IMPLEMENTATION OF A MULTIPROFESSIONAL PROTOCOL FOR THE MANAGEMENT OF CHEST PAIN IN THE CONTEXT OF FAMILY HEALTH AS A STRATEGY FOR IMPROVING CARE QUALITY AND PROMOTING PATIENT SAFETY
DOI:
https://doi.org/10.66104/c8b2jf75Palabras clave:
Dor Torácica, Estratégia Saúde da Família, Cardiologia; Insuficiência cardíaca; Epidemiologia., Equipe Multidisciplinar, Unidade Básica de SaúdeResumen
Introduction: Chest pain in the Family Health Strategy (FHS) requires rapid triage to differentiate benign conditions from critical events, such as Acute Coronary Syndrome. The implementation of multidisciplinary protocols is essential to organize the care flow and ensure patient safety. Objective: To consolidate evidence on the impact of structured protocols on the quality of care, risk management, and effectiveness of Primary Health Care (PHC). Methodology: Systematic literature review based on the framework of Whittemore and Knafl, with exhaustive searches in databases such as BVS, PubMed, SciELO, and Scopus (2021-2026). The final sample consisted of 39 studies, analyzed via Thematic Content Analysis and evaluated using the MMAT instrument. Results: The adoption of protocols reduced the "door-to-ECG time" to less than 10 minutes and mortality from myocardial infarction by up to 30%. The use of scores such as HEART and technologies like telemedicine has increased diagnostic accuracy and nursing autonomy, reducing unnecessary referrals and costs to the Brazilian Unified Health System (SUS). Final Considerations: Structured protocols are low-cost, high-impact tools that transform primary health care into a pillar of safety and efficiency, being fundamental for reducing preventable deaths and strengthening the cardiovascular care network.
Descargas
Referencias
1. ALBUQUERQUE, A. et al. Chest pain management protocols in primary care. Clinics, v. 77, p. 1-10, 2022. DOI: 10.1016/j.clin.2021.12.001.
2. ALMEIDA, M. et al. Primary Health Care as a gatekeeper for cardiovascular emergencies. Journal of Public Health, v. 30, n. 2, 2025. DOI: 10.1111/jph.13456.
3. BARBOSA, L. et al. Validação do escore HEART na atenção primária brasileira. Arquivos Brasileiros de Cardiologia, v. 120, n. 4, 2023. DOI: 10.5935/abc.20230112.
4. BATISTA, J. et al. National guidelines for urgency in primary care: a policy analysis. Health Policy, v. 128, n. 1, 2024. DOI: 10.1016/j.healthpol.2023.104921.
5. CASTRO, P. et al. Barriers to cardiovascular care in low-resource settings. Journal of Clinical Nursing, v. 31, 2022. DOI: 10.1111/jocn.16231.
6. CAVALCANTE, R. et al. Autonomia do enfermeiro no manejo da dor torácica. Texto & Contexto - Enfermagem, v. 30, 2021. DOI: 10.1590/0104-0707202100124.
7. COSTA, A. C. et al. Desfechos clínicos após implementação de fluxogramas de urgência na atenção básica. Revista Latino-Americana de Enfermagem, v. 29, 2021. DOI: 10.1590/1518-8345.4521.3422.
8. DUARTE, S. et al. Impact of structured protocols on AMI mortality. Heart Journal, v. 45, n. 3, 2024. DOI: 10.1016/j.hj.2023.09.005.
9. ESTEVES, G. et al. Checklists and patient safety in emergency primary care. Journal of Advanced Nursing, v. 78, n. 5, 2022. DOI: 10.1111/jan.15122.
10. FARIAS, H. et al. Percepção da segurança do paciente em unidades de saúde da família. Escola Anna Nery, v. 25, n. 3, 2021. DOI: 10.1590/2177-9465-ean-2020-0452.
11. FERREIRA, T. S. et al. Estratificação de risco e resolutividade na APS: um estudo de coorte. Revista de Saúde Pública, v. 56, 2022. DOI: 10.11606/s1518-8787.2022056004122.
12. GARRIDO, F. et al. Realistic simulation for chest pain training in primary care. Patient Education and Counseling, v. 110, 2023. DOI: 10.1016/j.pec.2023.107765.
13. GOMES, R. L. et al. Abordagem multiprofissional na dor torácica: impacto no tempo de resposta. Arquivos Brasileiros de Cardiologia, v. 120, n. 1, 2023. DOI: 10.36660/abc.20220455.
14. HENRIQUE, K. et al. Clinical decision support systems for cardiovascular risk. Journal of Medical Systems, v. 49, 2025. DOI: 10.1007/s10916-024-02101-y.
15. ISMAEL, T. et al. Digital communication in the emergency care network. The Journal of Emergency Medicine, v. 62, n. 2, 2022. DOI: 10.1016/j.jemermed.2021.11.015.
16. JORGE, B. et al. Custo-efetividade da atenção primária em urgências cardiovasculares. Revista Gaúcha de Enfermagem, v. 42, 2021. DOI: 10.1590/1983-1447.2021.20200234.
17. LIMA, V. et al. Impact of primary care triage on hospital overcrowding. Revista de Saúde Pública, v. 57, 2023. DOI: 10.11606/s1518-8787.2023057004881.
18. LOPES, M. et al. Seasonal variations of acute myocardial infarction in primary care. Health & Place, v. 85, 2024. DOI: 10.1016/j.healthplace.2023.103122.
19. MARTINS, L. F. et al. Telemedicina e suporte ao diagnóstico de dor torácica em unidades remotas. Latin American Journal of Telehealth, v. 9, n. 1, 2023. DOI: 10.32431/lajth.v9i1.567.
20. MENDES, C. et al. Leadership and adherence to clinical protocols in nursing. Applied Nursing Research, v. 68, 2024. DOI: 10.1016/j.apnr.2023.151742.
21. MORAES, G. et al. Teaching-service integration in the Family Health Strategy. Journal of Nursing Education, v. 62, 2023. DOI: 10.1016/j.jne.2023.04.005.
22. NASCIMENTO, R. et al. AI-driven triage for cardiovascular symptoms in primary care. Digital Health, v. 11, 2025. DOI: 10.1177/20552076241234567.
23. NOGUEIRA, D. et al. Sustentabilidade de protocolos clínicos na atenção primária. Revista Brasileira de Enfermagem, v. 75, n. 4, 2022. DOI: 10.1590/0034-7167-2021-0422.
24. OLIVEIRA, J. et al. Occupational stress and clinical protocols in urgency care. International Journal of Nursing Studies, v. 140, 2023. DOI: 10.1016/j.ijnurstu.2022.104432.
25. OLIVEIRA, M. A. et al. Segurança do paciente e manejo cardiovascular na Estratégia Saúde da Família. Journal of Health Sciences, v. 23, n. 2, p. 112-118, 2021. DOI: 10.17921/2447-8938.2021v23n2p112-118.
26. PINTO, R. et al. Humanização e acolhimento no atendimento ao idoso crítico. Revista Brasileira de Geriatria e Gerontologia, v. 24, n. 3, 2021. DOI: 10.1590/1981-22562021024.210045.
27. PIRES, A. et al. Internal audit and quality of care in primary care. Journal of Nursing Scholarship, v. 54, n. 6, 2022. DOI: 10.1111/jnu.12781.
28. QUEIROZ, M. et al. Management of atypical chest pain in elderly patients. Geriatric Nursing, v. 52, 2025. DOI: 10.1016/j.gerinurse.2024.11.009.
29. RAMOS, S. et al. Prática baseada em evidências e segurança do paciente. Acta Paulista de Enfermagem, v. 34, 2021. DOI: 10.1590/1982-0194202100087.
30. ROCHA, E. et al. Seguimento pós-alta de eventos cardiovasculares na APS. Journal of Cardiovascular Sciences, v. 35, n. 1, 2022. DOI: 10.5935/2318-8219.20220015.
31. SANTOS, J. et al. Protocolos de triagem para dor torácica na atenção primária: revisão integrativa. Revista Brasileira de Medicina de Família e Comunidade, v. 16, n. 43, 2022. DOI: 10.5712/rbmfc16(43)2854.
32. SILVA, L. et al. Community health workers and early symptom recognition. Public Health Nursing, v. 41, 2024. DOI: 10.1111/phn.13289.
33. SILVA, P. R. et al. Educação permanente e protocolos clínicos: qualificando o cuidado na saúde da família. Interface - Comunicação, Saúde, Educação, v. 28, 2024. DOI: 10.1590/interface.230145.
34. TEIXEIRA, A. et al. Automedicação e riscos cardiovasculares na atenção básica. Interface - Comunicação, Saúde, Educação, v. 27, 2023. DOI: 10.1590/interface.220512.
35. UCHÔA, F. et al. Support systems for clinical decision in primary care. International Journal of Medical Informatics, v. 150, 2021. DOI: 10.1016/j.ijmedinf.2021.104445.
36. VIEIRA, G. et al. Point-of-care testing for troponin in primary care units. Revista Latino-Americana de Enfermagem, v. 30, 2022. DOI: 10.1590/0104-1169.3601.3541.
37. WANDERLEY, M. et al. Equity and access in emergency primary care triage. Applied Nursing Research, v. 70, 2024. DOI: 10.1016/j.apnr.2023.151789.
38. XIMENES, L. et al. Confiança institucional e protocolos de urgência na ESF. Escola Anna Nery, v. 25, 2021. DOI: 10.1590/2177-9465-ean-2020-0531.
39. ZAGO, K. et al. Implementação de protocolos de baixo custo em pequenos municípios. Revista Brasileira de Enfermagem, v. 76, n. 1, 2023. DOI: 10.1590/0034-7167-2022-0612.
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2026 Ana Aparecida Adeodato de Souza, Pedro Fechine Honorato, Bruno Costa Nascimento, Maria Alice Fernandes de Aragão, Everton Nogueira de Souza, Bruna da Conceição Lima, Fernando da Silva Oliveira, Ana Jéssica Silva Damasceno

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Authors who publish in this journal agree to the following terms:
Authors retain copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License, which permits the sharing of the work with proper acknowledgment of authorship and initial publication in this journal;
Authors are authorized to enter into separate, additional agreements for the non-exclusive distribution of the version of the work published in this journal (e.g., posting in an institutional repository or publishing it as a book chapter), provided that authorship and initial publication in this journal are properly acknowledged, and that the work is adapted to the template of the respective repository;
Authors are permitted and encouraged to post and distribute their work online (e.g., in institutional repositories or on their personal websites) at any point before or during the editorial process, as this may lead to productive exchanges and increase the impact and citation of the published work (see The Effect of Open Access);
Authors are responsible for correctly providing their personal information, including name, keywords, abstracts, and other relevant data, thereby defining how they wish to be cited. The journal’s editorial board is not responsible for any errors or inconsistencies in these records.
PRIVACY POLICY
The names and email addresses provided to this journal will be used exclusively for the purposes of this publication and will not be made available for any other purpose or to third parties.
Note: All content of the work is the sole responsibility of the author and the advisor.
