Preparation of a preoperative evaluation protocol in a university hospital in the city of Manaus-Amazonas-Brazil

Submitted by Gleide Ferreira (bragagleide@hotmail.com) on 2021-03-31T22:22:51Z No. of bitstreams: 4 Disserta????o .pdf: 1813555 bytes, checksum: d8560d26d388e717c83f71256e80bb0e (MD5) Carta de encaminhamento.pdf: 243913 bytes, checksum: fc7d97681043c30c4994db4dd52d4520 (MD5) Ata defesa Gleide.pdf: 174190 bytes, checksum: bd9dff98f668c32fdec248673a3277c0 (MD5) Termo de Anuencia Versa??o Final Gleide.pdf: 182317 bytes, checksum: 1c12c61dbefa82eebe1239a5386aa2fe (MD5) Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2021-04-04T19:44:53Z (GMT) No. of bitstreams: 4 Disserta????o .pdf: 1813555 bytes, checksum: d8560d26d388e717c83f71256e80bb0e (MD5) Carta de encaminhamento.pdf: 243913 bytes, checksum: fc7d97681043c30c4994db4dd52d4520 (MD5) Ata defesa Gleide.pdf: 174190 bytes, checksum: bd9dff98f668c32fdec248673a3277c0 (MD5) Termo de Anuencia Versa??o Final Gleide.pdf: 182317 bytes, checksum: 1c12c61dbefa82eebe1239a5386aa2fe (MD5) Approved for entry into archive by Divis??o de Documenta????o/BC Biblioteca Central (ddbc@ufam.edu.br) on 2021-04-05T02:03:52Z (GMT) No. of bitstreams: 4 Disserta????o .pdf: 1813555 bytes, checksum: d8560d26d388e717c83f71256e80bb0e (MD5) Carta de encaminhamento.pdf: 243913 bytes, checksum: fc7d97681043c30c4994db4dd52d4520 (MD5) Ata defesa Gleide.pdf: 174190 bytes, checksum: bd9dff98f668c32fdec248673a3277c0 (MD5) Termo de Anuencia Versa??o Final Gleide.pdf: 182317 bytes, checksum: 1c12c61dbefa82eebe1239a5386aa2fe (MD5) Made available in DSpace on 2021-04-05T02:03:52Z (GMT). No. of bitstreams: 4 Disserta????o .pdf: 1813555 bytes, checksum: d8560d26d388e717c83f71256e80bb0e (MD5) Carta de encaminhamento.pdf: 243913 bytes, checksum: fc7d97681043c30c4994db4dd52d4520 (MD5) Ata defesa Gleide.pdf: 174190 bytes, checksum: bd9dff98f668c32fdec248673a3277c0 (MD5) Termo de Anuencia Versa??o Final Gleide.pdf: 182317 bytes, checksum: 1c12c61dbefa82eebe1239a5386aa2fe (MD5) Previous issue date: 2020-12-03 Background: The patient with indication for an elective surgery, as opposed to an emergency surgery, can be stratified in order to decrease the waiting time, as well as prevent adverse events. Examination requests are routinely observed, which most often present results within normal limits and do not influence preoperative management. In this sense, it is common to find difficulties in following a protocol in the preoperative evaluation, since, in general, each professional draws up his own flowchart, causing a series of obstacles to the performance of surgical procedures. Objective (general): To develop a preoperative evaluation protocol for patients referred to elective surgery at the General Surgery Service of Hospital Universit??rio Get??lio Vargas (HUGV). Objectives (specific): 1. Conduct a situational analysis of the preoperative evaluation of elective general surgery developed at HUGV; 2. Promote discussion among the participating professionals to collect indications for the elaboration of the protocol; 3. Build a protocol for use in the preoperative evaluation based on the indications of the participating professionals, articulating their foundation with the scientific literature; 4. Develop a flowchart for the follow-up of the preoperative evaluation. Methods: This is a qualitative study using the action research methodology, using strategic planning tools such as the Likert Scale, SWOT Matrix and Brainstorming in order to emerge and substantiate the data. Such instruments helped in the survey of factual situations, positive and negative, in the development of this study in order to present proposals and solutions in the construction of the protocol. After data exploration, they were organized and analyzed through content analysis. Results: In the discussion of the data, primary categories emerged, such as: university hospital, multidisciplinary and regional aspects, which underlie the construction of criteria for preoperative evaluation and requests for complementary exams. In line with the professional indications, the elaboration of the protocol is structured based on the following elements: age, associated comorbidities, findings on physical examination and surgical size. The analyzed categories supported the construction of the criteria in the elaboration of the protocol. As a final result, in addition to the elaboration of the protocol, the importance of collaborative work is emphasized. The articulation of the multidisciplinary team in the construction of the work, based on the exchange of practices and knowledge, provided the experience with richness and ensured the validity of the flowcharts and the protocol as a final product. Justificativa: O paciente com indica????o de uma cirurgia eletiva, ao contr??rio de uma cirurgia de emerg??ncia, pode ser estratificado e modo a diminuir o tempo de espera, bem como prevenir eventos adversos. Observa-se, de forma rotineira, a solicita????o de exames, que na maioria das vezes apresentam resultados dentro dos padr??es de normalidade e n??o influenciam no manejo pr??-operat??rio. Nesse sentido, ?? frequente encontrar dificuldades no seguimento de um protocolo na avalia????o pr??-operat??ria, pois, em geral cada profissional elabora seu pr??prio fluxograma, acarretando uma s??rie de entraves para a realiza????o dos procedimentos cir??rgicos. Objetivo (geral): Elaborar um protocolo de avalia????o pr??-operat??ria para pacientes encaminhados a cirurgia eletiva no Servi??o de Cirurgia Geral do Hospital Universit??rio Get??lio Vargas (HUGV). Objetivos (espec??ficos): 1. Realizar an??lise situacional da avalia????o pr??-operat??ria de cirurgia geral eletiva desenvolvida no HUGV; 2. Promover discuss??o entre os profissionais participantes para coleta de indica????es para elabora????o do protocolo; 3. Construir um protocolo para a utiliza????o na avalia????o pr??-operat??ria a partir das indica????es dos profissionais participantes articulando sua fundamenta????o com a literatura cient??fica; 4. Elaborar um fluxograma para o seguimento da avalia????o pr??-operat??ria. M??todos: Trata-se de um estudo qualitativo com emprego da metodologia pesquisa-a????o, utilizando-se ferramentas de planejamento estrat??gico como a Escala Likert, Matriz SWOT e Brainstorming com o intuito de emergir e consubstanciar os dados. Tais instrumentos auxiliaram no levantamento de situa????es f??ticas, positivas e negativas, no desenvolvimento desse estudo com o intuito de apresentar propostas e solu????es na constru????o do protocolo. Ap??s explora????o dos dados, os mesmos foram organizados e analisados atrav??s de an??lise de conte??do. Resultados: Na discuss??o dos dados emergiram categorias prim??rias, como: hospital universit??rio, multidisciplinaridade e aspectos regionais, os quais fundamentam a constru????o de crit??rios para avalia????o pr??-operat??ria e solicita????es de exames complementares. Em conson??ncia com as indica????es profissionais a elabora????o do protocolo se estrutura a partir dos seguintes elementos: idade, comorbidades associadas, achados no exame f??sico e porte cir??rgico. As categorias analisadas fundamentaram a constru????o dos crit??rios na elabora????o do protocolo. Como resultado final, al??m da elabora????o do protocolo, ressalta-se a import??ncia do trabalho colaborativo. A articula????o da equipe multidisciplinar na constru????o do trabalho, a partir da troca de fazeres e saberes, oportunizou riqueza ?? experi??ncia e assegurou a validade dos fluxogramas e do protocolo como produto final.