How Much of Root Cause Analysis Translates into Improved Patient Safety: A Systematic Review.

OBJECTIVES: The aim of this systematic review was to consolidate studies to determine whether root cause analysis (RCA) is an adequate method to decrease recurrence of avoidable adverse events (AAEs). METHODS: A systematic search of databases from creation until December 2018 was performed using PubMed, Scopus and EMBASE. We included articles published in scientific journals describing the practical usefulness in and impact of RCA on the reduction of AAEs and whether professionals consider it feasible. The Mixed Methods Appraisal Tool was used to assess the quality of studies. RESULTS: Twenty-one articles met the inclusion criteria. Samples included in these studies ranged from 20 to 1,707 analyses of RCAs, AAEs, recommendations, audits or interviews with professionals. The most common setting was hospitals (86%; n = 18), and the type of incident most analysed was AAEs, in 71% (n = 15) of the cases; 47% (n = 10) of the studies stated that the main weakness of RCA is its recommendations. The most common causes involved in the occurrence of AEs were communication problems among professionals, human error and faults in the organisation of the health care process. Despite the widespread implementation of RCA in the past decades, only 2 studies could to some extent establish an improvement in patient safety due to RCAs. CONCLUSIONS: RCA is a useful tool for the identification of the remote and immediate causes of safety incidents, but not for implementing effective measures to prevent their recurrence.

Patient safety and adverse events related with obstetric care.

PURPOSE: To determine the frequency and distribution of Adverse Events (AE) in obstetrics departments at Spanish hospitals. METHODS: We present a retrospective cohort study including 816 women admitted to the obstetrics departments at 41 hospitals that took part in the National Adverse Effects Study in Spain (ENEAS) and an extension of this study in all hospitals located in two Autonomous Regions. To identify AE, nurses from each participating hospital examined all medical records, and completed a validated screening guide. A team of external reviewers evaluated the medical records of all women who met at least one of the criteria in the screening guide to verify all AE. The main outcome measure was the incidence of AE during hospitalization. RESULTS: The cumulative incidence of patients with obstetric care-related AE was 3.6% (95% CI 2.3-4.8). The most frequent AE were those related with surgical interventions or procedures (59.4%). None of the AE detected were considered severe. 36.7% of the AE lengthened the woman's hospital stay, and 13.3% led to hospital admission. Additional procedures were needed after 71.9% of the AE, and additional treatment was needed after 59.4%. 56.3% of the AE were considered preventable. CONCLUSIONS: Obstetric care is characterized by generally younger ages among patients, their low frequency of comorbidities and high expectations for successful outcomes of care. However, some factors can increase obstetric risk and favor the appearance of preventable incidents and AE. Systems are needed to detect preventable AE, and measures are needed to reduce risks or attenuate their consequences.

[News items about clinical errors and safety perceptions in hospital patients]. / Noticias de prensa sobre errores clínicos y sensación de seguridad al acudir al hospital.

OBJECTIVE: To analyze how news items about clinical errors are treated by the press in Spain and their influence on patients. METHODS: We performed a quantitative and qualitative study. Firstly, news items published between April and November 2007 in six newspapers were analyzed. Secondly, 829 patients from five hospitals in four autonomous regions were surveyed. RESULTS: We analyzed 90 cases generating 128 news items, representing a mean of 16 items per month. In 91 news items (71.1%) the source was checked. In 78 items (60.9%) the author could be identified. The impact of these news items was -4.86 points (95% confidence interval [95%CI]: -4.15-5.57). In 59 cases (57%) the error was attributed to the system, in 27 (21.3%) to health professionals, and in 41 (32.3%) to both. Neither the number of columns (p=0.702), nor the inclusion of a sub-header (p=0.195), nor a complementary image (p=0.9) were found to be related to the effect of the error on safety perceptions. Of the 829 patients, 515 (62.1%; 95%CI: 58.8-65.4%) claimed to have recently seen or heard news about clinical errors in the press, on the radio or on television. The perception of safety decreased when the same person was worried about being the victim of a clinical error and had seen a recent news item about such adverse events (chi(2)=15.17; p=0.001). CONCLUSIONS: Every week news items about clinical errors are published or broadcast. The way in which newspapers report legal claims over alleged medical errors is similar to the way they report judicial sentences for negligence causing irreparable damage or harm. News about errors generates insecurity in patients. It is advisable to create interfaces between journalists and health professionals.