Implementation of the Case Management Team for the Transfer of Care in the RUE in the DF: Report of a successful experience in management processes

Abstract

Introduction: The integration between different health services for continuity of care has been a challenge for the constitution of health care networks. The transfer or sharing of care for patients in urgent and emergency situations from PHC to fixed emergency doors is a point of great care tension and for network management. Given the context of the second wave of the COVID-19 pandemic, in view of the pioneering experience in the Southwest region, it was proposed to create new "case management teams" (EGC) to support patient care transfers from Primary Care to Health (APS) for fixed urgent and emergency doors in the RUE Objectives: To describe the experience and the first results of the creation of Case Management Teams in the health regions of the DF Method: Experience report of the implementation of a support device the transfer of patients in the urgency and emergency network, based on the data presented in technical reports of the EGC and records of meetings between regional and central managers of the PHC. Results: The implementation of the EGC produced different results that contributed to the identification and dimensioning of problems care and management and an immediate impact on patient safety and guarantee of access, among the main problems identified tified: partial regulation of emergencies, lack of regulation of sanitary transport, lack of sanitary transport with patients transferred by their own means, inequities in the structure of sanitary transport and RUE services between regions, emergency rooms of regional hospitals (and not UPAs) as the main rearguard, access restriction and rearguard for the APS due to "flags" in the services; Improved communication and integration between PHC, hospitals and UPA; Renegotiation of referral and diagnostic support flows in the region; Success with the intermediation of removals, bridges between PHC and referral hospitals; Notification of adverse events in the transfer of care; Superintendence support to EGC with expanded function, dedicated team, transport and integration between all levels of care. Conclusions: After about 6 months of operation of the EGC, it was possible to make dynamic situational diagnoses that supported decision-making at the local and central management level, in favor of improving the RUE throughout the DF. This experience was considered successful within the scope of PHC management, since it has been proving to be a powerful service of integration between points in the network and generation of information for the continuous improvement of the RUE. It is also expected to advance in the improvement of these teams, adding functions such as a second formative opinion through teleconsultation of urgent and emergency cases for PHC, surveillance of adverse events of transferred cases and promotion of patient safety.