Gestión de recursos en un servicio de urgencia en hospital federal delante la pandemia de COVID-19

Vianna, Elaine Cristine da Conceição; Pestana, Luana Cardoso; Meireles, Isabella Barbosa; Rafael, Ricardo de Mattos Russo; Marziale, Maria Helena Palucci; Faria, Magda Guimarães de Araújo; Gallasch, Cristiane Helena

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Revista Brasileira de Enfermagem

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EXPERIENCE REPORT • Rev. Bras. Enferm. 75 (Suppl 1) • 2022 • https://doi.org/10.1590/0034-7167-2021-0149 copiar

Gestión de recursos en un servicio de urgencia en hospital federal delante la pandemia de COVID-19

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Describir acciones de gestión organizacional de un servicio de urgencia resultantes de la pandemia de COVID-19, definidas basadas en la prevalencia de casos de infección por coronavirus, síndrome respiratoria aguda grave y síndromes gripales.

Método:

Relato de experiencia basado en análisis retrospectivo de atenciones de síndromes respiratorias en el primer semestre de 2019 y 2020, junto análisis documental de protocolos institucionales de servicio de urgencia federal.

Desarrollado:

Observado aumento de atenciones, representando 7,25% y 19,4% de los casos de 2019 y 2020, respectivamente, debido la formación del Gabinete de Crisis, con equipe multidisciplinar responsable por la construcción del plan de acción con cambios en la estructura física, procesos de trabajo y entrenamientos.

Consideraciones finales:

Evidenciado que planeamiento, coordinación de acciones pautadas en decisiones del Gabinete de Crisis y divulgación de informaciones confiables mediante un punto focal fueron esenciales para organización, gestión del servicio de urgencia y protección a trabajadores.

Descriptores:
Pandemia; Infecciones por Coronavirus; Gestión de Recursos; Enfermería; Servicio de Urgencia en Hospital

ICD-10	Description
A41.9	Sepsis, unspecified organism
B33.4	Hantavirus (cardio)-pulmonary syndrome [HPS] [HCPS]
B34	Viral infection of unspecified site
B34.2	Coronavirus infection, unspecified
B34.9	Viral infection, unspecified
J01.9	Acute sinusitis, unspecified
J06.9	Acute upper respiratory infection, unspecified
J09	Influenza due to certain identified influenza viruses
J10	Influenza, due to other identified influenza virus
J11	Influenza due to unidentified influenza virus
J11.1	Influenza due to unidentified influenza virus with other respiratory manifestations
J11.8	Influenza due to unidentified influenza virus with other manifestations
J12.9	Viral pneumonia, unspecified
J15/J15.9	Bacterial pneumonia not elsewhere classified/Unspecified bacterial pneumonia
J15.8	Pneumonia due to other specified bacteria
J18/J18.9	Pneumonia, unspecified organism
J18.2	Hypostatic pneumonia, unspecified organism
J18.8	Other pneumonia due, unspecified organism
J21	Acute bronchiolitis
J21.8	Acute bronchiolitis due to other specified organisms
J21.9	Acute bronchiolitis, unspecified
J44	Other chronic obstructive pulmonary disease
J44.9	Chronic obstructive pulmonary disease, unspecified
J45	Asthma
J45.9	Other and unspecified asthma
J80	Acute respiratory distress syndrome
J90	Pleural effusion, not elsewhere classified
R06	Abnormalities of breathing
R06.9	Unspecified abnormalities of breathing
U07.1/U071	COVID-19
U07.2/U072	COVID-19, unidentified virus
U04.9	SARS
Z20.9/Z209	Contact with and (suspected) exposure to unspecified communicable disease

Field	Description
Physical structure management	Changes in the layout of the risk classification room to increase airflow and ease of access, eliminating the need for the patient to enter in the main reception area to receive attention from the nurse that made the classification, with all preventive barriers in place;
	Division of the attention wings in “COVID-19 free”, to attend emergency patients with no respiratory symptoms or other symptoms that could indicate an infection from the new coronavirus; and “COVID-19”, to attend all RS cases, with physical barriers adapted for isolation, attending the needs for respiratory precautions and counting on an exclusive and well-equipped team.
	The entrance for workers was changed to the door to the side of the emergency entrance, with a direct passage to their resting space, to avoid passing through the reception;
	Organization of the area where workers put on their vests and equipment, with the installation of a water tank, liquid soap, 70% alcohol gel, and personal protective equipment (PPE), with informational cards indicating the order in which these should be used. At the times of shift exchanges, were made available: water-proof aprons, surgical masks, filter masks (PFF-2), cap, disposable shoes, protective goggles, face shield, disposable scrubs;
	Organization of the area for removing vests with information about the removal of PPEs, water tank, alcohol gel 70%, counter to put the facial masks and goggles and disinfectant to clean these items;
	Definition of places for first medical attention, with the recommended distancing between armchairs, equipped with material for immediate oxygen supplementation;
Assistance management	Prioritization of patients with RS symptoms, as long as there are no cases with risk of death.
	Use of sets of forms for hospitalization and discharge;
	Organization of fast sequence intubation boxes to guarantee that the procedure is safe and fast;
	Request for the purchase of borrowing of equipment to increase the technological park, receiving equipment for monitoring, mechanical ventilation (MV), digital saturation, and beds;
	Guidance for the patient to assume a prone position early for indicated patients; stability for the procedure and pronation with a physical therapy team for patients in MV.
	Establishment of a familiar communication team to provide daily information to the families;
	Use of the daily huddle (²²22 Ministério da Saúde (BR). Projeto lean nas emergências: redução das superlotações hospitalares [Internet]. [Brasília, DF]: MS; 2019[cited 2020 Nov 18]. Available from: https://www.gov.br/saude/pt-br/acesso-a-informacao/acoes-e-programas/projeto-lean-nas-emergencias https://www.gov.br/saude/pt-br/acesso-a-... ) tool to evaluate what is yet to be done in the attention and in the management of the beds, considering the needs of each patient and the availability in the institution, making it possible to free the emergency beds to receive other cases.
Human resource management	Training of the multidisciplinary team about wearing and removing the PPE, using a virtual resource to be able to inform all the teams, in addition to in loco interventions;
	Training the nurses for risk classification so they can identify early the signs of severity and identify the suspected, probable, or confirmed cases, according to MS updated information.
	Revision of the administrative attributions of those who work on duty to guarantee that assistance is provided to critical patients, with recommendations for the delegation of bureaucratic activities to administrative workers of the sector;
	Sizing of the nursing team by transferring workers from less critical sectors to increase the workforce for emergencies;
	Monitoring of absenteeism due to COVID-19 and daily observation of signs of emotional exhaustion of frontline workers.

Card	Description
1	Advice about caring and protecting the skin of prone patients
2	Advice about preparing the body
3	Advice about swab collection
4	Advice about the clinical management of the patient hospitalized with COVID-19
5	Advice about the oral hygiene of critical patients
6	Advice about the order in which the PPEs should be worn and removed
7	Advice about the standard-precaution measures in regard to the use of the relevant PPE
8	Advice to the patients and visitors about circulation norms
9	Doses of medications for intensive care
10	Flowchart of the entrance, with COVID-19 cases separated from other users.
11	Flowchart to notify/investigate FLI/request testing
12	Proposal for the pharmacological management of patients hospitalized with COVID-19 and information on the use of chloroquine and its drug interactions
13	Set of forms for attendance, with discharges: form for notifications, consent form for isolation, guidance for home, medical prescription book, medical certificate
14	Set of forms for hospitalizations: notification form, testing request, authorization for hospitalization, guide for requestion transfers to the reference center

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Elaine Cristine da Conceição Vianna E-mail: enfavianna@gmail.com