Qualificação do cuidado ao paciente com síndrome coronariana aguda por meio da implementação de um fluxo assistencial: avaliação dos indicadores temporais em hospital público

Abstract

Objective: To evaluate the effects of implementing a care pathway on the quality of care for patients with acute coronary syndrome in a public hospital. Method: The study was conducted in three phases: the first was quantitative, retrospective, and documentary; the second was methodological and involved the development and content validation of a care pathway for patients with acute coronary syndrome; and the third was exploratory, longitudinal, and prospective. The research was conducted at a teaching hospital in southern Brazil between January 2024 and February 2026 and involved medical record review, pathway validation by experts, and assessment of nursing professionals. Data were subjected to descriptive and inferential statistical analyses, and all ethical principles for research involving human participants were followed. The study was based on Avedis Donabedian’s Structure–Process–Outcome model, adopted as the theoretical framework for understanding quality of care and interpreting the findings. Results: Before pathway implementation, 232 medical records were analyzed, with a predominance of male patients (72%), a mean age of 64.5 years (SD = 11.8), and higher proportions of recorded comorbidities involving circulatory diseases (44.0%) and endocrine, nutritional, and metabolic diseases (36.3%). Mean care time was 69 minutes (SD = 43.3), with substantial variability. The hospital had no structured care pathway for patients with acute coronary syndrome, and care was provided by the on-call cardiology team without defined protocols or specific training. The care pathway was developed, underwent face and content validation by experts, and was implemented after staff training. After one year of follow up, 114 medical records of patients treated following pathway implementation were analyzed, and differences in group composition regarding sex and race/color were observed. Mean care time decreased to 48.6 minutes (SD = 33.4), representing a reduction of approximately 20 minutes and lower variability, with a statistically significant difference between periods. Door-to-balloon time was assessed only after pathway implementation because records from the preceding period were insufficient; the mean was 62.2 minutes (SD = 34.5) and the median was 57 minutes, with 82.4% of patients having a door-to-balloon time of up to 90 minutes and 92.3% of up to 120 minutes, considering cumulative percentages, in accordance with national and international guideline recommendations. Field diary entries indicated favorable perceptions regarding pathway use. The recorded impressions indicated staff satisfaction with standardized care, although difficulties related to physical infrastructure and administrative demands were reported. Periodic training was also suggested, and concerns were raised regarding seasonal variation in service demand and changes in team composition. Conclusion: Implementation of the care pathway was accompanied by reduced care time and favorable door-to-balloon time performance in the post-implementation period. The findings suggest potential for improving the care process, considering the limitations of the before-and-after design. The research provides a validated and implemented pathway adapted to the institutional context, as well as information to support monitoring of time indicators.