Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study.

OBJECTIVE: Determine the frequency and preventability of adverse events (AEs) from available information sources in selected ambulatory care (AC) sites in Latin America (LA). DESIGN: Multinational observational cohort was conducted to determine the period prevalence (retrospective focus) and the cumulative incidence (prospective focus) of AEs. SETTING: Outpatient clinics in Mexico, Peru, Brazil and Colombia. PARTICIPANTS: A random selection of 2080 patients. INTERVENTIONS: The existence of AE was decided based on trigger information provided by the patient and crossing the data with each patient's medical history. MAIN OUTCOME MEASURES: AE occurrences 6 months prior (prevalence) and 42 days after (incidence) the patient receiving AC were identified. AE type and preventability were also described. RESULTS: Two thousand eighty patients participated in the study. AEs prevalence was 5.2% (108/2080) [95% confidence interval (CI) 4.2-6.1%], and cumulative incidence was 2.4% (42/1757) (95% CI 1.7-3.1%). AEs considered preventable were 44% (55/108) of prevalence period, and 52.4% (22/42) of incidence period. Preventability was associated with patient socioeconomic status (OR 3.5, 95% CI 1.4-8.8), medication error (OR 0.1, 95% CI 0.0-0.4), diagnostic error (OR 0.1, 95% CI 0.0-0.8) and a minor impact on the patient (OR 0.2 95% CI 0.1-0.9). CONCLUSION: The frequency of AE in ambulatory settings in LA is in the high-frequency range of research focused on the prevalence of AEs. Fifty percent was preventable. This study provides an approach for assessing the frequency and preventability of AE in order to enhance patient safety in LA.

[The epidemiological survey as a key instrument for events of Public Health importance]. / La encuesta epidemiológica como instrumento clave frente a eventos de importancia en Salud Pública.

The epidemiological survey is one of the key instruments, both in Public Health alerts or emergencies, and in epidemiological surveillance. Its main objective is to obtain information quickly, systematically, uniformly and easily. It is characterized by being dynamic and flexible, in addition to offering the relevant descriptive information of the epidemiological event studied: person, place and time . Thus, it allows us to quantify the frequency and distribution pattern of the event through measures such as incidence, prevalence or mortality, providing the basic information to propose a starting hypothesis.

La encuesta epidemiológica es uno de los instrumentos clave, tanto en las alertas o emergencias de Salud Pública, como en la vigilancia epidemiológica. Su principal objetivo es obtener información de forma rápida, sistemática, uniforme y sencilla. Se caracteriza por ser dinámica y flexible, además de ofrecer la información descriptiva relevante del evento epidemiológico estudiado: persona, lugar y tiempo . Así, permite cuantificar la frecuencia y el patrón de distribución del evento a través de medidas como la incidencia, la prevalencia o la mortalidad, aportando la información básica para plantear una hipótesis de partida.

[Risk perception, information received and occupational engagement of workers in a university hospital in the face of the COVID-19 pandemic.] / Percepción del riesgo, información recibida y participación laboral de los trabajadores de un hospital universitario ante la pandemia de la COVID-19.

OBJECTIVE: Hospital workers faced the pandemic with a lack of knowledge, procedures and resources, which generated different experiences based on the perceived risk of exposure. It was considered pertinent to conduct a study to learn about the risk perception, the information received and the occupational engagement of workers in a university hospital in the face of the pandemic. METHODS: A cross-sectional study (july-september 2020) was carried out by an ad hoc survey of workers in the Majadahonda Puerta de Hierro University Hospital with 20 items (Likert scale from 0=not at all agree to 5=totally agree). The sample size was set at 828 workers. The absolute frequency and percentage of agreement for each item were described. Chi-Square was used to assess the association of responses with sex, type of worker, work area and activity in COVID-19 units. RESULTS: 992 workers participated, with 80.7% being women, 79.8% healthcare personnel and 33.2% nurses. Workers perceived a high risk of exposure. Approximately half confirmed that they had received information on the use of masks, although not on PPE. More than half stated that they felt involved in teamwork, but not in COVID-19 unit planning. Statistically significant differences (p<0.05) were found in the risk perception by sex, between type of worker (healthcare vs. non-healthcare), work area (healthcare vs. non-healthcare) and working in COVID-19 Units vs. non-COVID-19 Units. CONCLUSIONS: Healthcare personnel who worked in care areas and COVID-19 units present greater perception of the risk of exposure, although they report a higher degree of agreement in the information received and in their work engagement in the face of the pandemic.

OBJETIVO: Los trabajadores del hospital afrontaron la pandemia con falta de conocimientos, procedimientos y recursos, lo que generó diferentes experiencias en base al riesgo de exposición percibido. Se consideró pertinente realizar un estudio para conocer la percepción del riesgo, la información recibida y la participación laboral de los trabajadores de un hospital universitario ante la pandemia. METODOS: Se realizó un estudio transversal (entre julio y septiembre de 2020) mediante una encuesta ad hoc con 20 ítems (Escala Likert de 0=nada de acuerdo a 5=totalmente de acuerdo) a los trabajadores del Hospital Universitario Puerta de Hierro Majadahonda, que desarrollaron su actividad laboral durante la primera ola pandémica de la COVID-19. El tamaño muestral se estableció en 828 sujetos. Se describieron la frecuencia absoluta y el porcentaje de acuerdo de cada ítem. Se usó la chi-cuadrado para valorar la asociación de las respuestas con el sexo, el tipo de trabajador, el área de trabajo y la actividad en unidades de COVID-19. RESULTADOS: Participaron 992 trabajadores, habiendo un 80,7% de mujeres, un de 79,8% personal sanitario y un 33,2% de enfermeras. Los trabajadores percibieron un alto riesgo de exposición. Aproximadamente la mitad afirmaron haber recibido información sobre el uso de mascarillas, aunque no de los equipos de protección individual (EPI). Más de la mitad afirmó sentirse partícipe del trabajo en equipo, pero no de la planificación de unidades de COVID-19. Se encontraron diferencias estadísticamente significativas (<0,05) en la percepción del riesgo por sexo, entre el tipo de trabajador (sanitario frente a no sanitario), el área de trabajo (asistencial frente a no asistencial) y trabajar en Unidades de COVID-19 frente a Unidades de no COVID-19. CONCLUSIONES: Los sanitarios que trabajaron en áreas asistenciales y unidades de COVID-19 presentan mayor percepción del riesgo de exposición, aunque refieren mayor grado de acuerdo en la información recibida y en su participación laboral ante la pandemia.

[Not Available]. / Utilización de la opinión de los pacientes para la mejora: 5 años de seguimiento (2001-2005).

OBJECTIVE: To evaluate changes in quality over a 5-year period from the perspective of patients, in an attempt to meet their expectations in a new hospital. METHOD: The procedure takes as a reference the results of an opinion survey carried out in the hospital in 2001 and compares these results with those of annual surveys and completes them with information from written complaints and demands for accountability. RESULTS: During the period studied, 821 surveys (a response rate of 22.3%), 3,756 complaints and 105 demands for administrative accountability were received and processed. The surveys revealed a degree of satisfaction of 96%, and study of the changes detected significant differences in comfort and response capacity. The most common reasons for complaints were medical transport (15.3%), delays in receiving care (12.6%), and waiting lists (9.3%). The main reasons for demands for accountability (only 20% of which were accepted) were death or serious secondary outcomes (59%), and the principal causes were related to omissions (42.9%) or malpractice (22.9%). DISCUSSION: Patients' opinions tended to worsen slightly over the 5-year period studied, related to their increased expectations. Although the reasons for making complaints and demands were independent of the problems identified in patients' opinions and showed different dimensions, there were certain areas of overlap. Greater efforts are required in the area of emergency services and, of course, in problems related to comfort, improvement of which is easily achievable and evident with the inauguration of the new hospital.