Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries.

BACKGROUND: Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). METHODS: We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. RESULTS: Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). CONCLUSION: Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

Developing the University of Tartu in Estonia into a well-networked Patient Safety Research Centre (PATSAFE): A study protocol.

Background: Patient safety (PS) is a serious global public health problem affecting all countries. Estimates show that around 10 percent of the patients are harmed during hospital care, resulting in 23 million disability-adjusted life years lost per year. Experts emphasize research advancements as a key precondition for safer care. Aim: The Patient Safety Research Centre (PATSAFE) project enhances the Institute of Clinical Medicine of the University of Tartu's (ICM-UT) research potential and capacities in PS in order to improve and strengthen knowledge and skills in methods, techniques and experience for PS research. Methods: A strategic partnership with Avedis Donabedian Research Institute in Spain, and IQ Healthcare in the Netherlands, both international leaders in PS research, enables the development of a long-lasting knowledge exchange, allowing the ICM-UT to capitalise on its current achievements and to overcome gaps in scientific excellence in the field of PS research. These twining activities will strengthen and raise the research profile of the ICM-UT academic staff and early-stage researchers (ESRs), by implementing the hands-on training on methods, techniques, and experience in PS research. The project also encourages the active participation of ESRs in PS research by increasing their soft skills, to ensure the continuity and sustainability of PS research in ICM-UT. Finally, development of the research strategy on PS contributes to the long-term sustainability of PS research in Estonia. To implement these activities, PATSAFE foresees a comprehensive strategy consisting of knowledge exchange, soft research skills capacity building, strategic planning, and strong dissemination and exploitation efforts. Expected results: As a result of the project, ICM-UT will have the capacity to carry out PS research using the appropriate methodology and the competences to apply state-of-the-art evidence-based strategies for PS research.

[Epidemiology of the hospital adverse events in Catalonia, Spain: a first step for the patient safety improvement]. / Epidemiología de los eventos adversos hospitalarios en Catalunya: un primer paso para la mejora de la seguridad del paciente.

It has been published that hospital adverse events are an important source of morbidity and mortality in different countries and settings. The aim of this study was to evaluate the frequency, magnitude, distribution and degree of preventability of adverse events in the Autonomous Community of Catalonia (Spain). We conducted a retrospective cohort study of 4,790 hospital discharges that were selected by simple random sampling after stratified multistage sampling in 15 hospitals in Catalonia. 38.25% of patients had positive risk criteria (screening phase). We identified 356 cases of adverse events, which represent a 7.4% (95%CI: 6.7% to 8.1%). Of these, 43.5% (155 cases) were considered preventable. This study confirms that adverse events in hospitals in Catalonia are frequent, and generate a significant impact on morbidity and mortality. As in other studies, corroborated that a high proportion of these adverse events are considered preventable. It was possible to identify priority areas to focus improvement efforts.

[A surgical safety checklist implementation: experience of a start-up phase of a collaborative project in hospitals of Catalonia, Spain]. / Implementación de un listado de verificación de prácticas seguras en cirugía: experiencia de la fase inicial de la puesta en marcha de un proyecto colaborativo en hospitales de Catalunya.

Surgical patient safety is a priority in the national and international quality healthcare improvement strategies. The objective of the study was to implement a collaborative intervention with multiple components and to evaluate the impact of the patient surgical safety checklist (SSC) application. This is a prospective, longitudinal multicenter study with a 7-month follow-up period in 2009 based on a collaborative intervention for the implementation of a 24 item-SSC distributed in 3 different stages (sign in, time out, sign out) for its application to the surgical patient. A total number of 27 hospitals participated in the strategy. The global implementation rate was 48% (95%CI, 47.6%-48.4%) during the evaluation period. The overall compliance with all the items of the SSC included in each stage (sign in, time out, sign out) was 75,1% (95%CI, 73.5%-76.7%) for the sign in, 77.1% (95%CI, 75.5%-78.6%) for the time out and 88.3% (95%CI, 87.2%-89.5%) for the sign out respectively. The individual compliance with each item of the SSC has remained above 85%, except for the surgical site marking with an adherence of 67.4% (95%CI, 65.7%-69.1%)] and 71.2% (95%CI, 69.6%-72.9%)] in the sign in and time out respectively. The SSC was successfully implemented to 48% of the surgeries performed to the participating hospitals. The global compliance with the SSC was elevated and the intervention trend was stable during the evaluation period. Strategies were identified to allow of a higher number of surgeries with application of the SSC and more professional involvement in measures compliance such as surgical site marking.

[Intervention to improve hand hygiene compliance in Catalonia, Spain]. / Estrategia para mejorar la práctica de higiene de manos en Catalunya.

Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated.

[Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain]. / Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña.

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

Epidemiología de los eventos adversos hospitalarios en Catalunya: un primer paso para la mejora de la seguridad del paciente / Epidemiology of the hospital adverse events in Catalonia, Spain: A first step for the patient safety improvement

Se ha documentado que los eventos adversos hospitalarios son una importante fuente de morbimortalidad en diferentes países y entornos. El objetivo de este estudio fue evaluar la frecuencia, magnitud, distribución y grado de preventibilidad de los eventos adversos en la comunidad autónoma de Catalunya (España). Se realizó un estudio de cohortes retrospectivo de 4.790 altas hospitalarias que fueron elegidas por muestreo aleatorio simple tras un muestreo polietápico estratificado en 15 hospitales de Catalunya. Un 38,25% de los pacientes presentó criterios positivos de riesgo (fase de cribado). Se identificaron 356 casos de eventos adversos, lo que representa un 7,4% (intervalo de confianza del 95%, 6,7-8,1). De estos, el 43,5% (155 casos) se consideraron prevenibles. Este estudio confirma que los eventos adversos en hospitales de Catalunya son frecuentes y generan un impacto considerable en morbimortalidad. Al igual que en otros estudios, se ha podido corroborar que una alta proporción de estos eventos adversos son considerados prevenibles. Se han podido identificar áreas prioritarias donde centrar esfuerzos de mejora (AU)

It has been published that hospital adverse events are an important source of morbidity and mortality in different countries and settings. The aim of this study was to evaluate the frequency, magnitude, distribution and degree of preventability of adverse events in the Autonomous Community of Catalonia (Spain). We conducted a retrospective cohort study of 4,790 hospital discharges that were selected by simple random sampling after stratified multistage sampling in 15 hospitals in Catalonia. 38.25% of patients had positive risk criteria (screening phase). We identified 356 cases of adverse events, which represent a 7.4% (95%CI: 6.7% to 8.1%). Of these, 43.5% (155 cases) were considered preventable. This study confirms that adverse events in hospitals in Catalonia are frequent, and generate a significant impact on morbidity and mortality. As in other studies, corroborated that a high proportion of these adverse events are considered preventable. It was possible to identify priority areas to focus improvement efforts (AU)

Implementación de un listado de verificación de prácticas seguras en cirugía: experiencia de la fase inicial de la puesta en marcha de un proyecto colaborativo en hospitales de Catalunya / A surgical safety checklist implementation: experience of a start-up phase of a collaborative project in hospitals of Catalonia, Spai

La seguridad en el paciente quirúrgico es un tema de alta prioridad en las estrategias de mejora de la calidad en atención sanitaria en los ámbitos nacional e internacional. El objetivo fue implementar una inte rvención colaborativa de múltiples componentes y evaluar su impacto en la aplicación de un listado de verificación quirúrgico (LVQ) de prácticas seguras en el paciente. Estudio prospectivo, longitudinal, multicéntrico, basado en la aplicación y seguimiento durante 7 meses en el año 2009 de una intervención colaborativa, para facilitar la implementación de un LVQ de 24 ítems distribuidos en 3 momentos de aplicación en el paciente quirúrgico, siendo estos los momentos de verificación preoperatoria (VP), pausa preoperatoria (PP) y verificación a la salida de quirófano (VS). Se adhirieron 27 hospitales a la estrategia. La implementación global fue del 48% (intervalo de confianza [IC] del 95%, 47,6-48,4). El cumplimiento de todos los ítems del LVQ para cada momento de aplicación fue de un 75,1% (IC del 95%, 73,5-76,7), un 77,1% (IC del 95%, 75,5-78,6) y un 88,3% (IC del 95%, 87,2-89,5) para la VP, la PP y la VS, respectivamente. El cumplimiento individual de cada ítem del LVQ se mantuvo por encima del 85%, excepto en la realización del marcaje, con un 67,4% (IC del 95%, 65,7-69,1) y un 71,2% (IC del 95%, 9,6-72,9) en la VP y PP, respectivamente. Se consiguió implementar el LVQ en el 48% de las cirugías en los hospitales participantes. El cumplimiento fue elevado y se mantuvo estable en el tiempo. Se identificaron estrategias para aumentar el alcance en el número de cirugías con aplicación del LVQ y más implicación de los profesionales en el cumplimiento de medidas tales como la realización del marcaje (AU)

Surgical patient safety is a priority in the national and international quality healthcare improvement strategies. The objective of the study was to implement a collaborative intervention with multiple components and to evaluate the impact of the patient surgical safety checklist (SSC) application. This is a prospective, longitudinal multicenter study with a 7-month follow-up period in 2009 based on a collaborative intervention for the implementation of a 24 item-SSC distributed in 3 different stages (sign in, time out, sign out) for its application to the surgical patient. A total number of 27 hospitals participated in the strategy. The global implementation rate was 48% (95%CI, 47.6%-48.4%) during the evaluation period. The overall compliance with all the items of the SSC included in each stage (sign in, time out, sign out) was 75,1% (95%CI, 73.5%-76.7%) for the sign in, 77.1% (95%CI, 75.5%-78.6%) for the time out and 88.3% (95%CI, 87.2%-89.5%) for the sign out respectively. The individual compliance with each item of the SSC has remained above 85%, except for the surgical site marking with an adherence of 67.4% (95%CI, 65.7%-69.1%)] and 71.2% (95%CI, 69.6%-72.9%)] in the sign in and time out respectively. The SSC was successfully implemented to 48% of the surgeries performed to the participating hospitals. The global compliance with the SSC was elevated and the intervention trend was stable during the evaluation period. Strategies were identified to allow of a higher number of surgeries with application of the SSC and more professional involvement in measures compliance such as surgical site marking (AU)

Estrategia para mejorar la práctica de higiene de manos en Catalunya / Intervention to improve hand hygiene compliance in Catalonia, Spain

La higiene de manos (HM) es la medida individual más importante y efectiva para reducir el riesgo de infecciones relacionadas con la atención sanitaria. Sin embargo, es habitual encontrar resultados de cumplimiento de las indicaciones de HM bajos entre los profesionales sanitarios. El principal objetivo de esta estrategia fue dar un nuevo impulso a la promoción de la HM en los hospitales y concienciar a los profesionales sobre la importancia de esta acción. La estrategia se planteó como un estudio de intervención multicéntrico para promover la HM en los centros sanitarios de Catalunya en el período 2009-2010. La intervención se basó en 4 grandes ejes: encuesta de barreras y facilitadores, difusión de material gráfico, formación a diferentes niveles y evaluación con indicadores. Con esta estrategia se alcanzó el 57% del número de camas de agudos de la red pública concertada y privada de la comunidad. La encuesta reveló que la formación era percibida como el principal aspecto facilitador de la práctica de HM. En el curso de formación online se registraron 15.376 profesionales. El cumplimiento global de las indicaciones de HM (basada en los "cinco momentos para la HM") fue del 56,45% en el área de agudos. Las acciones de promoción de HM llevadas a cabo en los últimos 4 años han ido aumentando el número de centros adheridos a esta estrategia de la Alianza para la Seguridad del Paciente en Catalunya. La formación online fue una de las intervenciones más bien valoradas por los profesionales para promover el conocimiento y cumplimiento de las indicaciones de HM. El indicador de cumplimiento de las indicaciones de HM parece seguir aumentando en los hospitales de Catalunya evaluados (AU)

Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated (AU)

Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña / Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain

Desde su creación en 2006, la Alianza para la Seguridad del Paciente ha tenido en Cataluña un papel muy destacado para impulsar y dar forma a una serie de proyectos relacionados con la estrategia del Ministerio de Sanidad, Servicios Sociales e Igualdad para la mejora de la seguridad del paciente. Uno de estos ha sido el proyecto de creación de unidades funcionales o comisiones de seguridad en los hospitales con el objetivo de facilitar la gestión de la seguridad del paciente. La estrategia se planteó en un determinado número de hospitales de Cataluña seleccionados en función de criterios de representatividad. La intervención se basó en 2 líneas de actuación: una, para enmarcar el modelo y otra, para su desarrollo. En el primer caso se definió la estrategia de gestión de la seguridad basada en el modelo EFQM (European Foundation for Quality Management) con la elaboración de estándares, objetivos e indicadores de seguridad que se proponía implementar, mientras que la segunda línea supuso la introducción de herramientas, metodologías y conocimientos como soporte a la gestión de la seguridad del paciente y a la prevención de riesgos. El proyecto se desarrolló en las 4 áreas del hospital consideradas de mayor riesgo, asumiendo cada una de ellas 6 objetivos de gestión de la seguridad. Algunos de estos objetivos, como el cuadro de mando o el sistema de notificación de eventos adversos, fueron compartidos por las 4 áreas. Se adhirieron al proyecto 23 hospitales de Cataluña. A pesar de las diferentes situaciones de cada centro se alcanzó un alto cumplimiento en el desarrollo de los objetivos. Se elaboró el cuadro de mando de seguridad en cada una de las áreas participantes. Se crearon o reforzaron estructuras estables para la gestión de la seguridad. La formación en seguridad del paciente, que tuvo un papel prioritario, llegó a 1.415 profesionales. A través de este tipo de proyectos no solo se introducen y desarrollan programas de efectividad contrastada en la reducción de riesgos, sino que se dota a los centros de una sistemática de trabajo que les permite la autonomía en el diagnóstico y análisis de las diferentes situaciones de riesgo o problemas de seguridad propios de cada centro (AU)

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues (AU)

Guías de práctica clínica y atención primaria. Informe SESPAS 2012 / Clinical practice guidelines and primary care. SESPAS report 2012

Las guías de práctica clínica pretenden servir de puente entre los niveles de decisión y las fuentes de conocimiento, ofreciendo a los decisores la mejor síntesis de la evidencia científica y un análisis del contexto, para proporcionar elementos de juicio y poder trasladar el conocimiento científico a la práctica clínica. Sin embargo, su impacto real en la asistencia sanitaria es variable y la efectividad a la hora de cambiar la práctica médica moderada. Estudios cualitativos y cuantitativos nos muestran que para la mayoría de los médicos de atención primaria las guías son una valiosa fuente de asesoramiento y formación, y creen que mejoran la calidad de la atención sanitaria. No obstante, subrayan su rigidez, la dificultad para aplicar a pacientes individuales y que su objetivo es reducir costes sanitarios. En España existen diversas experiencias en la elaboración de guías de práctica clínica, muchas de ellas dirigidas específicamente a atención primaria, siendo destacable el papel que en este sentido está jugando GuíaSalud. Pero la adecuada implementación de una guía de práctica clínica incluye no solamente la calidad y la rigurosidad de las evidencias utilizadas para desarrollarla, sino también la credibilidad de los profesionales y las organizaciones que la elaboran y otros factores contextuales, como características de los pacientes, de los proveedores y de las organizaciones o sistemas. Un importante paso en la investigación futura será desarrollar una mejor comprensión teórica sobre el cambio organizativo que se requiere para que los sistemas de gestión y los profesionales den la orientación adecuada a la implementación de las guías de práctica clínica (AU)

Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines (AU)

[Clinical practice guidelines and primary care. SESPAS report 2012]. / Guías de práctica clínica y atención primaria. Informe SESPAS 2012.

Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines.

[Clinical safety and patient oriented care: descriptive study of 113 Spanish hospitals and similarities in other European countries]. / Seguridad clínica y orientación al paciente: estudio descriptivo en 113 hospitales españoles y similitudes en otros países europeos.

OBJECTIVES: This study describes the stage of development of the Spanish acute care hospitals quality improvement systems. It also presents data on their achievement of some specific requirements related to clinical safety and patient oriented care. Additional data from seven other European countries are included, in order to provide a comparative reference for the analysis of results. MATERIAL AND METHODS: Cross-sectional descriptive study developed in acute care hospitals with more than 100 beds from 8 European countries. Data was gathered using an on-line questionnaire that had more than 500 close questions. In order to validate the responses, a sample of the hospitals that had answered the questionnaire received an evaluation by external assessors. RESULTS: A total of 113 public and private Spanish hospitals participated in the study, which represented 34% of the total group that met the inclusion criteria. Another 276 hospitals from 7 other countries also answered the questionnaire. The results associated with quality management, clinical safety and patient oriented care from both groups are presented. CONCLUSIONS: Improvements must be made in those areas where Spanish hospitals have a lower developmental level than the rest of the participating countries: public dissemination of results from external quality assessments, development of some key mechanisms to promote clinical safety and patient involvement in organisational management.

Seguridad clínica y orientación al paciente: estudio descriptivo en 113 hospitales españoles y similitudes en otros países europeos / Clinical safety and patient oriented care: descriptive study of 113 Spanish hospitals and similarities in other european countries

Objetivos: Describir el grado de desarrollo del sistema de mejora de calidad de los hospitales de agudos en España y la medida en que dan respuesta a algunos requisitos específicos de seguridad y orientación al paciente. Se presentan también datos agregados de otros 7 países de la Unión Europea, con el fin de disponer de datos de referencia que ayuden al análisis de resultados. Material y métodos: Estudio transversal descriptivo llevado a cabo en hospitales de agudos de más de 100 camas de 8 países europeos. La recogida de datos se realizó mediante un cuestionario compuesto por más de 500 preguntas cerradas, autoaplicado a través de internet, que posteriormente validaron evaluadores externos en una muestra por conveniencia de los centros participantes. Resultados: Participaron en el estudio 113 hospitales españoles públicos y privados, lo que representa un 34% de los que cumplen los criterios de inclusión. Además, 276 hospitales de otros 7 países respondieron al cuestionario. Se presentan los resultados de ambos grupos respecto al sistema de gestión de calidad, la seguridad y la orientación al paciente. Conclusiones: Se recomienda trabajar en las principales áreas en que los hospitales españoles tienen un grado de desarrollo menor que el de los demás países participantes: el acceso público a los datos de evaluaciones externas de calidad, la implantación de algunos mecanismos clave para la seguridad del paciente y la implicación del paciente en la gestión de la organización (AU)

Objectives: This study describes the stage of development of the Spanish acute care hospitals quality improvement systems. It also presents data on their achievement of some specific requirements related to clinical safety and patient oriented care. Additional data from seven other European countries are included, in order to provide a comparative reference for the analysis of results. Material and methods: Cross-sectional descriptive study developed in acute care hospitals with more than 100 beds from 8 European countries. Data was gathered using an on-line questionnaire that had more than 500 close questions. In order to validate the responses, a sample of the hospitals that had answered the questionnaire received an evaluation by external assessors. Results: A total of 113 public and private Spanish hospitals participated in the study, which represented 34% of the total group that met the inclusion criteria. Another 276hospitals from 7 other countries also answered the questionnaire. The results associated with quality management, clinical safety and patient oriented care from both groups a represented. Conclusions: Improvements must be made in those areas where Spanish hospitals have a lower developmental level than the rest of the participating countries: public dissemination of results from external quality assessments, development of some key mechanisms to promote clinical safety and patient involvement in organisational management (AU)

Sistemas de identificación de pacientes en hospitales de Cataluña / Patient identification systems in Catalonian hospitals

Objetivo: Conocer la situación actual del grado de implantación de los sistemas de identificación de los pacientes en los centros hospitalarios de agudos de Cataluña. Métodos: Encuesta enviada vía electrónica y dirigida a la dirección de enfermería de los hospitales de agudos de Cataluña sobre la utilización de sistemas de identificación de los pacientes, la implantación en los diferentes servicios hospitalarios y los datos utilizados en el sistema. Resultados: De los 75 centros estudiados un 90,7% declaró utilizar algún sistema de identificación de los pacientes. Solamente el 26,7% de los centros disponían de sistemas de identificación en todos los servicios de hospitalización. Los datos identificativos más frecuentemente utilizados en el sistema de identificación fueron: nombre y apellidos del paciente (100%), número de historia clínica (79,4%), fecha de nacimiento (67,6%) y número de cama (66,2%). El 77,3% de los centros utilizaban un único sistema de identificación de pacientes y el más frecuente fue el brazalete identificativo (85,3%). El uso del brazalete identificativo sólo estaba protocolizado en el 67,2% de los centros y el 50% refirió algún problema con su utilización. Conclusiones: Hay un buen nivel de implantación de los sistemas de identificación de los pacientes en Cataluña; sin embargo, es necesario promover una mayor utilización en todos los servicios hospitalarios y potenciar la protocolización de su uso, así como realizar un seguimiento de su cumplimiento

Objective: To know the current situation on the implementation of the patient identification systems in hospital centres in Catalonia. Methods: Interviews carried out with nurse managers of Catalonian hospitals on patient identification systems, implementation in the different hospital services and data used in the system. Results: Of the 75 centres studied, 90.7% used some kind of patient identification system. Only 26.7% of the interviewed centres had patient identification systems in all its hospital services. The most used identity data were patient name and surname (100%), clinical history number (79.4%), birth date (67.6%) and bed number (66.2%). 77.3% of the centres used only one patient identification system, and the most used was the wristband (85.3%). A wristband identification protocol was used in only 67.2% of the centres and 50% of all the centres had some problem with its use. Conclusions: There is good level of implementation of patient identification systems in Catalonia, nevertheless greater use of these systems and their standardisation needs to be promoted in all hospital services, as well as continuously monitoring compliance

[Not Available]. / Sistemas de identificación de pacientes en hospitales de Cataluña.

OBJECTIVE: To know the current situation on the implementation of the patient identification systems in hospital centres in Catalonia. METHODS: Interviews carried out with nurse managers of Catalonian hospitals on patient identification systems, implementation in the different hospital services and data used in the system. RESULTS: Of the 75 centres studied, 90.7% used some kind of patient identification system. Only 26.7% of the interviewed centers had patient identification systems in all its hospital services. The most used identity data were patient name and surname (100%), clinical history number (79.4%), birth date (67.6%) and bed number (66.2%). 77.3% of the centres used only one patient identification system, and the most used was the wristband (85.3%). A wristband identification protocol was used in only 67.2% of the centres and 50% of all the centres had some problem with its use. CONCLUSIONS: There is good level of implementation of patient identification systems in Catalonia, nevertheless greater use of these systems and their standardisation needs to be promoted in all hospital services, as well as continuously monitoring compliance.

Derechos de los pacientes en los principales sistemas de acreditación hospitalaria / Patients’ rights in the main healthcare accreditation systems

Objetivo: Analizar cómo se abordan los derechos de los pacientes en los principales sistemas de acreditación del mundo. Material y método: Estudio de los principales sistemas de acreditación hospitalaria existentes, empleando una metodología cualitativa de análisis de textos. Los estándares de derechos de pacientes de los distintos sistemas de acreditación son agrupados según el tema que tratan. Se establecen 9 temas principales: Información al paciente, Intimidad, trato y apoyo emocional, Protección del paciente, Protección de la autonomía, Donación de órganos, Código de derechos del paciente, Expresión de quejas y reclamaciones, Ética de la organización y Nuevos derechos. Resultados: No todos los sistemas de acreditación estudiados incluyen un capítulo sobre derechos de los pacientes. A pesar de las diferencias observadas en la cobertura que los sistemas de acreditación dan a los derechos de los pacientes, tanto por la profundidad de su análisis como por los aspectos concretos que cubren los estándares, todos los sistemas de acreditación estudiados tratan este tema, aunque no sea en forma de un capítulo independiente. Conclusiones: En la revisión realizada se evidencia la creciente importancia del tema de los derechos de los pacientes en los sistemas de acreditación

Objective: To analyze how the world's main healthcare accreditation systems approach issues concerning patients' rights. Material and method: The main hospital accreditation systems were studied, using a qualitative methodology for text analysis. Patients' rights standards from several accreditation systems were grouped and organized on the basis of the subject they covered. Nine main subjects of study were established: patient information, privacy, care and emotional support, patient protection, protection of autonomy, organ donation, code of patients' rights, expression of complaints and legal claims, the organization's code of ethics, and new rights. Results: Not all the accreditation systems studied include a chapter on patients' rights. Despite the differences observed in the way accreditation systems cover issues concerning patients' rights, both in the depth of their analysis and in the specific aspects covered by the standards, all the accreditation systems studied cover this issue, although not always in an independent chapter. Conclusions: The review performed illustrates the growing importance of issues concerning patients' rights in accreditation systems

Los sistemas de registro y notificación de efectos adversos y de incidentes: una estrategia para aprender de los errores / Systems for registering and reporting adverse events and incidents: a strategy for learning from mistakes

La necesidad de buscar estrategias de prevención y promoción de la seguridad de los pacientes ha estimulado a los países a desarrollar herramientas que permitan el mejor conocimiento de la producción de eventos adversos. Entre ellas destacan los sistemas de registro y notificación de efectos adversos. El objetivo de este artículo es examinar los sistemas de notificación existentes, describir los modelos desarrollados por los países con más tradición en el diseño de estrategias de promoción y prevención de la seguridad, y determinar aspectos necesarios a abordar para el desarrollo de futuros sistemas de notificación de efectos adversos. Los sistemas de notificación y registro de efectos adversos fueron creados en el ámbito no sanitario, con el objetivo de poder agrupar datos referentes a incidentes (sin daño) o accidentes (con daño) y poder establecer un perfil de los problemas más frecuentes en la organización, y generar una fuente de aprendizaje de los errores. Existen distintos tipos de sistemas de notificación; sin embargo, con independencia del sistema de notificación que se utilice, su aplicación y su desarrollo implican beneficios para las organizaciones, ya que involucran oportunidades de modelización de los efectos, monitorización, aumento de la concienciación de los problemas de seguridad y utilización más eficiente de recursos. Es necesario revisar y diseñar nuevas estrategias para aumentar el compromiso de los profesionales en la notificación de errores. Se deben también analizar barreras legales y organizacionales que dificultan su implantación

The need to find strategies of error prevention and promotion of patient safety has stimulated countries to develop models that improve knowledge of adverse events. One of the tools used are reporting systems for gathering information about errors. To review existing reporting systems, to describe the models developed by the countries with the longest tradition in designing strategies for the promotion of patient safety and prevention of adverse events and to determine the factors required for the development of future reporting systems. Adverse event reporting systems were created in nonmedical fields, with the aim of collecting information relating to near-misses (without harm) or accidents (with harm). This information was used to establish a profile of the most frequent problems in an organization and to understand the factors that contribute to errors. There are different types of reporting systems. Nevertheless, independently of the reporting system used, their application and development benefits the organization since they generate opportunities for modeling events, monitoring, increasing awareness of safety problems and more efficient resource use. New strategies should be designed to increase health professionals' commitment to reporting adverse events. Legal and organizational barriers that hamper their implementation should be analyzed