Surgery Is in Itself a Risk Factor for the Patient.

(1) Background: Adverse events (AE) affect about 1 in 10 hospitalised patients, and almost half are related to surgical care. The aim of this study is to determine the prevalence of AE in operated and non-operated patients in surgical departments in order to determine whether surgical treatment is a risk factor for AE. (2) Methods: A cross-sectional design that included 3123 patients of 34 public hospitals in the Community of Madrid determining the prevalence of AEs in operated and non-operated patients in surgical departments. (3) Results: The prevalence of AE in non-operated patients was 8.7% and in those operated was 15.8%. The frequency of AE was higher in emergency surgery (20.6% vs. 12.4%). The 48.3% of AEs led to an increase in hospital stay, and surgery was involved in 92.4% of cases. The most frequent AEs were related to hospital-acquired infection (42.63%), followed by those related to a procedure (37.72%). In the multivariate analysis, being operated on represented 2.3 times the risk of developing an AE. (4) Conclusions: Surgical sites are particularly vulnerable to AE. Surgical intervention alone is a risk factor for AE, and we must continue to work to improve the safety of both patient care and the working environment of surgical professionals.

Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study.

OBJECTIVE: To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability. DESIGN: Prospective cohort study with isolated and non-isolated patients. SETTING: One public university hospital in the Valencian Community (southeast Spain). PARTICIPANTS: We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. EXCLUSION CRITERIA: patients age <18 years old and/or reverse isolation patients. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated. RESULTS: The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients). CONCLUSIONS: AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.

Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness.

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.

SOBRINA Spanish study-analysing the frequency, cost and adverse events associated with overuse in primary care: protocol for a retrospective cohort study.

INTRODUCTION: Several institutions and quality national agencies have fostered the creation of recommendations on what not to do to reduce overuse in clinical practice. In primary care, their impact has hardly been studied. The frequency of adverse events (AEs) associated with doing what must not be done has not been analysed, either. The aim of this study is to measure the frequency of overuse and AEs associated with doing what must not be done (commission errors) in primary care and their cost. METHODS AND ANALYSIS: A coordinated, multicentric, national project. A retrospective cohort study using computerised databases of primary care medical records from national agencies and regional health services will be conducted to analyse the frequency of the overuse due to ignore the do-not-do recommendations, and immediately afterwards, depending on their frequency, a representative random sample of medical records will be reviewed with algorithms (triggers) that determine the frequency of AEs associated with these recommendations. Cost will determine by summation of the direct costs due to the consultation, pharmacy, laboratory and imaging activities according to the cases. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of Primary Care Research of the Valencian Community. We aim to disseminate the findings through international peer-reviewed journals and on the website (http://www.nohacer.es/). Outcomes will be used to incorporate algorithms into the electronic history to assist in making clinical decisions. TRIAL REGISTRATION NUMBER: NCT03482232; Pre-results.

[Patient Safety Culture and teaching: an ins- trument to evaluate knowledge and perceptions among different health professionals of the Madrid Region health system]. / Cultura de Seguridad del Paciente y Docencia: un instrumento para evaluar conocimientos y percepciones en profesionales del sistema sanitario de la Comunidad de Madrid

OBJECTIVE: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. METHODS: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Be- fore each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (greater than or equal to 75% of positive evaluations) and opportunities for improvement (greater than or equal to 50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. RESULTS: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. CONCLUSIONS: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations.

OBJETIVO: La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP. METODOS: Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/ acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (mayor o igual al 75% de valoraciones positivas) y oportunidades de mejora (mayor o igual al 50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción. RESULTADOS: El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10. CONCLUSIONES: La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones.

Cultura de Seguridad del Paciente y Docencia: un instrumento para evaluar conocimientos y percepciones en profesionales del sistema sanitario de la Comunidad de Madrid / Patient Safety Culture and teaching: an instrument to evaluate knowledge and perceptions among different health professionals of the Madrid Region health system

Fundamentos: La cultura de seguridad del paciente (CSP) en las instituciones sanitarias depende de diversos factores organizativos y humanos. Nuestro objetivo fue evaluar, como estrategia docente, los conocimientos y percepciones sobre la CSP. Métodos: Muestra de conveniencia, con 122 profesionales sanitarios y no sanitarios, que asistieron en 2015 a cursos sobre seguridad del paciente organizados por la Consejería de Sanidad de Madrid. Antes de cada curso, autocompletaron un cuestionario de conocimientos sobre seguridad del paciente (elaboración propia) y otro cuestionario validado sobre CSP (estimando 3 dimensiones: apoyo directivo, percepción de seguridad y expectativas/acciones). Las valoraciones sobre la CSP se recategorizaron en positivas, negativas y neutras, identificando fortalezas (≥75% de valoraciones positivas) y oportunidades de mejora (≥50% de valoraciones negativas). Al finalizar cada curso, cumplimentaron un cuestionario anónimo de satisfacción. Resultados: El 60% respondió correctamente a las preguntas sobre conocimientos en seguridad del paciente, identificando áreas de mejora en prácticas seguras (higiene de manos y microorganismos resistentes a antibióticos, con 66% y 61% de respuestas incorrectas, respectivamente), y en gestión de riesgos sanitarios (investigación e identificación de eventos adversos, con el 62% y 56% de respuestas incorrectas, respectivamente). El 80% consideró positiva la CSP institucional, y la percepción de seguridad como oportunidad de mejora (63,9% de valoraciones negativas). Así, el 88% reconocía preocuparse por la seguridad del paciente sólo tras incidentes adversos, y el 65% sentía miedo a hablar sobre estos. La satisfacción con la metodología docente fue de 9,3 puntos sobre 10. Conclusiones: La valoración global de la CSP fue mayoritariamente positiva, identificándose áreas de mejora específicas utilizadas como estrategia docente para ilustrar conceptos, motivar a los participantes y sugerir estrategias de intervención para mejorar la cultura de seguridad del paciente en nuestras organizaciones

Background: The patient safety culture (PSC) in health institutions depends on various organizational and human factors. Our aim was to evaluate, as a teaching strategy, the knowledge in patient safety and perceptions about the PSC. Methods: A convenience sample, with 122 health professionals from Regional Minister of Health's patient safety courses attendees in 2015. Before each course, were delivered a knowledge questionnaire about patient safety (own elaboration) and a validated PSC questionnaire (estimating 3 dimensions: managerial support, perception of safety and expectations / actions). Valuations on CSP were recategorized in positive, negative and neutral, identifying strengths (≥75% of positive evaluations) and opportunities for improvement (≥50% of negative evaluations). At the end of each course an anonymous satisfaction questionnaire was delivered. Results: 60% responded correctly to questions about knowledge in patient safety, identifying areas for improvement in safe practices (hand hygiene and microorganisms resistant to antibiotics, with 66% and 61% of incorrect answers, respectively), and in management of health risks (investigation and identification of adverse events, with 62% and 56% of incorrect answers, respectively). 80% considered the institutional PSC positive, and the perception of safety as an opportunity for improvement (63.9% of negative evaluations). Thus, 88% admitted worrying about patient safety only after adverse incidents, and 65% felt afraid to talk about them. The satisfaction with the teaching methodology was 9.3 points out of 10. Conclusions: The overall assessment of PSC was mostly positive, identifying specific areas for improvement that allowed orienting the training in patient safety, motivating the participants and suggesting intervention strategies to improve patient safety in our organizations

Comparison of two methods to estimate adverse events in the IBEAS Study (Ibero-American study of adverse events): cross-sectional versus retrospective cohort design.

BACKGROUND: Adverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs. OBJECTIVES: The aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design. SETTING: Secondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru. PARTICIPANTS: The IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population. METHODS: This study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study. RESULTS: The prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk. CONCLUSION: The retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.

Evaluación de la implantación de un bundle para la prevención de la infección de localización quirúrgica en artroplastia de rodilla y cadera en un hospital universitario / No disponible

Objetivo: Analizar el resultado de la implantación de un Bundle para la prevención de infección de localización quirúrgica (ILQ) en artroplastia de rodilla y cadera. Material y métodos: Estudio de intervención antes-después. Intervención: Bundle. Determinaciones: incidencia acumulada (IA) de ILQ y cumplimiento del Bundle. La medición de la IA de ILQ se realizó mediante un sistema de vigilancia prospectiva y la medición del cumplimiento del Bundle mediante la revisión de historias clínicas. Resultados: En 2012 la IA de ILQ fue del 4,4% frente a 1,6% en 2013. El Bundle se implantó en 2013, para el cumplimiento se revisó una muestra aleatoria del 33% de los pacientes intervenidos de prótesis de rodilla y cadera ese año. El cumplimiento de cada medida fue variable. Conclusiones: Se ha evidenciado una reducción de la ILQ coincidente con la puesta en marcha del Bundle. Se han identificado puntos críticos de incumplimiento y tomado medidas para su mejora

Objetivo: Analyze the result of the implantation of a Bundle for the prevention of surgical site infection (SSI) in knee and hip arthroplasty. Material y métodos: Intervention study before-after. Intervention: Bundle. Determinations: cumulative incidence (CI) of patients with SSI and Bundle compliance. The measurement the CI of SSI was made through a prospective vigilance system and the measurement of the Bundle compliance through a review of the medical histories. Results: In 2012, CI of SSI was 4,4% versus 1,6% in 2013. The Bundle was implanted in 2013, to size the compliance was revised a random sample of 33% of the patients who received knee and hip prosthesis that year. The compliance of each measurement varied.Conclusions: A reduction of the SSI coinciding with the commissioning of the Bundle has been evidenced. Critical points of failure were identified and measures have been implemented

Infección cutánea por Staphylococcus aureus resistente a meticilina de origen comunitario con transmisión intrafamiliar / Skin infection by community-acquired methicillin resistant Staphylococcus aureus with familial transmission

No disponible

Diseño de una estrategia multimodal incluyendo marketing sanitario para la mejora del cumplimiento de la higiene de manos / Design of a multimodal strategy including health marketing for the improvement of hand hygiene fulfillment

No disponible

Factores asociados a la adherencia en el tratamiento de la infección tuberculosa / Factors associated with treatment adherence for tuberculosis infection

OBJETIVO: Analizar la adherencia al tratamiento de la infección tuberculosa (TIT) e identificar los factores de riesgo para su cumplimiento. DISEÑO: Estudio observacional de cohortes históricas. Emplazamiento: Hospital Universitari Sant Joan d'Alacant (Alicante). Participantes: Todos los sujetos con una prueba de tuberculina (PT) realizada durante el estudio de contactos (EC) de tuberculosis durante 6 años. RESULTADOS: Se incluyeron en el análisis 764 contactos. El 59,7% de los 566 pacientes que terminaron el EC presentaron infección tuberculosa (IT). De los pacientes con IT, el 45,6% no iniciaron tratamiento y los factores asociados fueron: edad (36-65 años; RR: 5,8; IC 95%: 1,2-27,5 y > 65 años; RR: 11,3; IC 95%: 2,0-64,0), relación social con el caso índice de tuberculosis (RR: 2,2; IC 95%: 1,2-3,8) e induración de la PT (≥ 15 mm; RR: 0,5; IC 95%: 0,3-0,9). La tasa de cumplimiento fue del 80,4% entre los que comenzaron el TIT. La pauta de tratamiento 7-9H se asoció con mayor cumplimiento del TIT (RR: 12,7; IC 95%: 1,5-107,3). CONCLUSIONES: La tasa de cumplimiento del TIT fue elevada entre los que iniciaron tratamiento. Casi la mitad de los contactos con IT no iniciaron tratamiento y los factores asociados fueron: edad, relación social e induración de la PT. La pauta de tratamiento se asoció con mayor cumplimiento. Debemos conocer con precisión los factores asociados a la adherencia al tratamiento de la IT en cada área de salud y actuar sobre los grupos de riesgo, y de esta manera aproximar el control global de la tuberculosis

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. Setting: Hospital Universitari Sant Joan d'Alacant (Alicante). Participants: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6%had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥15 mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis

[Factors associated with treatment adherence for tuberculosis infection]. / Factores asociados a la adherencia en el tratamiento de la infección tuberculosa.

OBJECTIVE: To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. DESIGN: An observational historical cohort study. SETTING: Hospital Universitari Sant Joan d'Alacant (Alicante). PARTICIPANTS: All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. RESULTS: We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6% had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥ 15mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). CONCLUSIONS: The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis.

Efectos adversos prehospitalarios: un camino por recorrer / Pre-hospital adverse events: a way to go

AntecedentesLa ocurrencia de efectos adversos (EA) es un problema presente en todos los niveles asistenciales y genera una carga importante de morbimortalidad. En España se han realizado 2 estudios nacionales de EA: uno en hospitales y otro en atención primaria; sin embargo, aún no se han estudiado aquellos EA que detectados durante un proceso de hospitalización hubieran tenido su origen en una atención sanitaria previa. El objetivo de este estudio es conocer las características de los pacientes con EA y la frecuencia, naturaleza, evitabilidad, gravedad e impacto de los EA prehospitalarios que se detectaron en la hospitalización índice, y comparar los de origen ambulatorio y los de origen no ambulatorio.MétodoEstudio de serie de casos, con componentes analíticos, de una muestra de sujetos incluidos en el Estudio Nacional de Efectos Adversos ligados a la Hospitalización (ENEAS). Los datos cualitativos se presentan como proporciones con su intervalo de confianza (IC). Para el análisis comparativo de datos cualitativos, se utilizó el test de χ2.ResultadosDe un total de 5.624 pacientes, un 2,3% (n=131) (IC del 95%: 1,94–2,72) presentó algún EA prehospitalario, y de éstos, en el 40,5% (n=53) (IC del 95%: 32,05–48,86) el EA fue evitable. En 44 pacientes el origen del EA fue ambulatorio y en 85 pacientes el origen fue no ambulatorio.ResultadosLos pacientes con EA ambulatorio son mujeres de edad avanzada y hombres de mediana edad que consultan por problemas médicos y el EA suele estar relacionado con la utilización de medicamentos. Los pacientes con EA no ambulatorio con mayor frecuencia son hombres de edad avanzada, que ingresan en servicios tanto médicos como quirúrgicos y los EA están relacionados, además de con los medicamentos, con las infecciones nosocomiales y los procedimientos...(AU)

BackgroundThe occurrence of adverse events is a problem at all levels of care and creates a significant burden of morbidity and mortality. In Spain there have been significant investigations of adverse effects (AE) in hospitals and primary care, however, studies of pre-hospital care are not yet developed. The aim of this study was to determine the frequency, type, preventability, severity and impact of “pre-hospital” adverse events, which were detected in the hospitalization index and the comparing those that occurred in ambulatory and non-ambulatory care.MethodCase Series Study, with analytical components, of a sample of subjects included in the “National study of adverse events related to hospitalization (ENEAS). Qualitative data are presented as proportions with confidence intervals. For comparative analysis of qualitative data, we used the chi-square test.ResultsOf a total of 5624 patients, 2.3% (N=131) (95%CI: 1.94–2.72) had an AE that occurred prior to hospitalization or “pre-hospital”, and 40.5% of these (N=53) (95%CI: 32.05–48.86) were preventable. In 44 patients the AE had its origin in ambulatory care and 85 patients in non-ambulatory care.ResultsThe characteristic of patients with ambulatory AE are men and older women (median 76 years) who consulted for medical problems (84.1%) and the AE were related to medication in 77.8%. The characteristic of patients with non-ambulatory AE, were men (median 73 years), consulting for medical and surgical problems (44,7–55,3%) and the EA is related to medications, infections and procedures.ConclusionsThe characteristics of patients with AE and undesirable effects that occurred during pre-hospitalization period depended on whether they originated during ambulatory care or non-ambulatory care. Therefore prevention strategies should take these differences into account(AU)

[Pre-hospital adverse events: a way to go]. / Efectos adversos prehospitalarios: un camino por recorrer.

BACKGROUND: The occurrence of adverse events is a problem at all levels of care and creates a significant burden of morbidity and mortality. In Spain there have been significant investigations of adverse effects (AE) in hospitals and primary care, however, studies of pre-hospital care are not yet developed. The aim of this study was to determine the frequency, type, preventability, severity and impact of "pre-hospital" adverse events, which were detected in the hospitalization index and the comparing those that occurred in ambulatory and non-ambulatory care. METHOD: Case Series Study, with analytical components, of a sample of subjects included in the "National study of adverse events related to hospitalization (ENEAS). Qualitative data are presented as proportions with confidence intervals. For comparative analysis of qualitative data, we used the chi-square test. RESULTS: Of a total of 5624 patients, 2.3% (N=131) ((95%)CI: 1.94-2.72) had an AE that occurred prior to hospitalization or "pre-hospital", and 40.5% of these (N=53) ((95%)CI: 32.05-48.86) were preventable. In 44 patients the AE had its origin in ambulatory care and 85 patients in non-ambulatory care. The characteristic of patients with ambulatory AE are men and older women (median 76 years) who consulted for medical problems (84.1%) and the AE were related to medication in 77.8%. The characteristic of patients with non-ambulatory AE, were men (median 73 years), consulting for medical and surgical problems (44,7-55,3%) and the EA is related to medications, infections and procedures. CONCLUSIONS: The characteristics of patients with AE and undesirable effects that occurred during pre-hospitalization period depended on whether they originated during ambulatory care or non-ambulatory care. Therefore prevention strategies should take these differences into account.

[Adverse events in general and digestive surgery departments in Spanish hospitals]. / Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles.

OBJECTIVE: To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. MATERIAL AND METHOD: We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. RESULTS: The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P< .001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P< .001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. CONCLUSIONS: Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority.