Introduction: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. Patients and methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel–Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). Conclusion: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.

Objective: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. Methods: Patients with COVID-19 admitted to a private hospital in the city of Sao Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. Results: A total of 2,138 patients were included. The mean age was 58.6 +/- 15.8 years, and the median length of hospital stay was 9.0 (5.015.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. Conclusions: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.

A melhoria da gestão na área da saúde é um desafio mundial que afeta tanto organizações públicas, como privadas, sendo o fluxo do paciente um processo chave para o desenvolvimento do sistema. A jornada do paciente dentro do hospital envolve não apenas o deslocamento físico deste, mas uma série de processos paralelos que refletem no resultado de diversos indicadores administrativos e clínicos dentro de uma instituição. Um fluxo eficiente representa, entre outros fatores, redução de custos, aumento do giro de leito e aumento da segurança do paciente. Entretanto, analisar e modificar esse fluxo tem sido um desafio devido a quantidade de variáveis que envolvem esse processo. Para melhores resultados, uma das abordagens mais utilizadas é a padronização das etapas do fluxo do paciente, tanto nos gatilhos que envolvem uma comunicação clara e efetiva entre os profissionais da área, como no uso correto dos sistemas digitais que envolvem o fluxo que ajudam a dar visibilidade do que está acontecendo em tempo real para toda equipe envolvida. Com o intuito de verificar as falhas no processo e melhorar a ferramenta institucional que mede a avaliação da experiência do paciente (HCAHPS), a gestão do Hospital Sírio Libanês desenvolveu um projeto para a melhoria no processo de alta do paciente internado. O estudo para a questão ora apresentada foi feito utilizando a metodologia Lean Seis Sigma com roteiro DMAIC (Definição, Medição, Análise, Implementação e Controle).