[Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy].
OBJECTIVE
To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process.


METHODS
A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff training.


RESULTS
Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in the post-intervention period with a total of 1246 and 1191 observations respectively. Among the indicators related to the global population, there was a significant improvement in chest x-ray control, multidisciplinary rounds and shift changes as well as in compliance with these decisions. Indicators related to the population under mechanical ventilation, obtained by direct observation at bedside, showed a significant improvement in the compliance with the tidal volume of 6-8 mL/Kg, plateau pressure <30 cmH₂O, adequate mechanical ventilation alarm setting, mechanical ventilation humidification control, adequate humidification line exchange and orotracheal tube position. Among the mechanical ventilation indicators collected through the physiotherapy records, there was significantly improved compliance with the predicted tidal volume registry and cuff pressure registry. There was a significant reduction in the number of adverse events. There was no impact on intensive care unit mortality, length of stay, duration of mechanical ventilation and ventilator-free days.


CONCLUSIONS
It is possible to measure the quality of physiotherapy care using indicators of quality control. The implementation of care protocols and training of the professionals can improve team performance.
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Walkyria Araújo Macedo
WA
Pinto
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Heloisa Baccaro
HB
Rossetti
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Abigail
A
Araújo
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
José Jonas
JJ
Spósito
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Hellen
H
Salomão
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Simone Siqueira
SS
Mattos
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Melina Vieira
MV
Rabelo
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Flávia Ribeiro
FR
Machado
D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004496:Education, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000193:education / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care