Efeitos adversos em saúde e a atuação médica: perspectivas, impactos e estratégias de prevenção

Abstract

Introduction: Medical error is a historically taboo subject, but in the last decade, it has gained notoriety due to its high morbidity and mortality (qualifying it as one of the leading causes of death in Brazil) and the psychosocial impact on professionals. Patient safety requires a systemic approach, recognizing human fallibility and the importance of a just institutional culture. Objective: To analyze the conceptual perspectives, impacts (physical, psychosocial, and economic), and prevention strategies of Adverse Health Effects (AEs) related to medical practice. Methodology: Narrative literature review and Systematic Review of Reviews (Umbrella Review) using the PubMed and BVS databases, filtered for the last 5 years, covering Portuguese, Spanish, and English languages. The study synthesized evidence on the impact of AEs on multiple victims (primary to quaternary) and the effectiveness of prevention and safety culture promotion strategies. Results: The narrative and systematic review confirmed the high incidence and preventability of AEs in Brazil (ranging from 5.7% to 14.2%), resulting in a substantial economic impact (estimated at R$ 10.61 billion in hospital expenses). The impact on professionals ("second victim") is severe; burnout is a predictor of care failure, increasing the probability of serious errors by 2.2 times. The most effective prevention strategies are multimodal, focusing on: Just Culture, Active Surveillance (Global Trigger Tool), Technology (CDSS/CPOE), Standardization (Checklists), and Second Victim Support Programs (SSVP). However, there is a scarcity of high-certainty evidence regarding the comprehensive impact of AEs, especially in the Brazilian context. Conclusion: Patient safety is inseparable from professional health. The effective implementation of policies requires harmonizing professional accountability rigor with psychological support and transforming the punitive institutional culture. Critical gaps persist in quantifying the total impact of AEs and evaluating interventions adapted to the context of the Unified Health System (SUS), highlighting the urgent need for more Brazilian primary studies.