RESUMEN
BACKGROUND: Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. OBJECTIVE: To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. MATERIAL AND METHODS: A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). RESULTS: A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (P<.0001). CONCLUSIONS: The improvement strategies applied showed to be effective in detecting PIEAR, as well as the prevention of such errors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified.
Asunto(s)
Laboratorios de Hospital/organización & administración , Errores Médicos/prevención & control , Sistemas de Identificación de Pacientes , Seguridad del Paciente , Manejo de Especímenes/normas , Sistemas de Información en Laboratorio Clínico , Documentación , Control de Formularios y Registros , Hospitales Urbanos , Humanos , Laboratorios de Hospital/normas , Errores Médicos/estadística & datos numéricos , Estudios Prospectivos , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Gestión de Riesgos , España , Manejo de Especímenes/métodosRESUMEN
PURPOSE: The concept of day surgery is becoming an increasingly important part of elective surgery worldwide. Relentless pressure to cut costs may constrain clinical judgment regarding the most appropriate location for a patient's surgical care. The aim of this study was to determine clinical and quality indicators relating to our experience in orthopedic day durgery, mainly in relation to unplanned overnight admission and readmission rates. Additionally, we focused on describing the main characteristics of the patients that experienced complications, and compared the patient satisfaction rates following ambulatory and non-ambulatory procedures. METHODS: We evaluated 10,032 patients who underwent surgical orthopedic procedures according to the protocols of our Ambulatory Surgery Unit. All complications that occurred were noted. A quality-of-life assessment (SF-36 test) was carried out both pre- and postoperatively. Ambulatory substitution rates and quality indicators for orthopedic procedures were also determined. RESULTS: The major complication rate was minimal, with no mortal cases, and there was a high rate of ambulatory substitution for the procedures studied. Outcomes of the SF-36 questionnaire showed significant improvement postoperatively. An unplanned overnight admission rate of 0.14 % was achieved. CONCLUSIONS: Our institution has shown that it is possible to provide good-quality ambulatory orthopedic surgery. There still appears to be the potential to increase the proportion of these procedures. Surgeons and anesthesiologists must strongly adhere to strict patient selection criteria for ambulatory orthopedic surgery in order to reduce complications in the immediate postoperative term.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Ortopédicos/métodos , Ortopedia , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Distribución por Sexo , España/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To develop models to improve accessibility of performing laboratory tests on chronic oncology patients, as well as a more flexible choice of sample collection in both primary and specialized care. MATERIAL AND METHODS: Circuit analysis of cancer patients. Patient survey to study access to laboratory tests. High Resolution Consultation Development Model (MCAR) and Patient Access Analytical Model (MAAP). RESULTS: The percentage of cancer patients on treatment has increased by 8.76% in the past two years. There was a 32% increased in the use of the MAAP model in the two years of its implementation, and has been the choice of 74% due to greater accessibility, with 8% of the patients having used both models to suit their needs. CONCLUSIONS: The implementation of optimized and preferred care systems has shown that both models improve accessibility and flexibility of the diagnostic testing laboratory in the patients studied.
Asunto(s)
Servicios de Laboratorio Clínico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Neoplasias/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Árboles de Decisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estudios ProspectivosRESUMEN
Thirty-five fractures of the distal femur were treated by antegrade intramedullary nailing. All of the fractures were treated by a closed technique. In the cases in which there was extension of the fracture to the knee joint, the fracture initially was stabilized with percutaneous lag screws. Four patients died before fracture healing was complete and 11 were lost to followup. There were 14 extraarticular (Type A) and six intraarticular (Type C1 and Type C2) fractures. All of these fractures healed in a mean time of 17.27 weeks. Functional outcome using the Hospital for Special Surgery knee score was 87. Complications were infrequent with one (5%) pseudarthrosis and no infections. Although this is a very demanding technique, antegrade intramedullary nailing is an efficient procedure compared with other methods of open reduction and internal fixation for difficult distal femoral fractures.