Banca de QUALIFICAÇÃO: TELMA RÉGIA BEZERRA SALES DE QUEIROZ

Uma banca de QUALIFICAÇÃO de MESTRADO foi cadastrada pelo programa.
STUDENT : TELMA RÉGIA BEZERRA SALES DE QUEIROZ
DATE: 20/10/2022
TIME: 10:00
LOCAL: Departamento de Saúde Coletiva
TITLE:

IMPROVEMENT OF QUALITY OF CARE FOR CERVICAL CANCER IN SECONDARY REFERENCE UNIT IN CEARÁ

KEY WORDS:

Quality improvement; Cervical neoplasm; Public health; Secondary prevention; Prevention of diseases.

PAGES: 55
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Saúde Pública
SUMMARY:

Introduction: In 2021, a quality improvement project was started at Ceará Cancer Prevention Institute, a state secondary reference unit for early detection and treatment of cancer and precursor lesions of the uterine cervix, endometrium, breasts and skin. The service chosen was the care of patients referred with suspected cervical cancer.

Objectives: To provide qualified care to women with precursor lesions and cervical cancer, assisted at the Cancer Prevention Institute, ensuring their treatment and follow-up until discharge, in case of precursor lesions, and staging and referral to tertiary reference units, in the case of invasive lesions.

Methods: We started an Improvement Cycle: I. Definition of the Improvement Team; II. Identification of the improvement opportunity, through the techniques of Brainstorm, nominal group and prioritization matrix; III. Analysis of the opportunity for improvement using the Ishikawa Diagram technique; IV. Initial assessment of the level of service quality, defining quality criteria for the types of process and results, related to: (a) coverage of the service; (b) the waiting time for surgical treatment of precursor lesions; (c) endo and ectocervical surgical margins; (d) follow-up of patients after surgical removal of precursor lesions; (e) the timely referral of patients with invasive lesions; and (f) patient satisfaction. The evaluation performed was retrospective, using data from reports from the pathological anatomy laboratory and from the Ars Vitae electronic medical record system; V. Intervention: after analysis of the initial evaluation, actions were defined, using the techniques of Affinity Diagram and Gantt, and some interventions are still in progress; VI. Reassessment carried out, with data analysis in progress.

Results: The preliminary results have so far allowed the analysis of four of the six criteria. The level of compliance with the criteria was: (a) Free surgical margins: 0,43   (0,08); (b) Time interval between indication and removal of precursor lesions: 0,75 (0,07); (c) First follow-up up to 6 months after the procedure: 0,53 (0,1); (d) Referral to tertiary unit within 30 days after diagnosis of invasive cancer: 0,90 (0,1). The first evaluation showed that the criteria related to the surgical margins and the time to start the follow-up of the patients represented 75% of the total of non-conformities (Pareto Diagram). The first criterion (“coverage”) lost its reason to be included, due to its systematic monitoring by the unit's Internal Regulation Nucleus. The analysis of the second evaluation is in progress, to verify the improvements obtained after the interventions.

Conclusions: Preliminary results have demonstrated the need for actions with gynecologists and the appointment scheduling and internal regulation sectors to increase the percentage of “free surgical margins” and ensure the start of patient follow-up within six months after the procedure. In terms of lessons learned, we observe the great importance of the development of: I. mechanisms of internal regulation of patients, integrated with the state and municipal regulatory centers of Fortaleza; II. integrated actions of an interprofessional nature, for technical improvement and engagement of health teams; III. promotion of the patients' autonomy and their effective participation in decisions about their diagnosis and treatment; IV. use of quality tools in service improvement initiatives.

COMMITTEE MEMBERS:
Presidente - 2171948 - PAULO JOSE DE MEDEIROS
Interna - 1645299 - MARISE REIS DE FREITAS
Interna - 1674688 - TATYANA MARIA SILVA DE SOUZA ROSENDO
Externo à Instituição - ALDAIR DE SOUSA PAIVA