Proposta de implantação de um protocolo clínico de condutas para o atendimento de pacientes com dor torácica em uma unidade de pronto atendimento (UPA) em Maringá-PR

Abstract

One of the major challenges for the medical and nursing staff of an Emergency Care Unit (ECS) is the patient with chest pain who may have several diseases with a clear risk of death. The high flow of patients attended at ECSs is also a difficulty to be overcome, as it delays the care of patients with chest pain. In cities where there is no specialized chest pain emergency care, it is necessary to implement a protocol of conducts as a working tool that enables emergency professionals to recognize patients with Acute Coronary Syndrome (ACS) who present a high risk of death, and thus initiate immediate treatment. In this study, the main difficulties for the care of patients with chest pain in a ECS in the city of Maringá-PR were initially identified through a questionnaire answered by doctors and nurses, as well as the implementation of a clinical protocol of conducts for the care of this patient was suggested, after the application of a validation questionnaire. The analysis of the answers to the first questionnaire showed that there is a consensus among the professionals of the emergency department of this ECS regarding the need to update their knowledge to care for patients with chest pain, as well as to perform and interpret the electrocardiogram (ECG). Also, in relation to the answers to this questionnaire, it was found that most professionals in the emergency sector report that the waiting time for patient care is more than 21 minutes and the release of the result of the laboratory examination of the biochemical marker troponin occurs after 2 hours. The fact that the patient with chest pain is not being monitored during his stay in the ECS, as well as the absence of a specialist professional to discuss the ECG result are other difficulties reported by the medical and nursing teams. In view of this situation, this study presented a workflow and a proposal for the implementation of a clinical protocol of conducts, aiming to provide greater speed and efficiency in the care of patients with chest pain. The content described in the workflow and in the clinical protocol of conducts was validated, following Fehring's model and using the Content Validity Index (CVI), obtaining the average score of 0.992 that reflects the high degree of agreement between the experts, opening the perspective for the implementation of the flowchart and the clinical protocol of conducts with the emergency sector, with the aim of contributing to the confirmation of the diagnosis of ACS-related cases, for decision-making regarding the referral of these patients for specific care, or for their release, thus helping to reduce costs with unnecessary hospitalizations.