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Auditoria clínica numa clínica privada de imagiologia
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| 1.29 MB | Adobe PDF |
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Abstract(s)
Introdução: Este trabalho consistiu na realização de uma auditoria clínica abrangente, relativamente à estrutura e processos, numa unidade privada de saúde, convencionada com o Serviço Nacional de Saúde (SNS) e ainda o estabelecimento de Níveis de Referência de Diagnóstico (NRDs) locais no contributo para a melhoria contínua da qualidade dos cuidados prestados para a população e cumprimento dos critérios legais estabelecidos pelo Decreto-Lei nº 108/2018. Metodologia: Foram realizados os procedimentos para uma auditoria interna em práticas radiológicas médicas, mais concretamente para a radiologia de diagnóstico, onde foi avaliado todo o percurso dos utentes, desde a marcação do exame ao relatório médico final, incluindo a dose de radiação ao doente. Neste trabalho fala-se, não só da importância do plano da garantia da qualidade da instituição, mas também da relevância das boas práticas clínicas e formação contínua dos profissionais. Aponta-se para a necessidade de uma prática clínica justificada e otimizada, assegurando que os níveis das diferentes exposições médicas estão de acordo com os Níveis de Referência de Diagnóstico (NRD) estabelecidos pela Comissão Europeia. Desta forma, foram estabelecidos os NRD locais para exames de mamografia e de radiologia convencional mais frequentes, realizados na unidade de saúde, e avaliou-se os resultados de forma a fornecer uma perspetiva geral da prática. Conclusões: Concluiu-se que a auditoria clínica interna promove o aumento da qualidade nas práticas clínicas, através da análise sistemática das práticas; fornece aprendizagem para os profissionais que nela participam e favorece oportunidades de colaboração interdisciplinar, com o envolvimento de médicos, técnicos de radiologia e físicos médicos; demonstra o compromisso com a segurança do paciente e dos profissionais, através da verificação do cumprimento dos requisitos legais de proteção e segurança contra radiações, mas o maior beneficiado é o doente, uma vez que todo o seu percurso foi estudado na tentativa de otimização.
Neste trabalho foram calculados os NRDs, estabelecidos estatisticamente através do percentil 50, exceto na mamografia que foi usado o percentil 75. Os resultados foram inferiores ao recomendado para as mamografias e para a maioria das incidências em radiologia convencional, exceto no perfil da coluna dorsal, coluna cervical AP e perfil e estudo contrastado do sistema digestivo alto.
Introduction: This work consisted of carrying out a comprehensive clinical audit, regarding the structure and processes, in a private health unit, contracted with the National Health Service (SNS) and also the establishment of local Diagnostic Reference Levels in contributing to the continuous improvement of the quality of care provided to the population and compliance with the legal criteria established by Decree-Law no 108/2018. Methodology: The procedures for an internal audit in medical radiological practices were carried out, more specifically for diagnostic radiology, where the entire path of the users was evaluated, from the exam schedule to the final medical report, including the radiation dose to the patient. This work highlights the importance of the institution's quality manual, clinical best practices, and continuous professional training. It points to the need for justified and optimized clinical practice, ensuring that the levels of different medical exposures are in accordance with the Diagnostic Reference Levels established by the European Commission. In this way, the local DRLs for mammography and the most frequent X-rays exams, performed in the health unit, were established and the results were evaluated in order to provide an overview of the practice. Conclusions: Internal clinical auditing enhances the quality of clinical practices, through the systematic analysis of practices; it provides learning for the professionals who participate in it and fosters interdisciplinary collaboration, with the involvement of physicians, radiology technicians and medical physicists; It demonstrates the commitment to patient and professional safety, through the verification of compliance with the legal requirements of protection and safety against radiation, but the greatest beneficiary is the patient, since his entire path has been studied in an attempt to optimize. In this study, the DRLs were calculated, statistically established through the 50th percentile, except in mammography, where the 75th percentile was used. The results were below the recommended levels for mammograms and for most of the views in conventional radiology, except for the lateral view of thoracic spine, AP and lateral views of cervical spine and for barium meal and swallow.
Introduction: This work consisted of carrying out a comprehensive clinical audit, regarding the structure and processes, in a private health unit, contracted with the National Health Service (SNS) and also the establishment of local Diagnostic Reference Levels in contributing to the continuous improvement of the quality of care provided to the population and compliance with the legal criteria established by Decree-Law no 108/2018. Methodology: The procedures for an internal audit in medical radiological practices were carried out, more specifically for diagnostic radiology, where the entire path of the users was evaluated, from the exam schedule to the final medical report, including the radiation dose to the patient. This work highlights the importance of the institution's quality manual, clinical best practices, and continuous professional training. It points to the need for justified and optimized clinical practice, ensuring that the levels of different medical exposures are in accordance with the Diagnostic Reference Levels established by the European Commission. In this way, the local DRLs for mammography and the most frequent X-rays exams, performed in the health unit, were established and the results were evaluated in order to provide an overview of the practice. Conclusions: Internal clinical auditing enhances the quality of clinical practices, through the systematic analysis of practices; it provides learning for the professionals who participate in it and fosters interdisciplinary collaboration, with the involvement of physicians, radiology technicians and medical physicists; It demonstrates the commitment to patient and professional safety, through the verification of compliance with the legal requirements of protection and safety against radiation, but the greatest beneficiary is the patient, since his entire path has been studied in an attempt to optimize. In this study, the DRLs were calculated, statistically established through the 50th percentile, except in mammography, where the 75th percentile was used. The results were below the recommended levels for mammograms and for most of the views in conventional radiology, except for the lateral view of thoracic spine, AP and lateral views of cervical spine and for barium meal and swallow.
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Keywords
auditoria clínica proteção radiológica níveis de referência de diagnóstico radiologia convencional mamografia Clinical audit radiological protection diagnostic reference levels radiography mammography