ABC | Volume 111, Nº2, August 2018

Original Article Marcolino et al Satisfaction of emergency physicians Arq Bras Cardiol. 2018; 111(2):151-159 128 000 km², with around 1 594 000 inhabitants. That region differs from the rest of the Minas Gerais state, as it has a human development index close to those of the poorest states in Northeastern Brazil. 10 Similar to the rest of Brazil, specialized healthcare is concentrated in the largest municipality of the region, Montes Claros, and mortality from AMI is very high, 11 motivating the implementation of a project to organize the AMI system of care in the region. This study aimed at assessing the satisfaction of physicians with the structure of care and diagnosis of public emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care in the region. Methods Organization of the Care Network for Emergency Services in the Northern Region of Minas Gerais The care network for emergency services in the Northern Region of Minas Gerais is an integrated network that comprises a regional mobile emergency care service (SAMU, in Portuguese), and micro- and macroregional hospitals. The “Projeto Estadual de Redes de Atenção” has categorized the hospitals according to their expertise and their response to two major problems that impact the potential years of life lost: severe trauma and cardiovascular and cerebrovascular emergencies. 12 SAMU has a macroregional scope, attending 86 of the 89 municipalities of the region, with 7 advanced ambulances (with ambulance driver, nurse and physician), 40 basic ambulances (with an ambulance driver and two nursing technicians) and a rapid interception vehicle. There is only one regulatory center. The regional hospitals are as follows: • Level I hospitals: provide several “high-complexity” procedures, such as neurosurgery, vascular surgery and interventional angiography, resuscitation room (red) with mobile radiography and ultrasound, computerized tomography, operating rooms for complex surgeries, heliport with exclusive access, trauma surgical team, transfusion unit, and several differentiated and special hospital beds at intensive care and coronary care units. • Level II hospitals: located in municipalities with more than 200 000 inhabitants, similar to level I hospitals, except for the absence of angiography, vascular surgery and coronary care units. • Level III hospitals: located in municipalities with more than 100 000 inhabitants, destined to patients’ stabilization until definite transfer to a level I or level II hospital. Their minimum requirements are: emergency healthcare professionals, general surgery, radiology, anesthesiology, transfusion unit and general intensive care unit. • Level IV hospitals: located in areas that lack healthcare, which are more than 60 minutes away from a reference microregional hospital. 12,13 Implementation of the AMI System of Care in the Northern Region of Minas Gerais: Minas Telecardio II Project Minas Telecardio II Project was aimed at implementing and assessing the AMI System of Care in the Northern Region of Minas Gerais and at evaluating its impact on AMI mortality. It was a quasi-experimental study conducted from June 19, 2013 to May 19, 2015 in three steps: (i) establishment of the baseline; (ii) implementation of the AMI Sysem of Care with the mobile tele-electrocardiology system and the new operational flow, in addition to training healthcare professionals of the pre-hospital and hospital emergency services of the region; and (iii) reassessment of the quality indicators for the care provided after the implementation. All phases have been concluded and detailed previously. 14 The satisfaction of the group of physicians with the structure of care provided to patients with cardiovascular diseases was one of the aspects assessed in the study baseline, being the object of this article. Study design and satisfaction assessment This is a cross-sectional study. Emergency physicians from SAMU and from the level II, III and IV regional hospitals that comprise the emergency network of the Northern Region of Minas Gerais participated in this study. The eligibility criteria were as follows: i) be a regular registered member at the Regional Council of Medicine; ii) provide care at SAMU and/or emergency centers of Northern Region of Minas Gerais’ regional hospitals. The research team visited all advanced ambulances of SAMU in the region. Due to the long distance between the regional hospitals, which would hinder the evaluation of the physicians’ satisfaction in all of them, a random selection was performed by use of probabilistic simple random sampling. Thus, a numerical list was created, and the municipalities were selected, so that there would be one level III or IV hospital per microregion in the sample. Two level III hospitals and five level IV hospitals were selected. Assessment of the physicians’ satisfaction was performed with the CARDIOSATIS-Team scale, specifically developed to evaluate physicians’ satisfaction with the care provided to cardiovascular emergencies. It follows the international standards for the creation of tools and has good validity and reliability for the Brazilian context. 15-17 It is a self‑administered tool with 11 closed items and 3 open questions. The open questions include information on access to and interest in professional qualification. The closed items include overall satisfaction and two domains: i) satisfaction with the care provided; and ii) satisfaction with the structure of care and diagnosis . Each item is assessed by use of a five-point Likert scale, where a score of 4 or 5 indicates higher satisfaction, a score of 1 or 2 indicates dissatisfaction, and a score of 3 indicates average satisfaction with the item assessed (‘neither’). Each participant received a questionnaire with the scale and filled it out individually, after providing written informed consent. Those procedures were supervised by a previously trained team, which was available for clarifications, checking the professionals’ understanding and answering all their doubts. 152