Lean Practices and Assistive Technology in Emergency Care Units (UPA): Improve the Service of People With Disabilities

Introduction

Brazilian healthcare network, SUS (Universal Health System), is based on the United Kingdom National Health System (NHS) and is composed of primary, secondary and tertiary care facilities. Primary care facilities are responsible for the promotion of health within the population through the action of family doctors, nurses and community agents. Those professionals have the responsibility to take care of the family before they get sick and, if monitor them, providing necessary assistance before the onset of any disease and worsening. Secondary care units contemplate specialized health services, like emergency care units and polyclinics. Emergency care units are institutions designed to provide the assistance for patients that are affected by some illness and need medical evaluation or treatment. Such type of medical care sometimes are low risk situations like throat inflammation and sometimes are patients in need of a hospitalization but will have the firs care in emergency care units and them be transferred to a specialized unit, a hospital. Hospitals are part of the tertiary care facilities and are designed to answer for complex and expensive care, consisting of specialized facilities with specialized professionals.

According to the Ministry of Health (MS, 2020), the Emergency Care Unit (UPA 24h) is part of the Emergency Care Network (RAE). The objective is to concentrate health care of intermediate complexity, composing a network organized together with primary care, hospital care, home care and the Mobile Emergency Care Service - SAMU 192.

The 24-hour UPA offers a simplified structure, with x-ray, electrocardiography, pediatrics, an examination laboratory and observation beds. If necessary, the patient can be referred to a hospital in the health network for a highly complex procedure. Emergency Care Units were implemented in 2007, initially in the Southeast region, and in 2016 there were 446 emergency care units considering all regions. Currently, there are 620 emergency care units in construction, indicating an expectation of expansion. Federal funding was a strong inducer of the implantation. The states planned their emergency care units, but the existence of direct negotiation between the municipalities and the Union contributed with the significant number of emergency care units built that do not work (O´Dwyer G. et al., 2017). Also, the purpose of many UPAS is diverted with inpatient services and unforeseen medical specialties. The emergency care units (24 h UPA) have been designed to UPAs are fundamentally serve urgencies and emergencies and are structured with medical services, examination rooms, x-rays, pharmacy, fracture immobilization room, electrocardiography room, observation room and material collection. The basic purpose of a UPA is to keep patients under observation, for up to 24 hours, for diagnostic elucidation or clinical stabilization, and refer those who have not had their complaints resolved with a guarantee of continuity of care for hospitalization in back-up hospital services, through the regulation of care access.

Table 1 shows the size classification of the 24 h UPA versus recommended population according to Ordinance nº 10 of the Ministry of Health for the purpose of obtaining financing and resources.