ABSTRACT
Objective: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators.DesignA prospective, observational and non-intervention cohort study was carried out.SettingA 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital.PatientsAll IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study.Main measurementsDemographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT.ResultsA total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable.ConclusionsAfter the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents (AU)
Objetivo: Analizar los incidentes relacionados con la seguridad del paciente (IRSP) durante los traslados intrahospitalarios (TIH) del paciente crítico tras la aplicación de un protocolo, así como sus factores de riesgo. Evaluar la seguridad durante los traslados mediante indicadores de calidad.DiseñoEstudio de cohorte, prospectivo, observacional y no intervencionista.ÁmbitoUnidad de Cuidados Intensivos (UCI) polivalente de 10 camas de un hospital universitario de segundo nivel.PacientesSe incluyen todos los TIH de pacientes críticos realizados de UCI a pruebas diagnósticas y a quirófano entre marzo de 2011 y marzo de 2017.Principales variables del estudioVariables demográficas, gravedad de los pacientes, prioridad del traslado, momento del día, motivo y tipo de equipo del traslado. Se recogen comprobaciones pre-traslado e IRSP. Análisis semestral de indicadores de calidad diseñados para el TIH.ResultadosDe los 805 traslados registrados, la mayoría urgentes (53,7%) y para pruebas diagnósticas (77%), 112 traslados (13,9%) presentaron algún tipo de IRSP, 54% relacionado con el equipamiento y 30% con el equipo y la organización. En 19 (2,4%) traslados se produjeron eventos adversos. En el análisis multivariante los factores de riesgo fueron la ventilación mecánica y el equipo que realiza el traslado. La evolución de los indicadores relacionados con los traslados es significativamente favorable.ConclusionesTras la aplicación de un protocolo de TIH, los IRSP son bajos y el principal factor de riesgo es la ventilación mecánica invasiva. La experiencia del equipo que realiza el TIH influye en la detección de un mayor número de incidentes (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Intensive Care Units , Patient Transfer/standards , Patient Safety , Prospective Studies , Cohort StudiesABSTRACT
OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
Subject(s)
Intensive Care Units , Patient Safety , Cohort Studies , Hospitals , Humans , Prospective StudiesABSTRACT
OBJECTIVE: To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN: A prospective, observational and non-intervention cohort study was carried out. SETTING: A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS: All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS: Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS: A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS: After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
ABSTRACT
OBJECTIVE: To assess the indications, settings and techniques used in renal replacement therapy (RRT) in Intensive Care Units (ICUs). STUDY DESIGN: A prospective, multicenter observational study was carried out. SETTING: Intensive Care Units. PATIENTS: All patients admitted to ICUs during the two-month study period in 2011 who required RRT. INTERVENTIONS: None. VARIABLES OF INTEREST: Patient demographic characteristics, baseline clinical data, RRT technique and materials used. RESULTS: Thirty-three patients were analyzed. RRT was started within the first 24hours after ICU admission in 17 of the 33 patients (52%). At the start of RRT, 18% of the patients (n=6) presented grade R on the RIFLE acute kidney injury (AKI) scale. The most common disorder associated with AKI was multiple organ dysfunction syndrome (64%; n=21). At the start of RRT, most patients (76%; n=25) presented hemodynamic instability, while the remaining 24% (n=8) were considered hemodynamically stable. The most common RRT technique in hemodynamically stable patients was continuous renal replacement therapy (CRRT) (63%; n=5). CRRT was the technique of choice in all 25 of the hemodynamically unstable patients (100%). Anticoagulation was used in 55% (n=18) of the patients. In most cases (61%, n=20), RRT was administered through the right femoral vein. In 84% (n=28) of the patients, the ultrafiltration effluent flow rate was ≤ 35ml/kg/h. CONCLUSIONS: The ICU physicians in this study followed current RRT guidelines. CRRT was preferred over intermittent renal replacement therapy, regardless of patient hemodynamic status.
Subject(s)
Acute Kidney Injury/therapy , Critical Care/methods , Intensive Care Units , Renal Replacement Therapy/methods , Acute Kidney Injury/blood , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Aged , Anticoagulants/therapeutic use , Creatinine/blood , Female , Hemodiafiltration/statistics & numerical data , Hemodynamics , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/complications , Prospective Studies , Renal Replacement Therapy/statistics & numerical data , Severity of Illness Index , Spain , Time-to-TreatmentABSTRACT
Objetivo: Realizar un revisión bibliográfica sobre la información de incidentes y eventos adversos a pacientes y familiares, así como revisar las principales políticas, guías institucionales y aspectos legales relacionados con dicho proceso. Material y método: Se consultaron diferentes fuentes electrónicas y en papel y se utilizó Pub-med como motor de búsqueda principal. Resultados: El sistema sanitario debe buscar la manera de cubrir las necesidades y expectativas de los pacientes cuando ocurre un evento adverso a través del cuidado, soporte emocional e información relativa al evento. Las guías éticas y profesionales establecen la responsabilidad de los profesionales y de las instituciones de desvelar los errores cometidos durante la atención sanitaria. Existen muchas barreras que dificultan llevar a cabo este complejo proceso. La formación de los profesionales y el desarrollo de guías institucionales pueden favorecer el cumplimiento. Los aspectos legales deben ser abordados a nivel local y evaluar el impacto real de un desarrollo legislativo específico sobre la efectividad del proceso. Conclusión: En nuestro ámbito no existen recomendaciones específicas en relación a la información a pacientes y familiares sobre eventos adversos. Se requieren propuestas consensuadas que den respuesta de forma científica y multidisciplinar a esta cuestión con importantes connotaciones tanto éticas como legales (AU)
Objective: Perform a literature review on incidents and adverse events open disclosure to patients and relatives, as well as to review major policies, institutional guides and legal aspects related to this process. Material and method: Different electronic and paper sources were consulted; Pub-med was used as main search engine. Results: The health system must find a way of meeting the needs and expectations of patients, emotional support and information on the event when an adverse event occurs through care. Ethical and professional guidelines set out the professionals and institutions responsibility of revealing the mistakes made during the health care. There are many barriers that make it difficult to carry out this complex process. The training of professionals and the development of institutional guides can encourage compliance. The legal aspects should be dealt with at local level and to assess the real impact of a specific legislative development on the effectiveness of the process. Conclusion: In our area, there are no specific recommendations in relation to the adverse event information to patients and relatives. Required consensus proposals that respond in a scientific and multidisciplinary manner to this question with important connotations both ethical and legal (AU)
Subject(s)
Humans , Male , Female , Access to Information , Information Dissemination/ethics , Information Dissemination/methods , 51835/adverse effects , 51835/methods , Patient Safety/statistics & numerical data , Patient Safety/standards , Medical Errors/prevention & control , Medical Errors/statistics & numerical data , Medical Errors/trends , Practice Management, Medical/standards , Practice Management, Medical , Patient Safety/legislation & jurisprudence , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/organization & administrationABSTRACT
El síndrome de la embolia grasa es una entidad frecuente en las Unidades de Cuidados Intensivos (UCI). En el caso del paciente politraumatizado con afectación neurológica, lo habitual es que la lesión neurológica sea por el propio traumatismo craneal, pero en algunos casos es secundario al síndrome de la embolia grasa, incluso pueden asociarse. Ante todo paciente politraumatizado que presente un deterioro neurológico conviene establecer un diagnóstico precoz.En ocasiones las pruebas neurorradiológicas habituales no muestran alteraciones en este síndrome de la embolia grasa cerebral. Recientemente hemos tenido ocasión de asistir a dos pacientes polifracturados que presentaron una sintomatología compatible con embolismo graso cerebral, siendo la tomografía computarizada (TC) normal en ambos casos. Para corroborar la sospecha diagnóstica se realizó una gammagrafía cerebral tomográfica (SPECT = Photon Single Emission Computed Tomography) que fue claramente demostrativa de lesión cerebral, sugiriendo que es una exploración a tener en cuenta en el diagnóstico y control evolutivo del embolismo graso cerebral. (AU)
