Gestão da clínica: grau de dependência dos cuidados de enfermagem como preditor de tempo de internação de pacientes na unidade de clínica médica de um hospital universitário brasileiro

Abstract

Introduction: Prolonged in-hospital stay increases the costs of hospitalization, in addition to exposing patients to the risk of adverse events. Being a tool that enables classifying care complexity of individual patients in relation to nursing care needs, the Fugulin Patient Classification System (PCS) might reflect in-hospital length of stay. Objective: To assess the relation between the care complexity regarding nursing care needs, as measured by the Fugulin scale and prolonged hospital stay. Method: Prospective cohort study conducted at a Brazilian university hospital from June to October 2018. In-hospital stay length of stay longer than the median was considered prolonged. Survival analysis with competing risks was used to model the association between in-hospital length of stay and the Fugulin Score. Results: During the study period, 419 of the 723 (58%) patients admitted to the Internal Medicine units of a public university hospital in Brazil, were consecutively recruited. The median age was 60 years (interquartile range [IIQ] 47-69). Most patients (282; 67.5%) were classified as having “minimum care needs”, 81 (19.4%) as “intermediate care needs”, and 55 (13, 2%) as “high dependency and semi-intensive care needs”. The median length of hospital stay was 17 (IIQ10–30) days. Length of hospital stay was associated with the Fugulin Score with a sub-hazard ratio (sub-HR) of 0.688 (95% confidence interval [95% CI] 0.477-0.992) for minimum care need and a sub-HR 0.409 (CI 95% 0.268 - 0.624) for intermediate care needs. Conclusion: Fugulin's SCP was directly associated with prolonged hospital stay. This suggests that Fugulin might be useful for planning and evaluating reduction of length stay strategies.