Impacto da reorganização da rede SUS nos óbitos por COVID-19: análise da rede de urgência e emergência pré-hospitalar do município de Salvador.

Abstract

Covid-19 is a disease caused by coronavirus 2 (SARS-CoV-2), which has spreading throughout the world, whose clinical evolution varies from asymptomatic and mild cases to moderate and severe cases. One of the most important measures was the reorganization of the regulation of access to assistance. Thus, general objective of this study was to analyze the effect of reorganizing the regulation of access to care for patients with Covid-19 on Covid-19 mortality in the fixed pre-hospital emergency network in Salvador/BA between March 1, 2020 and 31 December 2021. To this end, an assessment of the implementation of this reorganization was carried out, with an emphasis on its effects on mortality from Covid19. To obtain the necessary information, official documents were analyzed and interviews were carried out with key informants (managers and regulatory professionals). Furthermore, a monthly time series study was carried out on the following indicators: number of clinical and ICU beds, Occupancy Rate of clinical and ICU beds, Mortality Rate, Fatality Rate and Regulation Time, using secondary data from the SUREM and the SMS Salvador Covid-19 Transparency Portal. Among the main findings: based on Municipal Decrees and Technical Notes, Salvador's municipal health network was reorganized to combat Covid-19, investing in structure and processes and monitoring results. We sought to speed up the regulatory act, because, while the transfers of patients with mild cases of Covid-19 were quick (time lessthan a day), severe cases, which required an ICU bed, had an average time of regulation exceeding one day, especially during periods when ICU bed occupancy rates were high. This high occupancy rate increased the time required for patients to be regulated, which consequently increased the mortality rate in the UPA. The reorganization carried out included the expansion of the installed capacity of beds for Covid-19, the creation of “griparios” and Ventilatory Support Units and the centralization of regulation in SMSSalvador. This study therefore suggests that reorganizing the regulatory process saved lives. New studies, however, must be carried out in order to measure the magnitude of the influence of the reorganization of patient regulation on Covid-19 mortality, given that the variable of vaccination against Covid-19, which had significant effects on mortality, does not was included in this study.