Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor “quality improvement” and the keyword “Lean Healthcare”. A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services.
The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study aimed to map and analyze the value stream of patients classified as blue, green, or yellow in a Referral Emergency Unit. The evaluation research with analysis of processes was carried out in a teaching hospital on 30 patients seen at the emergency service. Value Stream Maps were drawn and the times involved in the process were calculated. Wastes and their possible causes were identified. A total of 13 maps were created and the mean process time between the activities involved in the process ranged between 7.3′ and 114.0′; the interruption time, between 0′ and 27.6′; the waiting time, between 43.2′ and 507.5′; and the lead time between 56.6′ and 638.0′ min. Some causes of waste were: high demand from patients; a shortage of personnel and offices. Following the Ishikawa Diagram, most of the waste is found regarding methods, human resources, and physical structure.
Objetivo: analisar a produção científica que descreve a longitudinalidade na Atenção Primária à Saúde e verificar como ocorre nos serviços. Método: revisão integrativa da literatura de estudos que tratam sobre a longitudinalidade do cuidado nos serviços. Foram utilizadas as bases de dados Literatura Latino-America e Caribe em Ciências da Saúde, Public MEDLINE, SciVerseScopus e no Portal Regional da Biblioteca Virtual em Saúde utilizando os termos: “Primary Health Care”, “Longitudinality” e “Public Health”. Resultados: 18 artigos, os quais foram categorizados pela sua similaridade nos temas: estudos sobre os atributos da APS, participação dos usuários na efetivação da longitudinalidade e longitudinalidade no cuidado à criança. Conclusão: a confiança mútua entre profissionais e usuários, a continuidade da atenção, a escuta, a credibilidade e a vinculação do usuário com os profissionais configuram a longitudinalidade nos serviços de saúde.
ObjectiveTo investigate the safety and efficacy of SARS-Cov-2 vaccination in patients with primary Sjögren syndrome (pSS) due to scarcity of data in this population. Methods By the first week of May 2021, all Big Data SS Consortium centres patients who had received at least one dose of any SARS-CoV-2vaccine were included in the study. The in-charge physician asked patients about local and systemic reactogenicity to collect SARS-CoV-2 vaccination data. ResultsThe vaccination data of 1237 patients were received. A total of 835 patients (67%) reported any adverse events (AEs), including local (53%) and systemic (50%) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%), and general symptoms were the most commonly reported systemic AEs (46%), followed by musculoskeletal (25%), gastrointestinal (9%), cardiopulmonary (3%), and neurological (2%). In addition, 141 (11%) patients reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms and fifteen (1.2%) patients reported active involvement in the glandular (n=7), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains due to post-vaccination SS flares. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 %) patients, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95% of vaccinated SS patients, according to data available. ConclusionOur data suggest that patients with pSS develop adequate humoral response and no severe AEs after SARS-CoV-2 vaccination and therefore raise no concerns about the vaccine's efficacy or safety profile in this population.
Trata-se de estudo descritivo que analisa a situação epidemiológica da sífilis, buscando compreender as causas relacionadas ao aumento de casos nos últimos anos. Primeiramente foi realizada uma Revisão Integrativa da literatura em quatro bases de dados. Os artigos foram selecionados e agrupados em duas categorias de análise de acordo com o seu conteúdo: 1. Aumento de casos de Sífilis associados à comportamentos de risco; 2. Aumento de casos de Sífilis associados à dificuldade na notificação e tratamento do parceiro. Na segunda etapa, os achados da revisão integrativa foram correlacionados aos dados de sífilis encontrados na pesquisa em andamento, denominada "Informatização da Vigilância em Saúde na Atenção Primária em Saúde", demonstrando que quando melhor organizado o Sistema de Vigilância Epidemiológica (SV2), é possível acompanhar melhor os casos de Sífilis. Conclui-se enfatizando a necessidade de estudos de novas estratégias para notificação de parceiros. Ambos projetos de pesquisa são vinculados ao Grupo de Estudos e Pesquisas em Educação e Práticas de Enfermagem e Saúde (GEPEPES).
Esse estudo tem como objetivo analisar a produção científica que descreve a longitudinalidade na Atenção Primária em Saúde (APS). Método: revisão integrativa da literatura. Os estudos foram selecionados nas seguintes bases de dados: LILACS, PubMed, Scopus e BIREME. Após seleção criteriosa, a amostra incluiu 18 artigos nacionais e internacionais. Resultados: emergiram três categorias temáticas: estudos para medir os atributos com PCATool; participação dos usuários na efetivação da longitudinalidade e longitudinalidade no cuidado à criança. Conclusão: a formação profissional voltada para a APS mostra-se fundamental. A confiança mútua entre profissionais e usuários, a escuta e o vínculo melhoram o atributo, por outro lado, a dificuldade no acesso pode interferir negativamente na longitudinalidade
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