The Good Cardiovascular Practices project, a partnership that brings together private institutions and the Ministry of Health, has improved care for patients in the Unified Health System (SUS). Hospital do Coração (HCor), Beneficência Portuguesa (BP) and the ministry participate in the project, through the SUS Institutional Development Support Program (Proadi-SUS).
The initiative is an in-service qualification project. The partnership between HCor and the Ministry of Health, through Proadi-SUS, began in 2009 with the electrocardiography (Tele-ECG) project, which made points available for carrying out electrocardiograms in emergency care units (UPAs 24h) and services of mobile emergency care (Samu) at a national level.
According to HCor’s Social Responsibility Assistance and Digital Health Project Manager, Patricia Vendramim, since the beginning of the project, the provision of the electrocardiogram report through interactive connections and remote platforms allowed the qualification of the service. “All the time, we qualify professionals who are on the front line in these urgent and emergency services that are UPAs, across the country,” Patricia told Brazil Agency.
Good Practices began in 2009 with only cardiovascular action in acute coronary syndrome and, over the last 15 years, it has been adjusted according to the current demands of the healthcare scenario, through the implementation of improvements.
“We select some services, which we provide supervision, teach how to collect indicators, make the protocol more up to date so that the best possible practice available at the time is used. All the time, we are qualifying in service and, therefore, collecting indicators”, she explained.
At the moment, the project has 735 units through HCor, plus 150 through BP, totaling 885 SUS units. The project provides an electrocardiography device in each service, capillarized throughout the country. The patient arrives with chest pain or some sign of a cardiovascular problem, takes an electrocardiogram, and the doctor, at the HCor or BP service in São Paulo, writes the report and returns it in around 3 minutes, on average.
According to Patricia, if the report is altered with severe arrhythmia or severe heart attack, the doctor contacts the UPA professional where the patient is and assists him with care. Both items are considered in-service qualifications.
Positive results
Patricia said that Beneficência Portuguesa, which joined the project in the last three years, “enlarged” the service qualification team in the UPAs. As a result, the time it takes for the patient to arrive at the UPA and undergo an electrocardiogram has been reduced, because the sooner a diagnosis is made for the person who arrives with chest pain, the better for them.
“We managed, by implementing improvements, to reduce the mortality rate of the UPAs that participated in this more select group by 44%. In adherence to drug therapy, there was an increase of 33, and the time to perform the electrocardiogram decreased by 59%.
The positive results allowed, since April 1st, to expand the focus not only on acute coronary syndrome, heart attack, but also on cerebrovascular accident or stroke, and sepsis, which would be infections with great clinical repercussions, so that Good practices in emergency care units are also established as a clinical protocol, providing greater structure and support in the management of the clinical case, stated the Project Coordinator of Beneficência Portuguesa de São Paulo (BP), Camilla Nicolino.
Camila highlighted that, among the UPAs that the project covers, 86% are authorized by the Ministry of Health.
Exams
Since 2009, more than 2 million exams have been performed. In 2019, the project began offering cardiological teleconsulting services by telephone, accounting for more than 19 thousand consultations in the consolidated HCor and BP. From 2021 to 2022, there was expansion to a platform online (Teams).
“In the 2021/2023 triennium alone, more than 750 thousand electrocardiogram reports were issued, which provided clinical discussion and early identification of patients with arrhythmias and heart attacks, resulting in a reduction in mortality and an increase in measures that prevent ischemic events, which is a great difference when talking about public health, care complexity and working in this network context”, he informed.
Camilla added that the project was adding value and expertise. In the next 32 or 33 months, as Good Practices will extend until December 31, 2026, it is expected that all active units will be established with this service and guaranteed quality of care. The forecast includes a reference reporting center and expansion of emergency care units, which will have tutoring, consultancy for the implementation of good practices for coronary syndrome, stroke and sepsis, as well as assessment in risk classification, through the methodology healthscarefull capacity plan and patient flow.
“As these units deal with situations of increased flow, demand, in all endemic scenarios, and seasonal increases that occur within the units, they work on the flow of patients to ensure less transit time, that is, that the patient stays in the UPA for the shortest possible time, avoiding rework and also any impact on clinical decisions”, added Camilla Nicolino.
