Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide.

PURPOSE: Determining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care. METHODS: This retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics. RESULTS: The MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide. CONCLUSIONS: The MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.

What makes hospitalized patients more vulnerable and increases their risk of experiencing an adverse event?

OBJECTIVE: To analyze the relationship between the appearance of adverse events (AEs) and both patient comorbidities and the use of medical devices. DESIGN: Retrospective medical records review study. SETTING: Twenty-four Spanish public hospitals. PARTICIPANTS: Clinical records of 5624 discharged patients. MAIN OUTCOME MEASURE: Incidence of AEs. RESULTS: Patients aged >65 have 2.4 times the risk of experiencing an AE compared with those aged <65. The presence of certain comorbidities and devices (neoplasia, chronic hepatic alteration, cardiac insufficiency, coronary disease, high blood pressure, urethral catheterization, catheterization of a vessel, tracheostomy or stay of >7 days) were associated with developing an AE during hospitalization. There is a trend effect if we consider the number of comorbidities and the number of devices used. Thus, the risk of an AE in subjects who present no comorbidities was 3.2%, which rose to 9.9% in those with one intrinsic risk factor, 16.7% in those with two and 29.3% in those with three or more. Similarly, subjects without extrinsic risk factor experienced an AE in 4.4% of cases, which rose to 9.6% when there was one risk factor, to 13.4% when there were two and to 33.0% when there were three or more risk factors. The effect of some of these pathologies and that associated with age disappeared on adjusting in line with other variables. CONCLUSIONS: The true risk resides in the number of exposures to potentially iatrogenic actions, rather than being intrinsic to age or the presence of certain comorbidities.

¿Podemos influir de forma efectiva sobre la conducta de clínicos y directivos? / No disponible

El liderazgo, entendido como la capacidad de un profesional y/o un servicio para influir sobre otros profesionales y/o servicios para que trabajen y se involucren en el logro de objetivos comunes, es una función clave de los servicios de medicina preventiva y unidades de calidad asistencial para promover e implementar iniciativas e incentivar y motivar a grupos y equipos en relación con la calidad asistencial y la seguridad del paciente. Aspectos clave a considerar para lograr cambios en individuos y organizaciones son: evidencia de las intervenciones, conocimiento de las actitudes de los profesionales, perseverancia, participación y existencia de un plan de implementación. Existen distintos planteamientos para abordar cambios de conductas entre los profesionales sin evidencia suficiente para recomendar uno u otro. A pesar de sus limitaciones, todos tienen elementos positivos para ser utilizados con mesura, en función de cada realidad asistencial (AU)

Leadership, understood as the power of a professional and/or service to influence other professionals and/or services to work and engage in achieving common goals is a key function of Preventive and Quality of Care Departments to promote and implement initiatives and encourage and motivate teams and groups in relation to the quality of care and patient safety. Key issues to consider for change in individuals and organizations are: evidence of the interventions, knowledge of professional attitudes, perseverance, participation and carry out an implementation plan. There are different approaches to achieve behavior changes among professionals without sufficient evidence to recommend one or the other. Despite their limitations, they all have positive elements to be used sparingly, depending on each health care locations (AU)

Adverse events in hospitals: the patient's point of view.

BACKGROUND: The publication of the report "To err is human: building a safer system" by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patient's perception and opinion about care safety in hospitals. METHODS: We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patient's safety perception published between 1989 and 2006. RESULTS: From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patient's opinions about the management and disclosure of adverse events and proposals to prevent them. CONCLUSIONS: The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.

A comparison of websites from Spanish, American and British hospitals.

OBJECTIVE: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. METHODS: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the "e-Information Scale of Health Care Centers". RESULTS: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. CONCLUSIONS: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of user-oriented content.

Los sucesos adversos en los hospitales españoles: Resultados del estudio eneas / No disponible

Declaración de intereses: Este trabajo es consecuencia del estudio ENEAS que fue realizado a través de un convenio de colaboración entre la Universidad Miguel Hernández y el Ministerio de Sanidad y Consumo, que lo financiación. Su realización fue aprobada por el Comité de Ética e Investigación Clínica de Aragón. Objetivo: Determinar la incidencia de pacientes con efectos adversos (EAs) en los hospitales españoles, establecer la proporción de EA que se producen en el periodo de prehospitalización, describir las causas inmediatas del EA, definir los EA evitables y conocer el impacto de los EA en términos de gravedad, exitus y/o prolongación de la estancia hospitalaria. Método: Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499) y 5 de tamaño grande (mayor o igual 500 camas). Pacientes ingresados, cuya hospitalización fuera superior a 24 horas, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y aquellos que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados: La incidencia de pacientes con EA relacionados directamente con la asistencia hospitalaria fue de 8,4% (IC95%: 7,7% - 9,1%), que aumentá a 9,3% (IC95%: 8,6% - 10,1%) al incluir los EA del periodo de prehospitalización. La densidad de incidencia fue de 1,2 EA por cada 100 dí­as de estancia (IC95%: 1,1 - 1,3). La densidad de incidencia de EA moderados o graves fue de 5,6 EA por cada 1.000 días de estancia (IC95%: 4,9 - 6,3). El 42,8% de los EA se consideró evitable. Se observó un 13,2% de EA cuando el paciente presentaba factores de riesgo intrínsecos y un 5,2% cuando no los tení­a (p< 0,001) (AU)

Objective: To assess patients with AE incidence in Spanish hospitals, to estimate the proportion of AE occurring during the preadmission period, to describe the immediate causes of AE, to define the preventable AE and to identify the impact of AE in terms of severity, death or longer hospital stay. Method: Retrospective cohort study. Sample of 24 hospitals, 6 of them were small-sized hospitals (fewer than 200 beds), 13 medium-sized hospitals (between 200 and 499 beds) and 5 large-sized hospitals (500 or more beds). Patients who stayed more than 24 hours in the selected hospitals, who had a clinical record in these centres and who had been discharged between the 4th and the 10th of June 2005. AE detected during hospitalisation and those being consequence of previous admissions were included. Results: The incidence of patients with AE related directly to hospital care was 8.4% (95%CI: 7.7% - 9.1%) and rose 9.3% (95%CI: 8.6% - 10.1%) including those from the prehospitalisation period. The incidence density was 1.2 AE per 100 patient-days (95%CI: 1.1 - 1.3). The incidence of moderate and serious AE was 5.6 AE per 1000 patient-days (95%CI: 4.9% - 6.3%). In 66.3% of AE, additional procedures were required and in 69.9% additional reatments. Some 42.8% of AE were considered as avoidable. Some 13.2% of the subjects with some intrinsic risk factors developed AE compared to the 5.2% of the subjects who had no risk factors (p<0.001), and 9.5% of the subjects who had some extrinsic risk factors developed AE compared to 3.4% of the subjects who had not (p<0.001). The most frequent AE were those associated to medication (37.4%), hospital infections of any type (25.3%) and those related to technical problems during a procedure (25.0%) (AU)

Seguridad del paciente y práctica clínica / No disponible

No disponible

[Can adverse effects related to hospital treatment be avoided?]. / Pueden evitarse los sucesos adversos relacionados con la atención hospitalaria?

The concept of care risk includes any undesirable situation, or any factor contributing to its occurrence, related to the health care received and which might have negative consequences. It includes conditions like adverse effects of medicines, negligence and litigation. A safe clinical practice requires that three objectives be obtained: to identify which diagnostic and therapeutic clinical procedures are the safest and most efficient; to assure that they are applied to those who need them; and to carry them out correctly and without mistakes. In this sense, what are needed, on the one hand, are systems of notification and epidemiological studies, and, on the other, actions at different levels of the health system. The maximum safety of the patient is obtained by a suitable knowledge of the risks, elimination of those that are unnecessary, and prevention and protection in those that must inevitably be assumed. This is because safety is not the same thing as absence of risk.

¿Pueden evitarse los sucesos adversos relacionados con la atención hospitalaria? / Can adverse effects related to hospital treatment be avoided?

El concepto de riesgo asistencial incluye cualquier situación no deseable o factor que contribuye a que se produzca, relacionado con la atención sanitaria recibida y que puede tener consecuencias negativas. Comprende condiciones como sucesos adversos, errores, casi-errores, accidentes, incidentes, efectos adversos de medicamentos, negligencias y litigios. Una práctica clínica segura exige conseguir tres objetivos: identificar qué procedimientos clínicos diagnósticos y terapéuticos son los más seguros y eficaces; asegurar que se aplican a quien los necesita, y realizarlos correctamente y sin errores. En este sentido son precisos, por un lado, sistemas de notificación y estudios epidemiológicos y por otro, actuaciones a distintos niveles del sistema sanitario. La máxima seguridad del paciente se consigue por un conocimiento adecuado de los riesgos, la eliminación de los innecesarios, y la prevención y protección de aquellos que hay que asumir de forma inevitable. Porque seguridad no es igual a ausencia de riesgo (AU)

Inhibin A serum levels in proteinuric and nonproteinuric pregnancy-induced hypertension: evidence for placental involvement in gestational hypertension?

OBJECTIVES: To evaluate the serum levels of inhibin A in pregnant women with different types of hypertension. METHODS: A case-control study, including 60 cases (20 women with preeclampsia, 20 with mild gestational hypertension, and 20 with chronic hypertension), and 60 gestational-age- and parity-matched controls. Inhibin A was measured in duplicate by enzyme-linked immunosorbent assay in serum samples frozen at -80 degrees C. RESULTS: As compared to controls, inhibin A levels were significantly elevated in women with preeclampsia ¿2.32 standard deviation (SD) 1.4¿ versus 0.50 (0.29) ng/mL, p < 0.001) and gestational hypertension [1.09 (0.73) versus 0.55 (0.29) ng/mL, p < 0.05], but not in the group of chronic hypertension [0.88 (0.69) versus 0.54 (0.39) ng/mL, p = 0.08]. Overlap in inhibin A values between cases and controls was observed in 20% (4/20) of women with preeclampsia and 55% (11/20) with gestational hypertension. CONCLUSIONS: Increased serum inhibin A may indicate that a proportion of mild nonproteinuric hypertension cases are associated with placental involvement.

[Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain]. / El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España.

BACKGROUND: In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD: A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study. RESULTS: Consult request took place 10.6 days (on average) after the patients admission (<>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <>. CONCLUSIONS: The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <> is also emphasized.

Prevalence of Parkinson's disease in lower Aragon, Spain.

OBJECTIVE: We attempted to measure the prevalence of Parkinson's disease (PD) and to improve PD diagnosis in Lower Aragon (LA), a rural area located in northeast Spain with an elderly population numbering 60,724. METHODS: Hospital records and a questionnaire targeted at general practitioners and retirement home personnel were used for case finding. Neurologic diagnoses were ascertained by a neurologist using a clinicoepidemiologic protocol and established diagnostic criteria after examining 84% of patients diagnosed with PD. Using stratified analysis, a comparison was run against reported PD prevalence from worldwide door-to-door surveys. RESULTS: On the prevalence date, 134 individuals were found to be affected with PD. The prevalence per 100,000 population was 220.6 (crude) and 121.9 when age-adjusted using the European Standard Population. Prevalence increased with age, declining at 90 years and over. Questionnaires returned by general practitioners disclosed 20% of the prevalent PD cases. The prevalence of PD in pooled European populations was 2.56 times (95% confidence interval [CI]: 2.02-3.24) greater than that found in our study. CONCLUSION: PD prevalence in Lower Aragon ranks at levels similar to those reported for white populations (European and non-European). One out of two individuals with PD was estimated to be undiagnosed before and three out of eight after the study.

High bilirubin levels interfere with serum tartrate-resistant acid phosphatase determination: relevance as a marker of bone resorption in jaundiced patients.

Serum tartrate-resistant acid phosphatase (TRAcP) activity is considered to be a biochemical marker of bone resorption. Recently, a lack of specificity of collagen-related markers for assessing bone turnover has been observed in patients with chronic liver disease. Thus, it could be of great interest to determine serum TRAcP activity in such patients. However, nonspecificity of the analytical reaction could occur when hemolyzed, lipemic, or icteric specimens are analyzed. Therefore, we have studied the interference caused by bilirubin in the measurement of serum TRAcP activity using the Hillmann method. The interference was assessed in two pools of serum containing different bilirubin concentrations but with similar total AcP levels. Mixing proportional parts of the two pools, 10 samples were also obtained. Serum activities of total AcP and TRAcP, and the concentration of bilirubin were measured in the 10 samples. Both the actual and the expected values obtained by theoretical calculations were compared. Serum bilirubin values of 2.4 mg/dl showed a negative interference of 15% in the determination of serum TRAcP activity, whereas values of bilirubin higher than 10 mg/dl interfered totally with the measurement of serum TRAcP. Bilirubin did not interfere with the total AcP determination. This study clearly shows the interference of bilirubin in the determination of serum TRAcP. This finding should be considered when bone metabolism disorders are evaluated in jaundiced patients.

First-trimester biochemical markers for Down syndrome.

The value of maternal serum pregnancy-associated protein A (PAPP-A), free and total beta human chorionic gonadotrophin (fbetahCG, betahCG) and alpha-fetoprotein (AFP) in screening for Down syndrome (DS) in early pregnancy has been assessed. To evaluate the different biochemical markers, 32 DS pregnancies and 267 controls were used for AFP, betahCG and PAPP-A. A subgroup of those (17 DS and 136 controls) were used to evaluate fbetahCG. All analytes were determined in fresh serum samples. Our results give support to the feasibility of maternal serum levels of PAPP-A as the best biochemical marker for DS in the first trimester, and either betahCG or fbetahCG as the second marker. No differences were found between betahCG and fbetahCG distribution levels as expressed as MoMs in normal and DS pregnancies in this study.