes mellitus, dyslipidemia, smoking, previous stroke, obesity, atrial fibrillation; alcoholism; Chagas disease and syphilis) and the National Institute of Health Stroke Admission Scale. For the quality and safety indicators, the variables analyzed from medical records were: pre-notification, porta-tomography time, symptoms-hospital care time, needle-door time, total hospital stay, patient complications (clinical and related to thrombolysis), outcomes (discharge, Best at Home Program, death), need for surgery, modified Rankin Scale scores at discharge. For the statistical analysis of continuous data, non-parametric tests were used and the results were presented as median and interquartile ranges. The decision level α was p < 0.05. Results: There was a 173% increase in stroke admissions after visits to the U-stroke. Among the participants, 144 (30,12%)composed the A cohort and 334 (69,87%) the P cohort. The median age was 63.50 for the A cohort and 66.00 years for the P cohort. Regarding risk factors, the most frequent were: hypertension, smoking and diabetes mellitus. Significant difference occurred only for atrial fibrillation (17.36% vs 6.30% p=0.00) and syphilis (0.70% vs 4.120 p=0.01). The P cohort had a higher proportion of slight cases, higher frequency of pre-notification (72.20% vs 81.40% p= 0.01), shorter times (door-needle= 43 vs 32 minutes; door-TC= 22 vs 15 minutes p=0.00), reduction of at least 40 minutes in HC-symptom time, reduction in hospitalization time by four days, less clinical complications such as pneumonia (31.25% vs 11.70% p = 0.00), urinary infections (20.10% vs 8.10% p= 0.02), pressure skin lesion formation (6.25% vs 0.0% p=0.00) and infection in other locations (46.50% vs 10.80% p=0.00), lower frequency of surgical procedures such as decompressive craniectomy (9% vs 1.80% p=0.00); craniotomy (4.90% vs 0.90% p=0.04); tracheostomy (17.40% vs 6.00% p=0.01); hematoma drainage 9% vs 2.10% p=0.01) and gastrostomy (16.70% vs 6.00% p=0.02), lower death rates (31.94% vs 13.50% p = 0.03), higher rates of discharge with asymptomatic patients (11.80% vs 19.50% p=0.00) and symptomatic patients without disabilities (6.30% vs 11.17% p=0.01). Conclusion: The implementation of U-stroke improved the quality of care for patients with optimization of quantity, quality and safety indicators (care and process), increasing the effectiveness of the reference service for the care of acute stroke.