[Use of complementary tests in emergencies and their relation with patient safety incidents]. / Uso de pruebas complementarias en urgencias y su relación con incidentes de seguridad.

OBJECTIVE: To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY: An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS: A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION: A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.

[Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services]. / Estudio Regional de Incidentes Derivados de la Atención (ERIDA) en Urgencias.

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATERIAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable.

[Benchmarking in the emergency unit process in 7 hospitals from different autonomous communities]. / Benchmarking en el proceso de urgencias entre siete hospitales de diferentes comunidades autónomas.

OBJECTIVE: To identify and to share the results among hospitals regarding the process of attention at the Emergency Unit, and to detect the practices that explain the differences. SETTING: 7 hospitals of different regions in Spain. PERIOD OF STUDY: 2005-2007. Firstly the comparability criteria were defined assuring the homotecia in the «emergency process¼. In order to fulfil the study objectives, 11 criteria were selected and every center sent the information of each one. 7 indicators were identified to compare hospitals processes'. Data regarding all the attentions provided during the study period was analyzed, establishing the benchmark among the centers. Finally, a questionnaire was elaborated for the process analysis, considering all the stages of the process, the resources and the procedures used in every stage, to be fulfilled in each hospital. RESULTS: The homotecia has been verified in the 7 hospitals, with some differences between centers. 7 indicators have been analyzed in the different hospitals, corresponding to 1,526,890 patients attended in the study period. A benchmark has been identified, with the best results in four of seven indicators: % of admissions from urgencies: 8.3%, emergency pressure: 56.14%, emergency length of stay: 2 hs 20min, and % of patients with length stay > 24h: 0.05%. Differences between the stages of the process, resources and procedures used in every stage in the benchmark center have been analyzed. CONCLUSIONS: A set of indicators to compare Emergency Departments has been identified, letting us establish the benchmark.

[Social assessment of anxiety in primary health care]. / Valoración social de la ansiedad en atención primaria de salud.

OBJECTIVE: Identification of the social profile of our anxious patients, and analysis of the usefulness of Bell's questionnaire for our area of work. DESIGN: A retrospective observation study of a crossover type. SETTING: Primary Care. PARTICIPANTS: 55 patients who consulted their Family Doctor and were diagnosed as suffering from Anxiety. MEASUREMENTS AND MAIN RESULTS: We confirmed the diagnosis with the DSM-III-R and then analysed the level of Anxiety with the Hamilton Scale. The social evaluation was done by means of Bell's profile. As test statistics we used the lineal correlation Coefficient, the Student's t and Xi2 tests and Variance Analysis. 65% of diagnoses were Generalised Anxiety. The Hamilton mean was 20.9 points (S = 9.2). Overall social adaptation was unsatisfactory, with the worst results being for the emotional aspects. We observed a higher level of Anxiety as age increased (p = 0.021), related to a worse adaptation to Health (p = 0.014). Dissatisfaction with work and the working environment took the form of professional adaptation being poorer as their work situation deteriorated (p = 0.006). Anxiety levels were higher among the unemployed. Social adaptation was less among people with higher Anxiety levels (p = 0.04), above all as a consequence of worse adaptation to Health (p = 0.002) and worse emotional (p = 0.00001) adaptation. CONCLUSIONS: 1) We must introduce social aspects into analysis of patients with Anxiety. 2) Bell's profile enables us to identify those social aspects which can be tackled when caring for our patients. Its fundamental use is in individual application.

[Tobacco: risk factor in a health district]. / El tabaco: factor de riesgo en una zona de salud.

OBJECTIVE: To find the prevalence of tobacco dependency in our community and to identify tobacco consumption in our chronic patients. DESIGN: A crossover study. A descriptive analysis of the data. SETTING: A Health District. Mixed population, both urban and rural. PARTICIPANTS: A Health Survey which included 1,071 individuals (95% Confidence and 3% precision), selected by means of simple random sampling from the Municipal Census. MEASUREMENTS AND MAIN RESULTS: A 32.3% prevalence of tobacco dependency, greater among men (50.7%) than women (15.7%). Among the young, there is a marked tendency for the number of smokers to level out between the sexes. 15.6% of smokers consume more than 24 cigarettes per day. Between 15 and 20% of patients suffering hypertension, diabetes, hypercholesterolaemia and the effects of ischaemic cardiopathy, along with 25% of those who had suffered a CVA and almost 40% of chronic bronchitics, continue to smoke. CONCLUSIONS: Advice against smoking must be directed towards younger and younger age groups, including both men and women. The high prevalence of people still smoking among the chronically ill should cause us to reflect on our advice against tobacco to such patients.