Adverse events: an expensive and avoidable hospital problem.

INTRODUCTION: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. METHODS: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. RESULTS: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. CONCLUSIONS: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messagesAdverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting.

OBJECTIVE: This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care. METHODS: A retrospective cohort study analyzing the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed. RESULTS: A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval [CI], 71.0%-74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 [5.3%]; 95% CI, 4.1%-6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%-6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%-9.1%). In adult patients, the majority of AAEs (51/901 [5.7%]; 95% CI, 4.2%-7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 [51.9%]; 95% CI, 38.5%-65.2%) and pediatric patients (15/15 [100%]). CONCLUSIONS: These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised. TRIAL REGISTRATION NUMBER: NCT03482232.

Eventos adversos evitables en atención primaria. Estudio retrospectivo de cohortes para determinar su frecuencia y gravedad / Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity

OBJETIVO: Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP). DISEÑO: Estudio retrospectivo de cohortes. Emplazamiento: consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana. PARTICIPANTES: Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres. Mediciones principales: Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019. RESULTADOS: Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p = 0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos. CONCLUSIONES: Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto

OBJECTIVE: To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC). DESIGN: Retrospective cohort study. LOCATION: Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia. PARTICIPANTS: A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients. MAIN MEASUREMENTS: Number and severity of identified AAEs from February 2018 to September 2019. RESULTS: A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients. CONCLUSIONS: Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults

Análisis de la cultura de seguridad del paciente en un hospital universitario / Analysis of the patient safety culture in a university hospital

OBJETIVO: 1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus fortalezas y debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras. MÉTODO: Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español. RESULTADOS: La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente). CONCLUSIONES: La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad

OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception

Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse / Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes. MATERIAL Y MÉTODOS: Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España. RESULTADOS: Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana. CONCLUSIÓN: En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. / Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse.

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.

[Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity]. / Eventos adversos evitables en atención primaria. Estudio retrospectivo de cohortes para determinar su frecuencia y gravedad.

OBJECTIVE: To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC). DESIGN: Retrospective cohort study. LOCATION: Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia. PARTICIPANTS: A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients. MAIN MEASUREMENTS: Number and severity of identified AAEs from February 2018 to September 2019. RESULTS: A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients. CONCLUSIONS: Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.

[Analysis of the patient safety culture in a university hospital]. / Análisis de la cultura de seguridad del paciente en un hospital universitario.

OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception.

Recomendaciones para la recuperación de las segundas víctimas del SARS-CoV-2 / No disponible

OBJETIVO: Enunciar un conjunto de recomendaciones para incrementar la resiliencia de las organizaciones y los profesionales sanitarios frente al impacto de la crisis ocasionada por la pandemia de SARS-CoV-2. MÉTODO: Estudio cualitativo para la búsqueda de consenso con participación de 30 profesionales de diferentes disciplinas (medicina preventiva, calidad asistencial, seguridad del paciente, atención primaria, psiquiatría y psicología). Principales resultados: Tras la identificación de las principales fuentes de estrés y la definición de los objetivos de la fase de recuperación, se consensuaron un total de 17 recomendaciones, 13 de ellas con foco organizacional y las cuatro restantes, centradas en profesionales. CONCLUSIONES: La recuperación del sistema sanitario tras la pandemia por la COVID19 pasa por restaurar la moral y el bienestar de sus profesionales, de lo contrario la calidad asistencial y la seguridad de los pacientes se verán comprometidas. Estas recomendaciones pretenden ser un punto de partida en esta dirección

OBJECTIVE: To provide a set of recommendations to increase the resilience of health care organizations and professionals to the impact of the SARS-CoV-2 pandemic crisis. METHOD: Consensual qualitative study with the participation of 30 professionals from different disciplines (preventive medicine, quality of care, patient safety, primary care, psychiatry and psychology). MAIN RESULTS: After the identification of the main sources of stress and the definition of the objectives of the recovery phase, a total of 17 recommendations were agreed upon, 13 of them with an organizational focus and the remaining four focused on professionals. CONCLUSIONS: The recovery of the health system after the COVID19 pandemic requires restoring the morale and well-being of its professionals, otherwise the quality of care and patient safety will be compromised. These recommendations are intended as a starting point in this direction

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.

Análisis de la implantación de un sistema de notificación y registro de eventos adversos en el proceso asistencial de una mutua de accidentes de trabajo / Analysis of a register for reporting adverse events to a mutual insurance society for accidents at work. Adverse event reporting of occupational injuries

Objetivos. Describir los resultados de un sistema voluntario de notificación de eventos adversos, dentro de un programa de Seguridad de Pacientes en el proceso asistencial de una Mutua de Accidentes de Trabajo. Método. En 2008 se implantó un sistema de notificación y registro de eventos adversos (reales o potenciales) en Unión de Mutuas, mutua de accidentes de trabajo, con 36 centros asistenciales, que da cobertura a 259.922 trabajadores. El cuestionario de notificación, contempla todos los ámbitos de la asistencia sanitaria prestada por la Mutua. El acceso al cuestionario se realizó a través de la intranet, fue voluntario, anónimo. Se describen las notificaciones registradas entre el 1 de enero de 2009 y el 31 de diciembre de 2010. Resultados. Se cumplimentaron 116 cuestionarios, con un total de 205 incidentes. El perfil del notificador fue médico del primer nivel asistencial (57,7%), y una antigüedad en su puesto de trabajo entre 5-10 años. Del total de notificaciones, la asistencia sanitaria se consideró causante del incidente en el 43,5% de los casos, de los que el 85,9% de los incidentes hubieran podido evitarse. Del total de eventos notificados, un 71,7% estaban relacionados con cuidados en centro asistencial ambulatorio, y solo un 2,4% fue relacionado con procedimiento quirúrgico. Conclusiones. La mayoría de las notificaciones fueron incidentes evitables, y registrados por médicos del primer nivel asistencial. El cuestionario de notificación se mostró como una herramienta válida en nuestro entorno de trabajo para la detección de eventos adversos en el proceso asistencial(AU)

Objectives. To describe the results of a voluntary reporting system for adverse events in a Patient Safety Program of an occupational injuries mutual insurance company. Method. In 2008 a system of notification and registration of adverse events (actual or potential) was introduced in 2008 by the Union de Mutuas, an occupational injuries insurance company with 36 health centres, and provides coverage for 259,922 workers. The reporting questionnaire covers all areas of health care provided by the mutual company. Access to the questionnaire was conducted through the intranet, was voluntary and anonymous. The notifications registered between 1 January 2009 and 31 December 2010 are analysed. Results. A total of 16 questionnaires were completed, with a total of 205 incidents. The profile of the reporter was first-level health care (57.7%), and seniority in their job for 5-10 years. Of all the notifications, a health care cause of the incident was seen in 43.5% of cases, of which 85.9% of the incidents were preventable. Of all reported events, 71.7% were related to an ambulatory care medical centre, and only 2.4% was related to a surgical procedure. Conclusions. Most of the notifications were preventable incidents, and recorded by first-level medical care. The reporting questionnaire was shown to be a valid tool in our work environment for the detection of adverse events in the care process(AU)

[Analysis of a register for reporting adverse events to a mutual insurance society for accidents at work. Adverse event reporting of occupational injuries]. / Análisis de la implantación de un sistema de notificación y registro de eventos adversos en el proceso asistencial de una mutua de accidentes de trabajo.

OBJECTIVES: To describe the results of a voluntary reporting system for adverse events in a Patient Safety Program of an occupational injuries mutual insurance company. METHOD: In 2008 a system of notification and registration of adverse events (actual or potential) was introduced in 2008 by the Union de Mutuas, an occupational injuries insurance company with 36 health centres, and provides coverage for 259,922 workers. The reporting questionnaire covers all areas of health care provided by the mutual company. Access to the questionnaire was conducted through the intranet, was voluntary and anonymous. The notifications registered between 1 January 2009 and 31 December 2010 are analysed. RESULTS: A total of 16 questionnaires were completed, with a total of 205 incidents. The profile of the reporter was first-level health care (57.7%), and seniority in their job for 5-10 years. Of all the notifications, a health care cause of the incident was seen in 43.5% of cases, of which 85.9% of the incidents were preventable. Of all reported events, 71.7% were related to an ambulatory care medical centre, and only 2.4% was related to a surgical procedure. CONCLUSIONS: Most of the notifications were preventable incidents, and recorded by first-level medical care. The reporting questionnaire was shown to be a valid tool in our work environment for the detection of adverse events in the care process.

[Adverse events associated with the healthcare of patients with multimorbidity admitted to medium-long stay hospitals]. / Eventos adversos asociados a la asistencia del paciente pluripatológico ingresado en hospitales de crónicos.

BACKGROUND: Since medical practice involves risks, the aim of the health system is to promote and preserve health and to avoid, relieve and treat disease, while ensuring the quality of care. Patient safety is an essential component of the quality of care. OBJECTIVES: To determine the incidence and prevalence of adverse events in hospitalized patients with multimorbidity in a medium-long stay hospital, to analyze the patients and healthcare characteristics associated with adverse events, to assess their impact, and to identify the possibilities for prevention. MATERIAL AND METHODS: We performed a retrospective cohort study in a medium-long stay hospital in 2004, and a prevalence study once a year from 2005 to 2008. RESULTS: The incidence of patients with adverse events directly related to hospital care was 3.3%, and the prevalence of patients with adverse events associated with health care was 5.8%. In both studies, extrinsic risk factors and length of stay were related to a greater risk of adverse events. In the incidence study, most of the adverse events (68.7%) were moderate, while in the cross-sectional study, most (84%) were mild. Fifty percent of the AE increased the length of hospital stay, and 14.5% led to readmission to the incidence study. Most of the adverse events detected in both studies required additional treatments and procedures to be performed. Between 30% and 49% of the adverse events were considered avoidable. CONCLUSIONS: The incidence and prevalence of patients with adverse events in medium-long stay hospitals were lower than those found in acute-stay hospitals. The most frequent adverse events were related to medication in the incidence studies and with healthcare in the prevalence studies. Cohort studies are the most suitable type of study to assess the impact of adverse events. Sequential cross-sectional studies seem to be useful for identifying and performing surveillance of adverse events and allow strategies to reduce these events to be prioritized and the effectiveness of improvement programs to be assessed. Consequently, we recommend the introduction of this type of design to study adverse events in hospitals specializing in the care of patients with chronic diseases.

[Utility of the ENEAS study screening guide in a long-stay chronic care hospital]. / Utilidad de la guía de cribado del estudio ENEAS en un hospital de atención a enfermos pluripatológicos.

INTRODUCTION: Because of the characteristics of patients with multimorbidities, the methodology used in acute care hospitals is unsuitable to obtain valid results in long-stay chronic care hospitals. The present study aimed to determine the utility of the screening guide used in acute care hospitals to study adverse events (AE) in long-stay, chronic care hospitals and to identify the factors that could improve the adjustment of this screening guide to these hospitals. METHOD: We performed a retrospective cohort study from January 1 to December 31, 2004 and cross-sectional studies in 2005, 2006, 2007 and 2008 in a long-stay chronic care hospital. The variables studied were AE and incidents. We used the AE screening guide adapted to the Harvard study and the Spanish version of the Modular Review Form (MRF2) for case record review. Data analysis consisted of calculation of the global predictive value of the screening guide, the item-by-item predictive value, and the percentage of AE detected by each alert. RESULTS: Of the 19 criteria in the screening guide, the most frequently marked criterion in both the cohort and prevalence studies was criterion number 1 (prior hospitalization during the last year in patients less than 65 years old or prior hospitalization in the last 6 months in patients 65 years old or older). Of all the AE and complications detected, 57.2% were screened with warning criteria 17 and 19, corresponding to "another AE" and "any kind of nosocomial infection". Overall, the screening guide had positive predictive value (PPV) of 24.3% in the cohort study, and a PPV of 37.4% in the cross-sectional study when all types of AE were included (i.e. AE associated with healthcare, disease and incidents). Screening criteria 10 (new neurological deficit at hospital discharge), 11 (acute myocardial infarction, stroke or pulmonary thromboembolism during or after an invasive procedure), 12 (cardiorespiratory arrest or low Apgar score) and 13 (injury or complication related to abortion, amniocentesis, delivery or pre-delivery) were not marked in any type of study. CONCLUSIONS: The utility of the screening guide is low when used in a long-stay chronic care hospital. A new screening guide is required that excludes inefficient criteria and includes new, more specific criteria that take into account the characteristics of patients with multimorbidity.

[Evaluation of hand hygiene guidelines and protocols used in Spain]. / Evaluación de la calidad de las guías y protocolos de lavado de manos existentes en España.

The aim of this study was to evaluate, through a retrospective and external study, the quality of Spanish hand hygiene guidelines and protocols. None of the guidelines achieved a score of 100% in all areas. The mean score was only 43.9%, ranging from 23.8% for rigorous design to 69.4% for clarity and presentation. None of the protocols achieved a score of 100% in all areas; 100% clearly named the health problem dealt with in the protocol, which was reflected in its contents, and complied with length specifications and absence of formal defects; 80% had a paginated index and 66.7% a definition of compliance, while only 6.7% contained information on organization and functioning, the necessary resources, procedures and evaluation period. In general, the average compliance was less than 50%, except in one guideline, which met 87.5% of the requirements Problems with references were found in 77.7%. In view of the problems detected, a new guide for the drafting of hand hygiene guidelines and protocols is proposed.

Eventos adversos asociados a la asistencia del paciente pluripatológico ingresado en hospitales de crónicos / Adverse events associated with the healthcare of patients with multimorbidity admitted to medium-long stay hospitals

Introducción: La finalidad del sistema sanitario es promover y mantener la salud y evitar, aliviar y tratar la enfermedad asegurando la calidad de la asistencia, ya que la práctica médica va acompañada de riesgos. La seguridad del paciente es un componente esencial de la calidad asistencial. Objetivos: Estimamos la incidencia y la prevalencia de los eventos adversos en los pacientes pluripatológicos ingresados en un hospital de media o larga estancia, analizamos las características de los pacientes y de la asistencia que se asociaban a su aparición, estimamos su impacto en la asistencia e identificamos las posibilidades de prevención. Material y métodos: Estudio de cohortes retrospectivo en un hospital de media o larga estancia en 2004 y de prevalencia los años 2005 a 2008. Resultados: La incidencia de pacientes con eventos adversos asociados a la asistencia fue del 3,3%. La prevalencia de pacientes con eventos adversos asociados a la asistencia fue del 5,8%. En ambos tipos de estudio los factores de riesgo extrínseco y la duración de la estancia se asociaron a mayor riesgo de eventos adversos. En el estudio de incidencia, los más frecuentes fueron los moderados (68,7%) y en el de corte, los leves (84%). El 50% de los eventos adversos tuvieron como consecuencia un incremento de la estancia, y en un 14,5% el efecto adverso condicionó el reingreso en el estudio de incidencia. La mayoría de los eventos adversos detectados en ambos tipos de estudios requirieron pruebas diagnósticas y tratamientos adicionales. Se consideró evitable entre el 30 y el 49% de los eventos adversos. Conclusiones: La incidencia y la prevalencia de pacientes con eventos adversos en los hospitales de crónicos son menores que las encontradas en los hospitales de agudos. Los eventos adversos más frecuentes se relacionan con la medicación en los estudios de incidencia y con los cuidados en los de prevalencia. Los estudios de cohorte son los idóneos para estimar el impacto. Los de corte en abanico se muestran útiles para la vigilancia y la identificación de eventos adversos y permiten priorizar estrategias y valorar la efectividad de los programas de mejora; por lo tanto, son los que aconsejamos para su implantación en los hospitales de atención a pacientes con enfermedad de curso crónico (AU)

Background: Since medical practice involves risks, the aim of the health system is to promote and preserve health and to avoid, relieve and treat disease, while ensuring the quality of care. Patient safety is an essential component of the quality of care. Objectives: To determine the incidence and prevalence of adverse events in hospitalized patients with multimorbidity in a medium-long stay hospital, to analyze the patients and healthcare characteristics associated with adverse events, to assess their impact, and to identify the possibilities for prevention. Material and methods: We performed a retrospective cohort study in a medium-long stay hospital in 2004, and a prevalence study once a year from 2005 to 2008. Results: The incidence of patients with adverse events directly related to hospital care was 3.3%, and the prevalence of patients with adverse events associated with health care was 5.8%. In both studies, extrinsic risk factors and length of stay were related to a greater risk of adverse events. In the incidence study, most of the adverse events (68.7%) were moderate, while in the cross-sectional study, most (84%) were mild. Fifty percent of the AE increased the length of hospital stay, and 14.5% led to readmission to the incidence study. Most of the adverse events detected in both studies required additional treatments and procedures to be performed. Between 30% and 49% of the adverse events were considered avoidable. Conclusions: The incidence and prevalence of patients with adverse events in medium-long stay hospitals were lower than those found in acute-stay hospitals. The most frequent adverse events were related to medication in the incidence studies and with healthcare in the prevalence studies. Cohort studies are the most suitable type of study to assess the impact of adverse events. Sequential cross-sectional studies seem to be useful for identifying and performing surveillance of adverse events and allow strategies to reduce these events to be prioritized and the effectiveness of improvement programs to be assessed. Consequently, we recommend the introduction of this type of design to study adverse events in hospitals specializing in the care of patients with chronic diseases (AU)

Utilidad de la guía de cribado del estudio ENEAS en un hospital de atención a enfermos pluripatológicos / Utility of the ENEAS study screening guide in a long-stay chronic care hospital

Introducción: Las características peculiares de los pacientes pluripatológicos hacen que la metodología utilizada en los hospitales de agudos no sea aplicable directamente para la consecución de resultados válidos en hospitales de crónicos y larga estancia (HACLE). Por ello nos proponemos en este estudio conocer la utilidad de la guía de cribado usada en los hospitales de agudos para el estudio de eventos adversos en los HACLE e identificar los factores que puedan mejorar su adaptación a estos hospitales. Método: Estudio retrospectivo de cohortes desde el 1 de enero hasta el 31 de diciembre de 2004 y estudios transversales durante los años 2005, 2006, 2007 y 2008, en un hospital de atención a enfermos crónicos. Variables: efecto adverso (EA) e incidente. Se utilizó la Guía de cribado de EA adaptada del estudio de Harvard y la versión española del Cuestionario Modular para revisión de casos MRF2. Análisis de datos: se calculó el valor predictivo de la guía de cribado, en general y punto por punto, así como el porcentaje de EA que detectó cada alerta. Resultados: De los 19 criterios de la guía de cribado, el que fue marcado con mayor frecuencia tanto en el estudio de cohortes como en el de prevalencia, fue el criterio número 1 (Hospitalización previa durante el último año en paciente menor de 65 años u hospitalización previa en los últimos 6 meses en paciente de 65 o más años). Del total de EA o complicaciones detectadas, el 57,2% se cribó con los criterios de alerta 17 y 19, que corresponden a “algún otro EA” y “cualquier tipo de infección nosocomial”. En general, la guía de cribado presentó un valor predictivo positivo (VPP) del 24,3% en el estudio de cohorte y del 37,4% en el de corte considerando todo tipo de EA, es decir, tanto asociados a la asistencia como a la enfermedad e incidentes. Los criterios de cribado 10 (Déficit neurológico nuevo en el momento del alta hospitalaria), 11 (Infarto agudo de miocardio, accidente cerebrovascular agudo o tromboembolia pulmonar durante o después de un procedimiento invasivo), 12 (Parada cardiorrespiratoria o puntuación Apgar baja) y 13 (Daño o complicación relacionada con aborto, amniocentesis, parto o preparto) no se marcaron en ningún tipo de estudio. Conclusiones: La guía de cribado tiene escasa utilidad aplicada en los HACLE. Es necesaria una nueva guía de cribado que excluya los criterios poco eficientes e incluya nuevos criterios, más específicos, que tengan en cuenta las características peculiares de los pacientes pluripatológicos (AU)

Introduction: Because of the characteristics of patients with multimorbidities, the methodology used in acute care hospitals is unsuitable to obtain valid results in long-stay chronic care hospitals. The present study aimed to determine the utility of the screening guide used in acute care hospitals to study adverse events (AE) in long-stay, chronic care hospitals and to identify the factors that could improve the adjustment of this screening guide to these hospitals. Method: We performed a retrospective cohort study from January 1 to December 31, 2004 and crosssectional studies in 2005, 2006, 2007 and 2008 in a long-stay chronic care hospital. The variables studied were AE and incidents. We used the AE screening guide adapted to the Harvard study and the Spanish version of the Modular Review Form (MRF2) for case record review. Data analysis consisted of calculation of the global predictive value of the screening guide, the item-by-item predictive value, and the percentage of AE detected by each alert. Results: Of the 19 criteria in the screening guide, the most frequently marked criterion in both the cohort and prevalence studies was criterion number 1 (prior hospitalization during the last year in patients less than 65 years old or prior hospitalization in the last 6 months in patients 65 years old or older). Of all the AE and complications detected, 57.2% were screened with warning criteria 17 and 19, corresponding to “another AE” and “any kind of nosocomial infection”. Overall, the screening guide had positive predictive value (PPV) of 24.3% in the cohort study, and a PPV of 37.4% in the cross-sectional study when all types of AE were included (i.e. AE associated with healthcare, disease and incidents). Screening criteria 10 (new neurological deficit at hospital discharge), 11 (acute myocardial infarction, stroke or pulmonary thromboembolism during or after an invasive procedure), 12 (cardiorespiratory arrest or low Apgar score) and 13 (injury or complication related to abortion, amniocentesis, delivery or pre-delivery) were not marked in any type of study. Conclusions: The utility of the screening guide is low when used in a long-stay chronic care hospital. A new screening guide is required that excludes inefficient criteria and includes new, more specific criteria that take into account the characteristics of patients with multimorbidity (AU)

Evaluación de la calidad de las guías y protocolos de lavado de manos existentes en España / Evaluation of hand hygiene guidelines and protocols used in Spain

El objetivo del presente trabajo es evaluar de forma externa y retrospectiva la calidad de las guías y los protocolos de lavado de manos existentes en España. Para las guías: ninguna alcanzó el 100% de valoración positiva en todas las áreas y la media de cumplimiento sólo fue del 43,9%, desde el 23,8% en rigor de elaboración al 69,4% en claridad y presentación. Para los protocolos: ninguno cumplió todas las características propuestas para un protocolo; en el 100% se cumplió la denominación, la extensión y la ausencia de defectos formales de los protocolos; en el 80%, el índice paginado; en el 66,7%, definición de cumplimiento, y sólo en el 6,7%, organización y funcionamiento, recursos necesarios, normas y periodo de evaluación. En general, el cumplimiento es inferior al 50%, excepto en una guía con un 87,5%, y los problemas con las referencias bibliográficas alcanzan al 77,7%. Debido a los problemas encontrados, se incluye una normativa para la elaboración de guías/protocolos de lavado de manos (AU

The aim of this study was to evaluate, through a retrospective and external study, the quality of Spanish hand hygiene guidelines and protocols. None of the guidelines achieved a score of 100% in all areas. The mean score was only 43.9%, ranging from 23.8% for rigorous design to 69.4% for clarity and presentation. None of the protocols achieved a score of 100% in all areas; 100% clearly named the health problem dealt with in the protocol, which was reflected in its contents, and complied with length specifications and absence of formal defects; 80% had a paginated index and 66.7% a definition of compliance, while only 6.7% contained information on organization and functioning, the necessary resources, procedures and evaluation period. In general, the average compliance was less than 50%, except in one guideline, which met 87.5% of the requirements Problems with references were found in 77.7%. In view of the problems detected, a new guide for the drafting of hand hygiene guidelines and protocols is proposed (AU)

Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS).

OBJECTIVE: To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. DESIGN: Retrospective cohort study. SETTING: Twenty-four Spanish hospitals. PARTICIPANTS: Patients of any age with a clinical record indicating an inpatient stay of >24 h and a discharge between 4 and 10 June 2005 (n = 5908). INTERVENTION: None. MAIN OUTCOME MEASURES: Percentage of AEs considered preventable. RESULTS: We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8-6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). CONCLUSIONS: In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.