Application of a mindfulness program among healthcare professionals in an intensive care unit: Effect on burnout, empathy and self-compassion. / Aplicación de un programa de mindfulness en profesionales de un servicio de medicina intensiva. Efecto sobre el burnout, la empatía y la autocompasión.

OBJECTIVE: To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. DESIGN: A longitudinal study with an intrasubject pre-post intervention design was carried out. SETTING: Intensive Care Unit of a tertiary hospital. PARTICIPANTS: A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. INTERVENTION: A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. MAIN MEASUREMENTS: Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. RESULTS: Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high. CONCLUSIONS: In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.

[Unique patient identification in hospitals in the National Health Service]. / Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud.

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs.

A propósito de la adecuación de los ingresos hospitalarios no quirúrgicos desde un servicio de urgencias / One the adequacy of non-surgical hospital admission referrals from an emergency service

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[Assessment of the appropriate utilization of an emergency department observation unit with the Appropriateness Evaluation Protocol: analysis of 4,700 cases]. / Evaluación del uso apropiado de un área de observación de urgencias mediante el Appropriateness Evaluation Protocol: un análisis de 4.700 casos.

BACKGROUND: The Emergency Department Observation Units (EDO) constitutes an alternative of conventional hospitalization. The admissions and stays' appropriateness may influence the efficient use of bed resource in an acute care hospital. METHOD: Prospective evaluation of EDO admissions in a 18 month period, using the original criteria of Appropriateness Evaluation Protocol (A.E.P.), which were adapted to the area characteristics. RESULTS: We evaluate 4,700 admissions (55.1% male, 44.9% female; mean age: 64.9 +/- 14.9 years old). Average length of stay was 23.8 (+/- 18.3) hours. 35.5% patients were discharged at home and 62.0% were admitted in hospital. In 98.1% patients we obtained clinical stabilization in 48 hours. 85.0% of admissions were explained by 35 DRG categories, the most prevalent being chronic obstructive pulmonary disease (COPD) (411 admissions, 9.0%). A total of 258 (5.5%) admissions were qualified as inappropriate, primary due to diagnostic and therapeutical services that could have been provided in an outpatient basis (3.4%). A total of 797 (17.0%) stays were considered inappropriate, mainly due to hospital bed occupancy (13.0%) and discharge delays because of conservative medical management of patients (3.4%), social problems representing only 0.6%. A daily average of 4.2 beds (total of 19) were inappropriate used as assessed by modified AEP criteria. DISCUSSION: EDO represents an alternative for conventional hospitalization, obtaining patient clinical stabilization in 48 hours and saving unnecessary hospital admissions. AEP application lets know the impact of the efficient use of this area in the emergency department and the hospital.

Evaluación del uso apropiado de un área de observación de urgencias mediante el Appropriateness Evaluation Protocol: un análisis de 4.700 casos / Evaluation in emergency department observation unit with the appropiateness evaluation protocol: an analysis of 700 cases

Fundamento: El Área de Observación de los Servicios de Urgencias (AOSU) es una alternativa a la hospitalización convencional. La adecuación de sus ingresos y estancias puede repercutir en la eficiente utilización del recurso cama en el hospital. Métodos: Evaluación prospectiva de los ingresos en el AOSU durante 18 meses, según criterios del Appropriateness Evaluation Protocol (AEP) original adaptados al área. Resultados: Se evaluaron 4.700 ingresos (55,1 por ciento varones, 44,9 por ciento mujeres; edad media: 64,9 ± 14,9 años). La estancia media fue 23,8 (± 18,3) horas. El 35,5 por ciento fueron alta domiciliaria y 62,0 por ciento ingresaron en el hospital. En 98,1 por ciento de pacientes se consigue estabilización clínica en 48 horas. El 85,0 por ciento de ingresos correspondieron a 35 categorías GRD, siendo la patología más prevalente la enfermedad pulmonar obstructiva crónica (EPOC) (411 ingresos, 9,0 por ciento). Cumplieron criterios de admisión inadecuada 258 (5,5 por ciento) ingresos, predominando las necesidades diagnósticas y terapéuticas que podían realizarse como paciente externo (3,4 por ciento). Se consideraron inapropiadas 797 (17,0 por ciento) estancias, fundamentalmente debido a problemas hospitalarios por falta de camas (13,0 por ciento) y actitud médica conservadora retrasando el alta (3,4 por ciento), mientras que la problemática social únicamente representó 0,6 por ciento. Un promedio diario de 4,2 camas (del total de 19) se utilizaron inadecuadamente según el AEP modificado. Conclusiones: La AOSU representa una alternativa de la hospitalización convencional, consiguiendo la estabilización clínica de los pacientes en 48 horas y evitando ingresos innecesarios en el hospital. La aplicación del AEP permite conocer el impacto de la utilización inadecuada de esta área sobre el servicio de Urgencias y el propio hospital (AU)