Health care safety incidents in paediatric emergency care.

OBJECTIVE: To characterize safety incidents in paediatric emergency departments (PEDs): frequency, sources, root causes, and consequences. MATERIALS AND METHODS: We conducted a cross-sectional, observational and descriptive study in the PED of the Clinical University Hospital XX (blinded for review). Patients were recruited through opportunity sampling and the data were collected during care delivery and one week later through a telephone survey. The methodology was based on the ERIDA study on patient safety incidents related to emergency care, which in turn was based on the ENEAS and EVADUR studies. RESULTS: The study included a total of 204 cases. At least one incident was detected in 25 cases, with two incidents detected in 3 cases, for a total incidence of 12.3%. Twelve incidents were detected during care delivery and the rest during the telephone call. Ten percent did not reach the patient, 7.1% reached the patient but caused no harm, and 82.1% reached the patient and caused harm. Thirteen incidents (46.4%) did not have an impact on care delivery, 8 (28.6%) required a new visit or referral, 6 (21.4%) required additional observation and 1 (3.6%) medical or surgical treatment. The most frequent root causes were health care delivery and medication. Incidents related to procedures and medication were most frequent. Of all incidents, 78.6% were considered preventable, with 50% identified as clear failures in health care delivery. CONCLUSIONS: Safety incidents affected 12.3% of children managed in the PED of the HCUVA, of which 78.6% were preventable.

Early radiological worsening of SARS-CoV-2 pneumonia predicts the need for ventilatory support.

OBJECTIVES: Identifying early markers of poor prognosis of coronavirus disease 2019 (COVID-19) is mandatory. Our purpose is to analyze by chest radiography if rapid worsening of COVID-19 pneumonia in the initial days has predictive value for ventilatory support (VS) need. METHODS: Ambispective observational ethically approved study in COVID-19 pneumonia inpatients, validated in a second outpatient sample. Brixia score (BS) was applied to the first and second chest radiography required for suspected COVID-19 pneumonia to determine the predictive capacity of BS worsening for VS need. Intraclass correlation coefficient (ICC) was previously analyzed among three radiologists. Sensitivity, specificity, likelihood ratios, AUC, and odds ratio were calculated using ROC curves and binary logistic regression analysis. A value of p < .05 was considered statistically significant. RESULTS: A total of 120 inpatients (55 ± 14 years, 68 men) and 112 outpatients (56 ± 13 years, 61 men) were recruited. The average ICC of the BS was between 0.812 (95% confidence interval 0.745-0.878) and 0.906 (95% confidence interval 0.844-0.940). According to the multivariate analysis, a BS worsening per day > 1.3 points within 10 days of the onset of symptoms doubles the risk for requiring VS in inpatients and 5 times in outpatients (p < .001). The findings from the second chest radiography were always better predictors of VS requirement than those from the first one. CONCLUSION: The early radiological worsening of SARS-CoV-2 pneumonia after symptoms onset is a determining factor of the final prognosis. In elderly patients with some comorbidity and pneumonia, a 48-72-h follow-up radiograph is recommended. KEY POINTS: • An early worsening on chest X-ray in patients with SARS-CoV-2 pneumonia is highly predictive of the need for ventilatory support. • This radiological worsening rate can be easily assessed by comparing the first and the second chest X-ray. • In elderly patients with some comorbidity and SARS-CoV-2 pneumonia, close early radiological follow-up is recommended.

[Improvement of the management of outpatient consultations by a direct automatic citation of interconsultations]. / Mejora de la gestión de las consultas externas hospitalarias mediante la cita automática directa de interconsultas.

OBJECTIVE: The delay caused to provide an appointment and the uncertainty of the expected waiting time, are cause for discontent in the patients. The object of this work was to improve the accessibility to the consultation of specialized attention in our health area, decreasing the average waiting time and reduce the number of claims for this reason. METHODS: To measure the quality of the service provided, 5 criteria were developed and evaluated, by means of a cross section, in December 2015 for all patients pending appointment in the Area. Likewise, the complaints and claims collected during the 6 months prior to this date were quantified. As an intervention, a new circuit was designed and implemented in the interconsultation process, protocolizing a direct and automatic citation system. This system also eliminated patients without an appointment, allowing prioritization in preferred cases. At the end of 2016, a new evaluation was made with the same methodology. For the statistical analysis, Student's t and Chisquare were used. RESULTS: In six months the number of patients without appointment was reduced from 4726 to 0. The average waiting time for external consultations improved from 63 to 44.2 days. Patients waiting more than 50 days increased from 41.5% to 74.8%. The number of complaints and claims due to appointment in external consultations decreased from 161 to 80. CONCLUSIONS: Accessibility has improved by reducing the average waiting time and eliminating the list of patients without an appointment, although the number of patients pending appointments for more than 50 days has increased. The number of complaints and claims has been halved.

OBJETIVO: La demora originada para proporcionar una cita y la incertidumbre del tiempo previsto de espera, son causa de descontento en los pacientes. El objetivo de este trabajo fue mejorar la accesibilidad a la consulta de atención especializada en nuestra área de salud, disminuyendo el tiempo medio de espera y reducir el número de reclamaciones por este motivo. METODOS: Para medir la calidad del servicio prestado, se elaboraron 5 criterios que se evaluaron inicialmente mediante un corte transversal, en diciembre de 2015, en todos los pacientes pendientes de cita en el Área. Así mismo se cuantificaron las quejas y reclamaciones recogidas los 6 meses anteriores a esta fecha. Como intervención, se diseñó e implementó un nuevo circuito en el proceso interconsulta, protocolizando un sistema directo y automático de citación. Este sistema eliminaba además los pacientes sin cita, permitiendo la priorización en los casos preferentes. Al final de 2016 se realizó una nueva medición con la misma metodología. Para el análisis estadístico se han usado la t de Student y la Chi cuadrado. RESULTADOS: En seis meses se redujo el número de pacientes sin cita de 4.726 a 0. El tiempo medio de espera en consultas externas pasó de 63 a 44,2 días. Los pacientes en espera de más de 50 días pasaron del 41,5% al 74,8%. El número de quejas y reclamaciones debidas a cita en consultas externas pasó de 161 a 80. CONCLUSIONES: Ha mejorado la accesibilidad al disminuir el tiempo de espera media y se ha eliminado la lista de pacientes sin cita, si bien ha aumentado el número de pacientes pendientes de cita de más de 50 días. Se ha reducido a la mitad el número de quejas y reclamaciones.