Ferramentas tecnológicas utilizadas na comunicação entre profissionais de saúde durante as transições de cuidado no ambiente hospitalar: uma revisão sistemática e guia de boas práticas

• Ano de defesa: 2023
• Autor(a) principal: Oliveira, José Ilton Lima de
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Rio Grande do Norte; Brasil; UFRN; PROGRAMA DE PÓS-GRADUAÇÃO EM GESTÃO E INOVAÇÃO EM SAÚDE
• Palavras-chave em Português: Transição de cuidado - hospitais; Aplicativos de informática médica; Registros médicos eletrônicos; Comunicação; Revisão sistemática; CNPQ::CIENCIAS DA SAUDE
• Link de acesso: https://repositorio.ufrn.br/handle/123456789/57983

Introduction: Effective communication was established by the World Health Organization as an international patient safety goal, aiming to promote more qualified and safe care practices in hospital institutions. Failures in communication processes between health professionals are related to care errors, especially in care transitions, which result in harm to the patient. Guidelines established by the Joint Commission International suggest that the use of technological tools promotes improvements in the transfer of critical information during care transitions in the hospital context. Purposes: To investigate the effectiveness of the use of medical informatics applications in communication between health professionals during the care transition processes of hospitalized patients and to develop a guide to good practices based on the scientific evidence analyzed. Methodology: A mixed methodology, literature review and methodological study, consisting of a systematic review research, based on PRISMA guidelines and the creation of a good practice guide for the implementation of technological tools in the transition of care in an environment hospital. The search for studies was carried out in the following electronic databases: Embase, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus and Web of Science, as well as the gray literature in Google Scholar and ProQuest Dissertation and Thesis. Randomized and non-randomized studies were included that addressed a population of adult individuals of both genders with professional training in health working in hospitals and who participated in any transition of care, reporting the use of any medical informatics application directly related to the process of care. Outcomes related to the reduction of adverse events and improvements in communication during transitions were evaluated. The risk of study bias was assessed using the ROBINS-I tool for non-randomized clinical trials and RoB 2.0 for randomized clinical trials. For the elaboration of the guide, the evidence brought by the analysis of data from the systematic review was considered. Results: A total of 2,753 studies were identified, 10 of which were selected for the final analysis. Of these, 8 studies reported improvements in communication, including more efficient exchange of crucial information and a reduction in transition time, and 4 studies reported improvements related to the reduction of adverse events, in addition to better communication; however, these were not exclusively associated with the technology used in the communication. The implementation of technological interventions was usually accompanied by training and communication structuring based on the SBAR and I-PASS mnemonics, which may have contributed to the positive results observed. Additionally, the included studies had a variety of limitations, including biases in the assessment of outcomes, with difficulties in measuring adverse events, with 8 of them being evaluated at high risk of bias and 2 at moderate risk. A good practice guide, considering the available evidence, was presented. Conclusion: Electronic interventions have the potential to improve adverse event reduction and communication during care transitions. However, it is important to highlight that the positive impact on the reduction of events cannot be attributed solely to the technologies employed, given the role of training and improvements in clinical practice addressed in most studies. The effectiveness of technological interventions may vary depending on the clinical context, which implies the need to adapt and customize the intervention according to the local reality. Future research with robust methods is needed to optimize the implementation of technologies in the transition of care in the hospital environment.