[Adverse events in ambulatory surgical procedures]. / Efectos adversos en cirugía mayor ambulatoria.

OBJECTIVE: To assess the incidence of adverse events and patients with adverse events in ambulatory surgical procedures and to compare it with that of other studies. MATERIAL AND METHOD: Historical cohort study. The scope of the study was the ambulatory surgical procedures unit of a university hospital. All general surgery department patients seen in this unit during the year 2005 were included. RESULTS: The incidence of patients with adverse events directly related to hospital care was of 3% (95% CI, 0.9-5). Of the adverse events identified 5 were considered slight, 3 moderate and none were considered serious. All the moderate ones were considered unavoidable and of slight, only the one was avoidable. Six of the adverse events were associated to a procedure, one due to hospital infections and one with other causes. There was an increase in hospital stay due to 75% of the adverse events, and 25% of them affected admission. CONCLUSIONS: The incidence of adverse events related to medical care in the Spanish hospitals is similar to those found in the studies carried out in American and European countries using the same methodology. The surgical area is considered a high risk unit. However, ambulatory surgical procedures reduce these risks, in such a way that the incidence is far below that of surgery department. Therefore, besides improving the technical efficiency of the clinical services, it is safer for the patients.

[Health assistance as a risk factor: side effects related to clinical practice]. / La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica.

The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed.