Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide.

PURPOSE: Determining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care. METHODS: This retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics. RESULTS: The MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide. CONCLUSIONS: The MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

[Perceptions of clinical safety after hospital discharge]. / Percepción de seguridad clínica tras el alta hospitalaria.

OBJECTIVE: Patient perception of clinical safety has been scantly studied. This study describes the frequency of clinical errors from a patient point of view, their perception of safety and its relationship with the information received. MATERIAL AND METHODS: Descriptive study based on a postal survey to 336 surgical patients, 20 days after the discharge from the hospital (the corrected rate of response is 75.58%, the error is 5.7% for a confidence level of 95%). RESULTS: In the responses, 13.05% (95% CI, 9.16-16.95%) reported suffering a clinical error. Of these, 10.5% had severe complications. This experience decreases the perception of safety in future treatments (p = 0.0001). The risk of being a victim of a medical error with serious consequences is high was considered by 11.9% (95% CI, 7.2-16.6%) of the patients, although less than suffering from a traffic accident, a robbery or a serious illness. A higher frequency in the media related to medical mistakes, decreases the perception of safety (p < .001). The patients who positively value the information received regarding the treatment and who can formulate questions to ask the doctor are those who report less errors (p < .001). CONCLUSIONS: A total of 1.37% of surgical patients report mistakes with severe consequences, whereas 12% believe that the risk of a mistake with serious consequences is high. Distrust increases after an error. Improving communication with the patient helps to reduce mistakes, which strengthens the role of programs to increase safety that encourage more active patient involvement.

[Quality control systems implementation in the Spanish Dialysis Units]. / Implantación de sistemas de gestión de calidad en las unidades de nefrología españolas.

OBJECTIVE: The aim of this study was to evaluate and analyze the implementation of a Quality Management Systems (QMS) and the use of Clinical Performance measures by the Nephrology Services and Hemodialysis Units in Spain. METHOD: The Quality Management Work Group of the Spanish Society of Nephrology (SEN) realized a survey that was directed to all the Spanish Nephrology Services and Hemodialysis Units. No exclusion criteria were defined for the study. The survey was based on a multichotomous self completing "Ad Hoc" questionnaire. RESULTS: The survey was answered by 46.7% of the polled centers (44.5% were public hospitals and 55.5% private centers). Of those replying the survey 70 % had a QMS, with a higher implementation in the area of Hemodialysis (HD). The ISO 9001-2000 was the prefer QMS model chosen by 76.4% of the centers. 68.6% of the centers with a QMS were certified by an external Auditing Group. 91.7% of the Nephrology Services and Hemodialysis units were using some clinical practice guideline. A high percentage of the centers had medical protocols and nursing plans (> 90%). A significantly higher implementation of QMS was observed in Private Hospitals and Hemodialysis Units (88.8 %) when compared to public Hospitals (46.1%) (X2: 31.5; p < 0.001). The ISO 9000 Standard certification was selected by 78,3% of the private centers and by 21,7% of the public centers (X2: 37.3; p < 0.001). The certification or accreditation were done by an external auditing group in 68. 1% of the private centers compared to 31.9% for the public Hospitals (X2: 24.8; p < 0.001). Although the rate of answers prevents from extracting definitive conclusions, the result seems to indicate that in the Spanish Nephrology Community a clear trend exists towards the use QMS. This tendency suggests, that in the near future, there will be a progressive implementation and routine use of QMS in the Nephrology Community in Spain.

[Patient satisfaction as an outcome measure in health care]. / La satisfacción del paciente como una medida del resultado de la atención sanitaria.

In the last years an important change has taken place regarding doctor-patient relationships. One of its effects is that today healthcare results are measured in terms of effectiveness, efficiency, patient's perception of pain or autonomy, physical and mental well-being and, also, in terms of satisfaction with the achieved outcome. In literature it is easy to find studies on patient satisfaction with the conditions of hospitalization, emergencies, or visits. However, it is not usual, to find studies on patient satisfaction with medical outcomes, and this is the kind of information most relevant to clinical use. The concept of "patient-focused-care" obeys to this new position that is based on the recognition of patients' active role in the decision-making process and the notion that clinical decisions should take patients' views and perceptions into account. In this paper, the concept of patients' satisfaction is reviewed as a health outcome. The theories, instruments, methodological questions and implications of this measure are analysed in order to assess and improve the health care presently provided.

[What do patients think of public hospitals? Analysis of the perceived quality levels of 5 hospitals]. / Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales.

OBJECTIVE: To compare the opinions of patients assisted in 5 hospitals. DESIGN: Descriptive study based in a survey by mail has been used in all cases. INSTRUMENTS: The SERVQHOS questionnaire. SUBJECTS: 930 patients. Answer rate around 35%. RESULTS: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality. CONCLUSION: The patients value the hospital positively although there are an important number of unsatisfied patients.

[Can adverse effects related to hospital treatment be avoided?]. / Pueden evitarse los sucesos adversos relacionados con la atención hospitalaria?

The concept of care risk includes any undesirable situation, or any factor contributing to its occurrence, related to the health care received and which might have negative consequences. It includes conditions like adverse effects of medicines, negligence and litigation. A safe clinical practice requires that three objectives be obtained: to identify which diagnostic and therapeutic clinical procedures are the safest and most efficient; to assure that they are applied to those who need them; and to carry them out correctly and without mistakes. In this sense, what are needed, on the one hand, are systems of notification and epidemiological studies, and, on the other, actions at different levels of the health system. The maximum safety of the patient is obtained by a suitable knowledge of the risks, elimination of those that are unnecessary, and prevention and protection in those that must inevitably be assumed. This is because safety is not the same thing as absence of risk.

Satisfacción versus experiencia del paciente, calidad de diseño versus calidad de conformidad / Patient satisfaction versus patient experience. Quality of design versus quality of conformity

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Dejar de hacer lo que no hay que hacer / Ceasing to do what shouldn't be done

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[Patients informing of adverse events. Results in diabetes and kidney disease]. / Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal.

BACKGROUND: Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. MATERIAL AND METHODS: Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. RESULTS: A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error (Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. CONCLUSION: Information provided by patients can help improve safety procedures.

[Clinical safety paediatric patients]. / Seguridad clínica de los pacientes durante la hospitalización en pediatría.

OBJECTIVE: To describe the incidence and types of adverse events in children and how they can be prevented. MATERIAL AND METHODS: Analysis of paediatric hospitalisations in the ENEAS Study, the Asturias Study on hospitalisation -related adverse events (EAPAS) and the Aragon Study of the Adverse Effects related to the hospitalisation, which involved a retrospective medical record review of a population-based, representative sample of all paediatric hospital discharges. Adverse events were defined as an injury caused by medical management, rather than by disease processes. RESULTS: We were able to identify 24 paediatric patients suffering 29 AEs directly associated with medical care. Compared to non-elderly adult patients, infants and adolescents suffered lower rates of adverse events. Of these, 65.5% (19 AE) were considered as preventable. Adverse events occurred in 3.61% of paediatric hospitalisations. Adverse events rates were 3.8% in infants (0-1.5 years), 4.0% in children 1.5-6 years of age, and 2.6% in children 7-16 years of age, compared with a rate of 6.4% in non-elderly adults. Medication related (37.9%) events were the most common types of adverse event. CONCLUSIONS: The epidemiology of adverse events in children is different to that in adults. To reduce the adverse events that occur in hospitalized children, knowledge of AE epidemiology in paediatric patients will help in the development of prevention strategies to avoid or to minimise them.

Cómo pasa la vida, que de pronto son años / How life passes by, and how years fly

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[Evolution of the adverse effects prevalence related to healthcare in hospitals of the Valencia community]. / Evolución de la prevalencia de eventos adversos relacionados con la asistencia en hospitales de la Comunidad Valenciana.

OBJECTIVE: Improvement of knowledge on patient safety by a study of the number, importance and impact of Adverse Events (AEs), analysing the patient and healthcare characteristics associated with their occurrence. MATERIAL AND METHODS: Cross-sectional study of prevalence carried out for one week every year in the years 2005-2008 in hospitals of the Comunidad Valenciana. RESULTS: AE prevalence in participating hospitals remained constant at around 6 % during the four years of study. The mean age and sex distribution were also constant. The predominant causal factors of AEs were nosocomial infection, procedures and medicines, in that order, although we did observe an increase in AEs due to nosocomial infection during the period of study. With regard to severity, we observed a decrease in the percentage of serious AEs (31.5 % in 2005 vs.17.8 % in 2008), as well as an increase in the proportion of avoidable AEs from 50.8 % to 63.2 % in 2008. CONCLUSIONS: The results of the study demonstrate the need for a cultural change among professionals that will stimulate the promotion of a proactive culture for patient safety, and allows us to anticipate a social problem of increasing repercussions. Knowledge of EA epidemiology will help in the development of prevention strategies to avoid or to minimise them.

[How to identify adverse events in emergency services? A guide agreed for the screening]. / ¿Cómo identificar los efectos adversos en urgencias? Una guía consensuada para el cribado.

OBJECTIVE: Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE. MATERIAL AND METHODS: A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques. RESULTS: Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis. CONCLUSIONS: By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies.

Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal / Patients informing of adverse events. Results in diabetes and kidney disease

Fundamento. Diabetes y enfermedad renal son factores de riesgo de sufrir eventos adversos (EA). No contamos con estudios sobre la percepción del riesgo de estos pacientes. En este estudio se analiza la frecuencia con la que los pacientes diabéticos y renales describen indicios de un posible EA y su percepción de seguridad de la atención que reciben. Material y métodos. Estudio descriptivo basado en entrevistas a pacientes seleccionados al azar. Estudio de campo realizado entre febrero y mayo de 2010 en 3 centros de salud y 2 hospitales de Alicante y Madrid. Resultados. Respondieron 199 pacientes, 98 diabéticos y 101 con enfermedad renal. Estos últimos acumularon mayor número de indicios de EA (21,8% refirió un EA, 17,8% dos y un 3% 3 o más) que los diabéticos (16,3% un EA, 7,1% dos y 7,1% señaló 3 o más). En el último año, 6/98 diabéticos y 10/101 enfermos renales precisaron un tratamiento adicional. La probabilidad que el paciente cree tener de ser víctima de un error con consecuencias graves fue establecida en 1:10. Las mujeres con enfermedad renal creyeron tener una mayor probabilidad de sufrir un error (Chi2=12,7, p=0,002). Los errores clínicos se atribuyeron a la falta de tiempo para atender a todos los pacientes y a la insuficiencia de medios y recursos, sin diferencias estadísticamente significativas entre las submuestras. Los pacientes entrevistados consideraron similar el riesgo de error clínico, accidente de tráfico, atraco. Conclusiones. La información que proporcionan los pacientes puede contribuir a mejorar la seguridad de los procedimientos de trabajo(AU)

Background. Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. Material and methods. Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. Results. A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error(Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. Conclusion. Information provided by patients can help improve safety procedures(AU)