Avaliação pré-anestésica: grande aliada na era da remuneração por performance

Dr. Giorgio Pretto, presidente da Sociedade de Anestesiologia do Estado de Santa Catarina e CEO e fundador da Nuntius Data Expert

Assista ao vídeo desta palestra em nosso canal no YouTube

As vantagens da avaliação pré-anestésica são inúmeras. Ela é fortemente recomendada pelo Conselho Federal de Medicina (CFM) em consulta e, em casos emergenciais, antes da admissão em centro cirúrgico. Apesar disso, anualmente dez milhões de pré-anestésicos deixam de ser feitos no Brasil. É um mercado de dez milhões de consultas que se perde todos os anos.

A estimativa é do médico anestesiologista e presidente da Sociedade de Anestesiologia do Estado de Santa Catarina Dr. Giorgio Pretto. “Por que menosprezamos um mercado potencial enorme como esse, que deveria ser visto como um investimento que, acima de tudo, vai reduzir complicações?” perguntou ele na palestra “Registro Digital do Pré-anestésico (AxPré): Maior Impacto na Segurança do Paciente”, no AnestEdu. Para ele, é incompreensível porque tantos gestores de hospital, de equipes, de planos de saúde, não exigem que o pré-anestésico seja feito, mesmo com todas as evidências em favor desse procedimento. Muitas instituições estão sendo processadas, segundo ele, porque aceitam que pacientes sejam internados sem o Termo de Consentimento Livre e Esclarecido (TCLE) assinado e sem passar por avaliação pré-anestésica. “O médico anestesista aceita, o cirurgião aceita… Por que muitos médicos anestesistas desvalorizam o pré, mesmo com todos os benefícios que ele traz?”

Veja também: AxPré – Pré-anestésico em nuvem: iformações do paciente sempre á mão, com segurança e protocolos mais recentes

O Dr. Pretto afirmou que a avaliação pré-anestésica traz segurança ao paciente, reduzindo complicações, e segurança jurídica às instituições, e que acreditadoras não aceitam mais instituições que não realizam o pré-anestésico. “Quando me perguntam por que comecei com o pré-anestésico, respondo: porque é o começo. É preciso otimizar e preparar o paciente e inclui-lo em protocolos que serão executados no transopeatório, para poder oferecer suporte à decisão e redução de erros evitáveis. Uma cirurgia que não começa com um pré-anestésico já começa errado.”

Se você ainda tem dúvida, veja um resumo trazido pelo Dr. Giorgio Pretto de por que sempre começar com o pré-anestésico:

  • Os inquestionáveis benefícios da avaliação pré-anestésica;
  • Segurança jurídica;
  • Acreditação hospitalar;
  • Oportunidade de iniciar a relação médico-paciente;
  • Avaliar os pacientes baseado em melhores práticas;
  • Incluir os pacientes em protocolos já no pré-operatório;
  • Avaliar exames complementares;
  • Solicitar exames ou interconsultas quando necessário;
  • Rastrear pacientes de possível via aérea difícil;
  • Rastrear pacientes de risco para hipertermia maligna;
  • Identificar história prévia de complicações em anestesias;
  • Passar aos pacientes orientações sobre medicações em uso;
  • Passar aos pacientes orientações gerais e sobre jejum;
  • Obtenção do Termo de Consentimento Livre e Esclarecido (TCLE) assinado.
Breve história da consulta pré-anestésica

Gestão da informação médica começa com avaliação pré-anestésica

A alma da atividade médica, da prestação de de serviços em saúde, segundo o Dr. Giorgio Pretto, é a informação médica. Ele afirmou que essa informação tem sido menosprezada nas instituições de saúde, no entanto, é coletando e analisando os dados de saúde dos pacientes desde o início, com o pré-anestésico, que se tornam possíveis análises preditivas –  e a prevenção é o verdadeiro poder da análise de dados e informações. “A informação médica tem sido relegada a quinto plano nos hospitais, quando muito. Mas se você não souber todas as informações pré-anestésicas, desde o início da cirurgia, todo o raciocínio posterior será prejudicado e você só conseguirá olhar para trás”, afirmou. “O pré-anestésico é o início, sem as informações dele, todas as análises posteriores não serão confiáveis.”

Veja também: Prever o futuro na saúde? Com gestão de dados, você pode

Não há como avaliar o desempenho do médico anestesista, por exemplo, sem saber como era o paciente que ele anestesiou. Para o Dr. Pretto, não coletar os dados desde o início, é como se preparar para falhar. Falhando no início, todo o restante será uma continuidade de falhas de avaliação de informação médica.

“Hoje, as maiores empresas do mundo são empresas de dados e oferecem isso gratuitamente. O produto somos nós. Ficaram bilionárias com isso, e nós jogando fora nossos dados médicos colocando informação em campo texto e fazendo prontuários de papel”, afirmou o Dr. Pretto. Ele apelou aos gestores hospitalares e de instituições de saúde para que deem atenção à informação médica, façam gerenciamento de saúde e não apenas de números, preparando a base de dados para o futuro, pois perder esses dados é um prejuízo incalculável.

Tecnologia aplicada à avaliação pré-anestésica

A maior parte da tecnologia usada hoje para prontuário médico está muito desatualizada em relação à tecnologia que a maioria das pessoas carrega nas mãos, em smartphones. Segundo o Dr. Giorgio Pretto, os sistemas usados em instituições de saúde, em geral, são planilhas de Excel com uma “cara” diferente, e são assim porque servem bem à contabilidade e ao estoque, porque são bons para gerir números, ou seja, bons para o gestor. “A gestão da informação médica, que é a essência do que fazemos, acaba relegada a campo texto. Mas o número não é a essência do que a gente faz. Os números são o resultado e são muito necessários – sem esses números também não é possível fazer nada – mas são o mínimo.”

Veja também: Tempestade na saúde: saiba quais são os ventos que podem trazer um mundo de oportunidades

Ele ressaltou que não se faz gestão sem dados precisos, portanto, já passou da hora de as instituições de saúde pensarem, prepararem e produzirem as próprias bases de dados confiáveis, pois não se pode avaliar saúde com baixa confiabilidade. E a remuneração baseada na avaliação da performance já chegou. É necessária uma tecnologia que possibilite a automatização de análise que suporte a decisão médica. “É disso que precisamos para mudar desfechos e resultados e para fornecer suporte e decisão aos colegas em tempo real, pois nem sempre há tempo e possibilidade, como muitas vezes acontece, de resolver um problema fazendo uma reunião com todos os anestesistas da equipe, para novamente explicar um protocolo”, disse. “Quando o pagamento por performance se estabelecer, não vai resolver fazer protesto. É melhor se preparar.”

AxPré: avaliação pré-anestésica em nuvem

O Dr. Giorgio Pretto contou que a WMC Anestesia foi a primeira empresa a adotar a plataforma de pré-anestésico em nuvem AxPré desenvolvida pela Nuntius Data Expert, empresa de análise de dados de que é CEO e fundador. Segundo ele, a WMC Anestesia acreditou no AxPré desde o início, ajudando a refinar o sistema.

Para o diretor e fundador da WMC Anestesia, o médico anestesista Dr. Wanderson Machado Carvalho, o AxPré não entrega apenas tecnologia disruptiva para a gestão de anestesiologia que a empresa realiza, mas qualidade e valor para toda a cadeia de clientes da WMC Anestesia. Todos se beneficiam, pacientes, cirurgiões, secretárias dos cirurgiões, médicos anestesistas, colaboradores dos hospitais, operadoras de saúde e mesmo familiares de pacientes. “O AxPré permite que coloquemos em prática a filosofia slow medicine, medicina sem pressa, em que acolher o paciente, dar-lhe atenção e evitar a iatrogenia é a base do atendimento”, afirma. “Com o AxPré, a gestão de consulta pré-anestésica é mais profissionalizada.”

Ele afirmou que ao acessar o AxPré, é o paciente pode responder todas as perguntas do questionário no conforto de casa ou mesmo no trabalho, sem pressa, passando as informações importantes para a própria segurança no ato anestésico-cirúrgico e recuperação no pós-operatório. Assim, na consulta presencial com o anestesista, o médico tem mais tempo para conversar com o paciente e examiná-lo com atenção, tirando dúvidas, orientando sobre o jejum, etc. “O AxPré permite ainda que criemos a liberação anestésica para o cirurgião, o atestado de comparecimento em consulta para o paciente e de seus familiares, pedidos de fisioterapia, prescrição de medicamentos, suplementos, vitaminas e orientações nutricionais. E nos permite solicitar exames e avaliações com especialistas como cardiologistas, hematologistas, alergologistas, etc., gerar avisos e alertas de alergias, intolerâncias, fobias, todo o necessário”, disse o Dr. Carvalho.

O Dr. Giorgio Pretto informou que o AxPré usa computação de nuvem de alta tecnologia em um sistema universal para resolver a avaliação pré-anestésica e é customizável para as necessidades de cada instituição. A segurança de dados é a mesma de um internet banking. A plataforma disponibiliza uma central de artigos e protocolos e oferece uma série de análises automatizadas. O sistema permite o envio de parte do trabalho por e-mail, de forma automatizada, e oferece uma agenda inteligente que interage com o paciente e com a secretária, avisando a secretária, por exemplo, com um sistema de cores, de qual paciente já se cadastrou no sistema e já respondeu ao questionário. O sistema também fornece relatórios e estatísticas em tempo real e reduz uso de espaço físico, uso de tempo e de papel: economia, sustentabilidade. O modelo de negócio é um produto gratuito e com tutorial, o cliente aprende sozinho a utilizar o sistema.

A meta da Nuntius é 95% da informação tabulada e analisável: “Nosso objetivo final é sempre fazer automação e suporte à decisão”, afirmou o Dr. Pretto. A empresa desenvolve um relacionamento com os clientes do serviço de anestesia, ou seja, pacientes, cirurgiões, operadoras, hospitais. Ele conta que a Nuntius tem recebido um retorno muito bom dos usuários: “O paciente passa a se sentir parte do processo. Nossos usuários têm requerido minimamente o suporte ao uso do sistema, ele é intuitivo e simples de usar.”

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