Safety and quality in Brazilian hospitals

Error reduction in care performed by the health team has become a global concern. Population-based Studies of a number of nations around the world have consistently demonstrated unacceptably high error rates and avoidable deaths1.

Unsafe healthcare results in significant morbidity and deaths, additional expenditures for the maintenance of patients in health systems and represent a major concern in today's world.

Studies in hospitals in various countries show the association between the occurrence of adverse events (incidents that cause damage to patients) and increase in hospitalization, the mortality and hospital cost. An example of this reality are the estimates of developed countries indicating that at least 5% of patients admitted to hospitals acquire an infection2.

In Brazil, recent research in three teaching hospitals in Rio de Janeiro identified an incidence of 7.6% of patients with adverse events, being 66.7% of those with avoidable adverse events2.

This context has encouraged throughout the world in the last decade, the promotion of different initiatives to ensure safer healthcare. Among them is the creation of programs for the monitoring of quality and safety, based on indicators of quality of healthcare, which is considered by the World Health Organization as the degree to which healthcare services for individuals and populations increase the likelihood of the desired results and consistent with the current scientific knowledge3.

According to the Hospital Information System of the Unified Health System (SUS), in 2011 occurred in all of Brazil 11,117,837 hospital admissions, with an estimate of 844,875 (7.6 %) adverse events. Of these, an estimated 563,575 (66.7%) were preventable events, which led to the fatal outcome of almost 40% of cases4.

In the same year, in Rio de Janeiro, were deployed, in the federal network hospitals, the six major international goals for patient safety as defined by the World Health Organization. Namely, correctly identify the patients; enhance institutional communication; increase the security in the handling of high-risk medicines; ensure the correct surgery patient right and correct location; reduce the risk of infections; and reduce the risk of bed falls.

For the implementation of these measures was established, starting in 2012, the Ministry of Health, Technical Chamber for Quality and Patient Safety compulsorily existent in all government hospitals4.

Another national initiative is the Brazilian Program of Patient Safety, with multiple goals between them the goal Save 50,000 lives and prevents injuries to 150,000 patients which reproduces, in the country, the advances already achieved in other international programs, but with a big difference, become the only platform national database structured information on patient quality and safety. For this reason, the Epimed Monitor system is used, to manage in real time via web clinical and epidemiological information of high complexity patients in intensive care units. The system, developed by critical care physicians (now present in 260 intensive care units in 23 states in Brazil), it was the tool chosen by the Brazilian Patient Safety for data collection and monitoring of performance indicators with main focus on infections related to healthcare in the participating institutions.

Both the Ministry of Health and other institutions, responsible for the most diverse programs, consider that the most important aspect when it comes to safety in the healthcare field is to prevent harm to patients during their treatment. It is known that the problems are not just a random number, isolated events, or unconnected. It is known that the errors in healthcare systems are caused by imperfect and often have common causes that can be generalized and corrected. Although each case is unique, there is the likelihood of similarities and patterns of risk factors that may go unnoticed, when the incidents are not reported and analyzed 5.

Hence the importance of risk management in hospitals, as another tool in the search for quality and safety. The objective of risk management is to notify, treat and monitor the risk factors to prevent adverse events that may cause damage to people and to the hospital. Risk management becomes one of the main strategies to identify failures and to use them in order to improve the performance of healthcare organizations 4.

However, it is known that the professionals and health organizations are at an early stage in understanding and improving patient safety. Thus, the administrative, doctor and nursing leadership, committed, involved and concerned about patient and client safety need to take responsibility for safe and effective care.

All need to be encouraged regarding commitment to transparency in healthcare services and accountability with improved quality.

All need to admit that safety, above all, is a behavior that must be transformed into an institutional culture.


Lolita Dopico da Silva
Associate Editor


1.Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academy Press; 1999.

2.World Alliance for Patient Safety. Forward Programme 2005. Geneva (Swi): World Health Organization; 2004.

3.Reason J. Human error. Cambridge (UK): Cambridge University Press; 1990.

4.Agência Nacional de Vigilância Sanitária (Br). Gerenciamento de riscos. Brasília (DF): ANVISA; 2011.

5.Vincent C. Segurança do paciente: orientações para evitar eventos adversos. São Caetano do Sul (SP): Yendis; 2009.