RESUMEN

OBJECTIVE: To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY: An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS: A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION: A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

OBJETIVO: Evaluar los incidentes de seguridad del paciente en los servicios de urgencias de nuestra región. MATERIAL Y MÉTODO. Estudio observacional en todos los servicios de urgencias hospitalarios del Servicio Murciano de Salud. Tras muestreo aleatorio sistemático, se recogieron datos durante la asistencia y una semana después por encuesta telefónica. La recogida de información se realizó tras formación previa, por trabajadores de cada servicio, siguiendo la metodología del Estudio Nacional sobre los Eventos Adversos ligados a la hospitalización –ENEAS– y el Estudio sobre Eventos Adversos en Urgencias –EVADUR–. Resultados. Se tomó una muestra de 393 casos, proporcional a las asistencias de cada hospital. En 10 casos (3,1%) el motivo de consulta fue un incidente de seguridad previo. En 47 pacientes (11,9%; 8,7-15,1%) se ha detectado al menos un incidente. En 3 casos ha habido 2 (total 50 incidentes). Respecto al impacto, el 51% de los incidentes causaron daño al paciente. Los eventos más frecuentes fueron la necesidad de repetir visita (9 casos) y el mal manejo del dolor (8 casos). En 24 casos (51,1%) la atención sanitaria no se vio afectada, en 3 casos requirió una prueba adicional, en 11 casos requirió nueva consulta y en 2 motivó el ingreso. Los factores causales más frecuentes están relacionados con la medicación (14) y los cuidados (12). El 60% se han considerado evitables. Conclusiones. Se ha obtenido una tasa de incidentes en Urgencias representativa de toda la comunidad autónoma. La inferencia de los resultados a la población significa que 12 de cada 100 pacientes atendidos en Urgencias tendrán un evento adverso, de los cuales 7 serán evitables

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATEIRAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the PATIENTS: The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable (AU)

Asunto(s)

RESUMEN

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATERIAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable.

Asunto(s)

RESUMEN

Objetivo. Identificar y compartir los mejores resultados entre hospitales respecto al proceso de atención de urgencias, detectar las prácticas que expliquen las diferencias e identificar buenas prácticas. Material y método. Ámbito: 7 hospitales de diferentes comunidades autónomas. Periodo de estudio: 2005-2007. Se definieron los criterios de comparabilidad asegurando la homotecia. Se seleccionaron 11 criterios, y se establecieron 7 indicadores para comparar los hospitales, analizándose los datos de los últimos 3 años, estableciendo el benchmark (servicio con los mejores resultados) entre los centros. Se elaboró un cuestionario sobre el proceso, sobre las etapas, los resultados y los procedimientos usados en cada etapa del proceso en cada centro. Resultados. Se ha comprobado la homotecia entre los 7 hospitales, identificándose algunas diferencias entre centros. Se han analizado 7 indicadores, correspondiendo a 1.526.890 pacientes atendidos en el periodo de estudio. Se ha identificado un benchmark, con los mejores resultados en 4 de los indicadores: porcentaje de ingresos desde urgencias del 8,3%, presión de urgencias del 56,14%, tiempo de estancia en urgencias, 2h y 20min, y porcentaje de pacientes con estancia de más de 24h, 0,05%. Se han analizado las diferencias en las etapas del proceso, los recursos y procedimientos utilizados en cada etapa en el centro benchmark con el resto que puedan explicar mejores resultados. Conclusiones. Se ha establecido un conjunto de indicadores para identificar el benchmark entre los servicios de urgencias. Con dichos indicadores se ha establecido el benchmark(AU)

Objective. To identify and to share the results among hospitals regarding the process of attention at the Emergency Unit, and to detect the practices that explain the differences. Material and method. Setting: 7 hospitals of different regions in Spain. Period of study: 2005-2007. Firstly the comparability criteria were defined assuring the homotecia in the «emergency process». In order to fulfil the study objectives, 11 criteria were selected and every center sent the information of each one. 7 indicators were identified to compare hospitals processes’. Data regarding all the attentions provided during the study period was analyzed, establishing the benchmark among the centers. Finally, a questionnaire was elaborated for the process analysis, considering all the stages of the process, the resources and the procedures used in every stage, to be fulfilled in each hospital. Results. The homotecia has been verified in the 7 hospitals, with some differences between centers. 7 indicators have been analyzed in the different hospitals, corresponding to 1 526 890 patients attended in the study period. A benchmark has been identified, with the best results in four of seven indicators: % of admissions from urgencies: 8.3%, emergency pressure: 56.14%, emergency length of stay: 2 hs 20min, and % of patients with length stay > 24h: 0.05%. Differences between the stages of the process, resources and procedures used in every stage in the benchmark center have been analyzed. Conclusions. A set of indicators to compare Emergency Departments has been identified, letting us establish the benchmark(AU)

Asunto(s)

RESUMEN

OBJECTIVE: To identify and to share the results among hospitals regarding the process of attention at the Emergency Unit, and to detect the practices that explain the differences. SETTING: 7 hospitals of different regions in Spain. PERIOD OF STUDY: 2005-2007. Firstly the comparability criteria were defined assuring the homotecia in the «emergency process¼. In order to fulfil the study objectives, 11 criteria were selected and every center sent the information of each one. 7 indicators were identified to compare hospitals processes'. Data regarding all the attentions provided during the study period was analyzed, establishing the benchmark among the centers. Finally, a questionnaire was elaborated for the process analysis, considering all the stages of the process, the resources and the procedures used in every stage, to be fulfilled in each hospital. RESULTS: The homotecia has been verified in the 7 hospitals, with some differences between centers. 7 indicators have been analyzed in the different hospitals, corresponding to 1,526,890 patients attended in the study period. A benchmark has been identified, with the best results in four of seven indicators: % of admissions from urgencies: 8.3%, emergency pressure: 56.14%, emergency length of stay: 2 hs 20min, and % of patients with length stay > 24h: 0.05%. Differences between the stages of the process, resources and procedures used in every stage in the benchmark center have been analyzed. CONCLUSIONS: A set of indicators to compare Emergency Departments has been identified, letting us establish the benchmark.

Asunto(s)

RESUMEN

Objetivo: Identificar los posibles eventos adversos que ocurren en un Servicio de Urgencias mediante la revisión de casos de pacientes que vuelven a consultar en el mismo. Método: Estudio retrospectivo de la información clínica de los pacientes que retornan a Urgencias en un plazo inferior a una semana, en octubre de 2006, con el fin de identificar problemas ocurridos en la primera asistencia. La revisión la realizaron médicos adjuntos del mismo servicio, previa medida de la fiabilidad, comprobando la concordancia interobservador. Para el contraste de proporciones se ha utilizado el test de chi cuadrado. Resultados: Se estudiaron 311 casos. De ellos, 203 casos (79,6%) acudieron no citados y por una causa relacionada con la primera visita. En el 83,7% de ellos la evolución fue mala. Se revisaron las causas de mala evolución, siendo la más frecuente la «evolución natural del proceso» con 75 casos (44,1%), seguida de problemas en el tratamiento con 73 (42,9%). Se valoró si hubo consecuencias para el paciente, evidenciándose en 36 casos (21,2%). De estos 36 casos, 11 se calificaron como evitables (30,5%) por los evaluadores y un 1% de fallos claros en la actuación en pacientes que retornaron a Urgencias. Resultados: En el apartado de si había habido un claro fallo en la primera actuación, a juicio de los evaluadores, se calificaron como tal 3 casos, dos con consecuencias para el paciente y uno, sin consecuencias. Conclusiones: En las condiciones del estudio, la evaluación interna de las reconsultas permite identificar los eventos adversos ocurridos y conocer sus causas. Esto podría facilitar el aprendizaje y la mejora de la cultura de seguridad (AU)

Objective: To identify potential adverse events that occur in an emergency department by reviewing cases of patients who make repeat visits. Method: A retrospective study of clinical data of patients returning to the emergency department within a period of less than one week in October 2006 with the aim of identifying problems that occurred in the first visit. The review was conducted by senior doctors of the same service who measured the reliability of the first intervention, by checking between observer agreement. The Chi square test was used to calculate the comparison ratios. Results: We studied 311 cases. Of these, 203 cases (79.6%) returned to the department without been given a previous appointment and for a reason connected with the first visit. The progress was poor in 83.7% of cases. We reviewed the causes of the poor outcomes, with the most frequent being "natural progress of the process" in 75 cases (44.1%), followed by problems in treatment in 73 cases (42.9%). The effects on the patient were evaluated, and it was shown that there were consequences for the patient in 36 cases (21.2%). Of these 36 cases, 11 were considered as avoidable (30.5%) by the evaluators and 1% of clear failures in performance in patients returning to emergency rooms. Results: In the part of if, in opinion of the evaluators, there had been a clear failure in the first performance zoned like such 3 cases, two with consequences for the patient and 1 without consequences. Conclusions: In the conditions of the study, the internal evaluation of the reconsultas allows to identify the adverse events occurred and know his causes. This could facilitate the learning and the improvement of the culture of security (AU)

Asunto(s)

RESUMEN

OBJECTIVE: To find the prevalence of tobacco dependency in our community and to identify tobacco consumption in our chronic patients. DESIGN: A crossover study. A descriptive analysis of the data. SETTING: A Health District. Mixed population, both urban and rural. PARTICIPANTS: A Health Survey which included 1,071 individuals (95% Confidence and 3% precision), selected by means of simple random sampling from the Municipal Census. MEASUREMENTS AND MAIN RESULTS: A 32.3% prevalence of tobacco dependency, greater among men (50.7%) than women (15.7%). Among the young, there is a marked tendency for the number of smokers to level out between the sexes. 15.6% of smokers consume more than 24 cigarettes per day. Between 15 and 20% of patients suffering hypertension, diabetes, hypercholesterolaemia and the effects of ischaemic cardiopathy, along with 25% of those who had suffered a CVA and almost 40% of chronic bronchitics, continue to smoke. CONCLUSIONS: Advice against smoking must be directed towards younger and younger age groups, including both men and women. The high prevalence of people still smoking among the chronically ill should cause us to reflect on our advice against tobacco to such patients.

Asunto(s)

RESUMEN

OBJECTIVE: Identification of the social profile of our anxious patients, and analysis of the usefulness of Bell's questionnaire for our area of work. DESIGN: A retrospective observation study of a crossover type. SETTING: Primary Care. PARTICIPANTS: 55 patients who consulted their Family Doctor and were diagnosed as suffering from Anxiety. MEASUREMENTS AND MAIN RESULTS: We confirmed the diagnosis with the DSM-III-R and then analysed the level of Anxiety with the Hamilton Scale. The social evaluation was done by means of Bell's profile. As test statistics we used the lineal correlation Coefficient, the Student's t and Xi2 tests and Variance Analysis. 65% of diagnoses were Generalised Anxiety. The Hamilton mean was 20.9 points (S = 9.2). Overall social adaptation was unsatisfactory, with the worst results being for the emotional aspects. We observed a higher level of Anxiety as age increased (p = 0.021), related to a worse adaptation to Health (p = 0.014). Dissatisfaction with work and the working environment took the form of professional adaptation being poorer as their work situation deteriorated (p = 0.006). Anxiety levels were higher among the unemployed. Social adaptation was less among people with higher Anxiety levels (p = 0.04), above all as a consequence of worse adaptation to Health (p = 0.002) and worse emotional (p = 0.00001) adaptation. CONCLUSIONS: 1) We must introduce social aspects into analysis of patients with Anxiety. 2) Bell's profile enables us to identify those social aspects which can be tackled when caring for our patients. Its fundamental use is in individual application.

Asunto(s)

Asunto(s)