Structuring the Regional Reference System for Hospital Care of medium and high complexity in the HCFMRP-USP

Abstract

The hierarchizing of the fl ow of patients is the predominant factor in the Sistema Único de Saúde (SUS). In 2000, the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto - São Paulo University (HCFMRP-USP) decentralized the scheduling of fresh elective consultations and implanted Centers for Regulation of Consultations in the Regional Health Departments (DRS) under its area of coverage. The objective was to evaluate the impact of the implementation of the Centers for Regulation on the patient fl ow organization and the effectiveness of the hospital as an out-sourced reference. As methodology, it was seen that the degree of advantages of the program offered the DRSs, period 2000 to 2005, and the coherence between the case complexities of those referred cases with an out-sourced role by the hospital. No DRS made use of the totality of beds available. The average rate of appointments and absenteeism (66,2% and 22,4%, respectively) did not change in the period. Of the total number of beds offered only 37,9% were absorbed by the hospital system. Low complexity represented 41,5% (2000), and 39,3% (2005); the coherence of the referrals with access protocols was 74% (2000) and 75,5% (2005). It can be concluded that the decentralization of the HCRP schedule did not present signifi cant improvements in bed occupancy and the consolidation of the hospital as an out-source reference, and that investment is necessary to capacitate administrators to optimize services provided by the health network.