Implicancias de la medicina basada en la evidencia en la gestión y organización de servicios de anestesia, analgesia y reanimación / Implicantions of medicine based on evidence in the administration of anesthesia, analgesia and reanimation units

La administracion basada en la evidencia (ABE) se origina en la práctica médica, y más específicamente en la estrategia llamada medicina basada en la evidencia, y se aplica en cuatro pasos: formulación de preguntas adecuadas, búsqueda selectiva de la evidencia, valoración crítica y aplicación de la misma. Constituye una herramienta para ayudar a las empresas a crear las estructuras propias de las organizaciones que incorporan estas herramientas para facilitar la gestión del conocimiento, el recurso más valioso para las organizaciones en la nueva sociedad de la información y la economía digital. Este tipo de administración lleva implícito el concepto de trabajo según costos de la calidad, que son los costos incurridos en evitar la caída en la calidad de bienes y servicios o para mitigar los resultados adversos (producto final del servicio con defecto). Se distinguen cuatro tipos de costos: a) de prevención, que tienden a ajustarse estrictamente a las especificaciones técnicas; b) de evaluación, para identificar las unidades de productos o servicios que se apartan de las especificaciones; c) de falla interna, para subsanar eventuales fallas de calidad antes de entregar el bien al cliente; y d) de falla externa, para subsanar, a posteriori de la entrega al cliente, las fallas verificadas. Es necesario realizar un esfuerzo en la gestión de servicios de anestesia, analgesia y reanimación en pos de una medicina más racional que incluya valores como equidad, resultados y minimización de costos basados en los conceptos antes mencionados.

Organizaçåo de serviços de anestesia obstétrica na cidade de Såo Paulo / Organization of obstetric anesthesia services in the city of Såo Paulo

Background and objectives - The quality of obstetric anesthesia is directly related the to organization of obstetric anesthesia services. In Brazil, there is a lack of information on such services. The purpose of thisstudy was to charcterize the material and human resources and the functional organization of obstetric services in public, private and university affiliated hospitals in the city of Säo Palo. Methods - Questionnaires were sent to the chiefsof obstetric anesthesia services services of 75 hospitals located in the cityof Såo Paulo, which had more than 100 deliveries in 1991. Fifty-six were private,15public and 4 university hospitals. The questionnaires included 4 parts aimingat the characterizati0n of: size of hospitals and type of patient; physical and material resources available; human resources available, their qualification andorganization; preferred anesthetic techniques. Results - Fifty hospitals responded,33 being private, 13 public and 4 university affiliated. The majority of thehospitals are middle to large sized, with a great number of deliveries per year. Patients under the Public Health Care System are taken care of in almost all publichospitals (92.5 percent) and in all university hospitals. Support services are available in the great majority of the hospitals, although there is a lack of blood banks in private hospitals and of intensive care beds in public hospitals. The anesthesiologist is present in the hospital during 24 hours a day in 92 pre cent of the studied hospitals and is responsible for the administration of anesthesia in 98.0 per cent of them. The qualification of the anesthesiologists regarding basic training programs in anesthesiology is satisfactory, but only a small percentage is Board Certified (Brazilian Society of Anesthesiology) or has any academic titles. The anesthetic technique is standardized in only 16,0 per cent ofthe hospitals. Equipment and monitoring devices are available in most of the hospitlas, although there is a lack of mandatory devices in some; however, even when available, monitoring resources are often underutilized. Medical school affiliation and academic activities prevail in public hospitals. The routine use of new techniques and the participation of the anesthesiologist in the postanestheticperiod occurred more frequently in private hospitals. Conclusions - The conditions for the practice of obstetric anesthesia in the fifty hospitals studied in Säo Paulo are satisfactory. However, some important problems were detected such asthe lack of mandatory equipment in some hospitals, lack of standards of practiceand the underutilization of monitoring resources, even when available