IJCS | Volume 32, Nº6, November / December 2019

610 Table 2 - Comparison of the median length of stay at the CCU and hospital stay in the pre- and post-accreditation periods at a reference cardiology service. Salvador-Bahia, 2018 Variable Pre-accreditation Post-accreditation p value CCU length of stay General (median, IQR) 3 (2-4) 2.5 (2-4) 0.088 STEACS (median, IQR) 3 (2-4) 2 (2-4) 0.052 Non-STEACS (median, IQR) 3 (2-4) 3 (2-4) 0.427 Hospital length of stay General (median, IQR) 8 (5-12.25) 6 (4-11) 0.004 STEACS (median, IQR) 8 (5-10) 7 (4.75-12.50) 0.734 Non-STEACS (median, IQR) 8 (5-14) 6 (4-10) 0.001 Mann-Whitney test; IQR: interquartile range; CCU length of stay: length of stay in the Coronary Care Unit; STEACS: ST-segment elevation acute coronary syndrome; Non-STEACS: non-ST-segment elevation acute coronary syndrome. Leite et al. Accreditation in outcomes of patients with ACS Int J Cardiovasc Sci. 2019;32(6):607-614 Original Article Regarding the secondary outcomes, it was found that the type of clinical outcome most commonly presented in the sample was cardiorespiratory arrest (CRA) of any type, evolving to death or not (29 patients — 7.8%), followed by death (26 patients — 7%). Comparing the two periods, period 1 had a higher number of deaths than period 2 (14 and 12, respectively), but this data did not reach statistical relevance. (Table 3) By cross-comparing the data, it was found that mortality and cardiogenic shock were variables that showed a decrease in the number of cases between the pre- and post-accreditation period, but this data did not reach any statistical significance. Reinfarction, CRA (resulting in death or not) and combined outcomes showed an increase in the absolute number of cases in the comparison between the two periods analyzed, but this difference did not present a significant p-value. (Table 3) By analyzing the clinical outcomes correlated to the types of ACS, it was found that some outcomes increased and others decreased in frequency in the comparison between the pre- and post-accreditation periods, but this change is not statistically relevant. (Table 3) In themultivariateanalysisbymultiple linear regression, controlling for the variables of age, sex, systemic arterial hypertension, diabetes mellitus, dyslipidemia, previous acute myocardial infarction, previous coronary artery bypass grafting and type of ACS, the post-accreditation period was an independent predictor of reduced time of hospitalization (p = 0.041; B = 2.081; β = 0.105). By doing the same analysis for the hospitalization time at the coronary care unit, we found that accreditationwas not an independent predictor of this change in length of stay (p = 0.834 B = 0.086; β = 0.011). Discussion The accreditation process has a positive impact on the standardization of care offered to patients, generating a flow that results in faster and more effective practices, contributing to a better patient prognosis. 22 At Hospital Santa Izabel, where this study was conducted, the hospital accreditation process resulted in better health care processes and had a strong impact on the pursuit of patient safety. With regard to acute coronary syndromes (ACS), its line of care was devised by conducting analyses before the patient arrived at the hospital until their follow-up after discharge. Mortality and bleeding outcomes were established as indicators of the line of care, and these outcomes were adjusted by the GRACE score and the CRUSADE score obtained on admission to the coronary care unit. A set of measures were planned and implemented at the different phases of the line of care, such as taking joint actions with the Municipal Health Department and SAMU (Mobile Emergency Care Service), aiming at improving the time to the implementation of reperfusion in ST-segment elevation acute myocardial infarction. Another relevant aspect was the construction of a therapeutic plan for