O custo económico do cuidado de enfermagem ao utente paliativo em serviço de urgência

Introduction: Palliative Care comprises a set of principles of intervention in preventing suffering that accompanies the person in the experience of a disease that limits the quality and time of life. The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown, so its determination is considered the general objective of this study. Palliative care integration in health systems is recognized to prevent these admissions; a community support network can avoid and reduce costs, promoting health and quality of life gains. Methods: The study is divided into three stages, the first comprising the integrative literature review on the concept “avoidable urgency”, the second by obtaining consensus on the concept "avoidable urgency" using the Delphi Process and the third and last, through an observational, retrospective and analytical study encompassing the economic costs of nursing care to palliative patients in a hospital emergency department. Results: At RIL, we obtained contributions from 5 articles analyzed, which, associated with the Delphi Process carried out, allowed us to define the concept of avoidable urgency. From the study in a hospital context, we have a sample of 273 palliative users in preventable hospital admissions (76,3%,273,95%CI:71,7-80,8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 hours of complaints, mainly due to respiratory symptoms. These remained for approximately 24 hours in the general emergency department, totalling a median of €180.98 in costs per user admission. Extrapolating the data to the national reality, we could infer that the global costs incurred with avoidable emergencies (€5.558.804,16) could be reallocated to hiring 229 nurses (95%CI:216-243). Discussion: The results obtained can be read as contextualizing the evidence, with the limitation of small samples diversified and scarce studies, making comparative processes difficult. It was evident that with the savings assumed and extrapolated to the national context, it would be possible to hire the necessary number of nurses to complete and/or create the number of community support teams in palliative care lacking in Portugal and/or reinforce human resources of in-hospital palliative care support teams. Conclusions: There is an opportunity to increase results, manage resources and consolidate the integration of palliative care in health systems, assuming that its benefits are present, as this study was able to prove.