Gestão integrada no Setor de Hemodinâmica do Hospital Universitário Pedro Ernesto: um modelo para geração de valor em saúde

Abstract

Public health systems face significant challenges in resource management, striving to ensure universal and high-quality care. In this context, the Hemodynamics Department of Pedro Ernesto University Hospital (HUPE) stands out as a reference in the care of acute myocardial infarction (AMI) in the State of Rio de Janeiro. It operates efficiently and integrates services, playing a crucial role within the network in achieving its mission. Despite recent advancements, gaps remain in the application of methodologies that reconcile operational efficiency, quality of care, and sustainable resource use in hemodynamics departments. This study explores integrated management practices that can impact efficiency and generate value in cardiovascular patient care. The objective was to analyze the impact of implementing an integrated care cycle management approach in the Hemodynamics Department to generate value in healthcare. By adopting Value-Based Healthcare (VBHC) guidelines, the initiative aimed to optimize the care cycle in the Hemodynamics Department, benefiting both patients and the healthcare system. The study applied the Method for Identification, Analysis, and Problem Solving (MIASP), which combined process modeling tools and the Theory of Constraints, such as the Current Reality Tree (CRT), and Quality Management methods. These approaches identified operational and administrative bottlenecks, enabling the proposal of corrective interventions and the reorganization of workflows. These tools were applied collaboratively with the operations and management teams, ensuring the feasibility and acceptance of the proposed changes. The implemented changes contributed to improving the patient care cycle in the department, increasing the service capacity as reflected in a rise in procedures performed in the first half of 2024 compared to the same period in 2023. Additional benefits included improved efficacy and a reduction in patient care times within the AMI care pathway. Those conclusion were: integrated management practices applied to the Hemodynamics Department optimized care cycles for coronary procedures, enhancing efficiency and effectiveness in the treatment of acute and chronic ischemic diseases; there was an increase in coronary procedures and the completion of pending outpatient tests, supported by telehealth follow-ups that improved test predictability and patient adherence; the changes apparently contributed to reducing the time required for coronary procedures within the care network; a strategic management approach, based on integrated methodologies with engaged participants and a solution-focused perspective, successfully optimized the use of financial and operational resources, improved clinical outcomes, and positively impacted the healthcare system.