Repensando as Reuniões de Morbilidade e Mortalidade em Cirurgia
DOI:
https://doi.org/10.20344/amp.23724Palavras-chave:
Especialidade Cirúrgicas/educação, Governação Clínica, Melhoria da Qualidade, Morbilidade, Mortalidade, Portugal, Procedimentos Cirúrgicos Operatórios/educação, Segurança do Doente, Serviço de Cirurgia/organização e administraçãoResumo
As reuniões de morbimortalidade foram idealizadas como fóruns estruturados, sem culpabilização, para melhorar os resultados cirúrgicos através da reflexão. No entanto, em Portugal, não foi encontrada evidência publicada que descreva normas estruturadas para as reuniões de morbimortalidade; as observações disponíveis sugerem que as práticas permanecem fragmentadas, não normalizadas e pouco integradas na gestão clínica. O objetivo desta revisão é analisar criticamente o modelo atual de reuniões de morbimortalidade nos serviços cirúrgicos portugueses e propor reformas fundamentadas na evidência, inspiradas em modelos internacionais eficazes. Esta revisão narrativa integra evolução histórica, normas nacionais e experiências internacionais como o National Confidential Enquiry into Patient Outcome and Death (Reino Unido), o National Surgical Quality Improvement Program (Estados Unidos da América) e o Australian and New Zealand Audit of Surgical Mortality, identificando falhas e propondo uma estratégia multidimensional de reforma. Apesar de existirem referências a morbimortalidade nas regulamentações portuguesas, não existe um guia nacional sobre seleção de casos, condução das reuniões ou implementação de medidas corretivas. Barreiras culturais como o medo de culpabilização e dinâmicas hierárquicas dificultam o ambiente de segurança psicológica. Em contraste, os modelos internacionais oferecem abordagens estruturadas, auditadas e orientadas por dados. Recomenda-se a criação de diretrizes nacionais, benchmarking ajustado ao risco, participação multidisciplinar, tempo protegido, e sistemas formais de seguimento. Propõem-se ainda a integração do resultado de autópsias, partilha interinstitucional e publicação de resultados. As reuniões de morbimortalidade em Portugal devem evoluir de rituais simbólicos para instrumentos efetivos de segurança do doente e melhoria contínua, exigindo liderança regulatória, mudança cultural e reformas estruturais alinhadas com os padrões internacionais.
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