Avaliação das práticas de regulação assistencial do Núcleo Interno de Regulação como mecanismo de concreção ao direito à saúde da gestante: o caso da Maternidade Escola Assis Chateaubriand

Abstract

This work evaluates whether the operational tasks performed by the Internal Regulation Center at the Assis Chateaubriand Maternity School are in accordance with a true approach to the rights of pregnant women who search it, either due to pregnancy complications or due to delivery. The research enterprise focuses on the phenomenon of maternity overcrowding, which ends up by establishing care regimes for the Urgency and Emergency Unit related to restrict and unattended cases. As a basis for the evaluation process, aspects related to constitutional and fundamental rights to health were investigated such as health policies, health as regulated by the Unified Health System, National Hospital Care Policies, all overseen by the Internal Regulation Center. Research of a qualitative approach is descriptive. Field research and analysis of documents were carried out. Techniques for collection of main data were observation and interview. In documentary research, documents produced and used by professionals from the Internal Regulation Center were analyzed. Seven professionals from the study center participated in the survey, as interviewees. In the field observation stage, visits were made to the maternity hospital on different operating occasions: under conditions of full care, restrictive care and no-care. The study reveals that the Internal Regulation Center of the Assis Chateaubriand Maternity School does not take control of all beds, thus it does not centralize or standardize the way of meeting the demand for new admissions and internal transfers between units, which is its regular function. Although the waiting time for a bed in the maternity hospital is not very high, as shown at the Post-Anesthetic Recovery Room (21min04s), the Normal Birth Center (21min13s) and the Urgency and Emergency Unit (43min15s), it appears that care regimes of a restrictive or unattended nature in the emergency unit are a routine practice and result mainly from the impossibility of receiving more newborns in the Neonatal Intensive Care Unit, due to their overcrowding and the unavailability of medical oxygen distributing outlets. At the neonatal unit there were, on average, 71 monthly admissions of newborns, with an average length of stay of 11.91 days, which evidently demonstrates that the 21 available intensive care beds are insufficient. The regulation center, with the objective of reducing the overcrowding at the Intensive Care Unit and facilitating women's access to the maternity, resorts to the strategy of transferring newborns and babies to other hospitals. In addition, it also performs inter-hospital transfers of obstetric cases. However, these transfers did not prevent the Urgency and Emergency Unit from operating in restrictive and no-care mode. The fact is that women with pregnancy problems or in the process of parturition have not unconditionally guaranteed their right to health at the Assis Chateaubriand Maternity School, conditioning their constitutional rights to the number of patients who occupy the neonatal intensive care unit at a given point and to available oxygen distributing outlets, a practice that violates the citizen's right to health, as proclaimed in the Federal Constitution of 1988. The investigation leads to the understanding that the Internal Regulation Center of the Assis Chateaubriand Maternity School is not complying with regulatory practices to guarantee the full right to health for pregnant women, when the Urgency and Emergency Unit operates in restrictive care or no-care mode.