Gestão da atenção às urgências e emergências: o estudo de caso de municípios de pequeno porte

Abstract

Urgent and emergency care is one of the challenges facing the Brazilian public health system in the face of urgent health conditions and fragmented services. The Urgent and Emergency Care Network was set up to ensure access to actions and services with resoluteness and agility. In this configuration, primary care is the ordering system and the preferred gateway for users suffering from acute and chronic conditions, and must therefore have the necessary resources to provide initial care, stabilize more serious conditions and refer them to other levels of care. However, the literature shows that there are shortcomings in terms of material resources, infrastructure and professional qualifications at this first level of care. The question therefore arose: how do the structure, organization and health processes of two small cities enable users in urgent and emergency situations to access the referral service? Therefore, the aim of this research was to understand how the structure, organization and health processes of two small cities enable users in urgent and emergency conditions to access the referral service. To this end, a single case study with a qualitative approach was carried out, consisting of two integrated units of analysis: two small cities in the north of the state of Rio Grande do Sul. Data was collected using three sources of evidence that converged in a triangular way: interviews, document analysis and participant observation. The data was compiled into a single base for the analytical process, using content analysis and simple descriptive analysis. It should be noted that all the ethical precepts of Resolution No. 466/2012 were complied with. The results are presented in the form of two articles, which revealed that the units had material resources and equipment, physical space and ambulances for urgent and emergency care. In the organizational dimension, different arrangements were identified for the occurrences attended to during the operation of the units and in the period afterwards, revealing weaknesses in the organization of the team that reduce the capacity to respond to these demands. Facilitating mechanisms include the telephone channel available to the population and remote support for the on-call team. However, there was a lack of protocols and guiding flows for care, with care processes being instituted informally and according to the knowledge and experience of the professionals. This revealed care weaknesses and the need for protocols to systematize professional performance. Therefore, it can be concluded that structure, organization and processes are interconnected elements that condition the quality, effectiveness and safety of urgent and emergency care in small cities.