Safe handoff practices and improvement of communication in different paediatric settings.

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.

Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

Paediatric intensive care 'do not do' recommendations in Spain: Selection by Delphi method.

INTRODUCTION: Health care is not free of ineffective, unsafe or inefficient diagnostic and therapeutic practices. To address this, different scientific societies and health authorities have proposed 'do not do' recommendations (DNDRs). Our goal was the selection by consensus of a set of DNDRs for paediatric intensive care in Spain. MATERIAL AND METHOD: The research was carried out in 2 phases: first, gathering potential DNDRs; second, selecting the most important ones, using the Delphi method, based on the prevalence of the practice to be modified, the severity of its potential risks and the ease with which it could be modified. Proposals and evaluations were both made by members of working groups of the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP, Spanish Society of Paediatric Intensive Care), coordinated by email. The initial set of DNDRs was reduced based on the coefficient of variation (<80%) of the corresponding evaluations. RESULTS: A total of 182 DNDRs were proposed by 30 intensivists. The 14 Delphi evaluators managed to pare down the initial set to 85 DNDRs and, after a second round, to the final set of 26 DNDRs. The care quality dimensions most represented in the final set are clinical effectiveness and patient safety. CONCLUSIONS: This study allowed the selection by consensus of a series of recommendations to avoid unsafe, inefficient or ineffective practices in paediatric intensive care in Spain, which could be useful for improving the quality of clinical care in our field.

Set of Quality Indicators of Pediatric Intensive Care in Spain: Delphi Method Selection.

INTRODUCTION: This study objective was to identify, select, and define a basic set of quality indicators for pediatric intensive care in Spain. METHODS: (1) Review of the literature to identify quality indicators and their defining elements and (2) selection of indicators by consensus of a group of experts using basic Delphi methodology (2 rounds) and forms distributed by email among experts from the Spanish society of pediatric intensive care. RESULTS: We selected quality indicators according to their relevance and feasibility and the experts' agreement on their incorporation in the final set. We included only those indicators whose assessment was within the highest tertile and greater than or equal to 70% evaluator agreement in the final selection. Starting from an initially proposed set of 136 indicators, 31 experts first selected 43 indicators for inclusion in the second round. Twenty indicators were selected for the final set. This "top 20" set comprised 9 process indicators, 9 of results (especially treatment-associated adverse effects), and 2 indicators of structure. Several of them are classical indicators in intensive care medicine (rates of hospital-acquired infections, pressure ulcers, etc.), whereas others are specifically pediatric (eg, unrestricted parent visitation or training the parents of technology-dependent children). CONCLUSIONS: We reached a consensus on a set of 20 essential quality indicators for pediatric intensive care in Spain. A significant subset reflects the peculiarities of pediatric care. We consider this subset as a starting point for future projects of network collaboration between pediatric intensive care units in Spain.

Risk markers for disappearance of pediatric Web resources.

OBJECTIVES: The authors sought to find out whether certain Webometric indexes of a sample of pediatric Web resources, and some tests based on them, could be helpful predictors of their disappearance. METHODS: The authors performed a retrospective study of a sample of 363 pediatric Websites and pages they had followed for 4 years. Main measurements included: number of resources that disappeared, number of inbound links and their annual increment, average daily visits to the resources in the sample, sample compliance with the quality criteria of 3 international organizations, and online time of the Web resources. RESULTS: On average, 11% of the sample disappeared annually. However, 13% of these were available again at the end of follow up. Disappearing and surviving Websites did not show differences in the variables studied. However, surviving Web pages had a higher number of inbound links and higher annual increment in inbound links. Similarly, Web pages that survived showed higher compliance with recognized sets of quality criteria than those that disappeared. A subset of 14 quality criteria whose compliance accounted for 90% of the probability of online permanence was identified. Finally, a progressive increment of inbound links was found to be a marker of good prognosis, showing high specificity and positive predictive value (88% and 94%, respectively). CONCLUSIONS: The number of inbound links and annual increment of inbound links could be useful markers of the permanence probability for pediatric Web pages. Strategies that assure the Web editors' awareness of their Web resources' popularity could stimulate them to improve the quality of their Websites.

User preference as quality markers of paediatric web sites.

OBJECTIVE: Little is known about the ability of internet users to distinguish the best medical resources online, and how their preferences, measured by usage and popularity indexes, correlate with established quality criteria. Our objective was to analyse whether the number of inbound links and/or daily visits to a sample of paediatric web pages are reliable quality markers of the pages. DESIGN: Two-year follow-up study of 363 web pages with paediatric information. MEASUREMENTS: The number of inbound links and the average number of daily visits to the pages were calculated on a yearly basis. In addition, their rates of compliance with the codes of conduct, guidelines and/or principles of three international organizations were evaluated. RESULTS: The quality code most widely met by the sample web pages was the Health on the Net Foundation Code of Conduct (overall rate, 60.2%). Sample pages showed a low degree of compliance with principles related to privacy, confidentiality and electronic commerce (overall rate less than 45%). Most importantly, we observed a moderate, significant correlation between compliance with quality criteria and the number of inbound links (p < 0.001). However, no correlation was found between the number of daily visits to a page and its degree of compliance with the principles. CONCLUSIONS: Some indexes derived from the analysis of webmasters' hyperlinks could be reliable quality markers of medical web resources.