[Establishment of a modified surgical safety checklist for the neurosurgical patient: Initial experience in 400 cases]. / Implantación de la lista de verificación quirúrgica de la Organización Mundial de la Salud modificada para el paciente neuroquirúrgico: experiencia inicial en 400 casos.

INTRODUCTION: Adverse events during diagnostic and therapeutic procedures and medical errors associated with them are an important source of patient morbidity. In an attempt to reduce these, the WHO has proposed a series of measures applicable to medical and surgical patients. Within these last ones is the surgical safety checklist (SSC), a brief questionnaire that does not increase healthcare costs, is accessible to all surgical centres and can be adapted to each specific environment. OBJECTIVES: To evaluate the effectiveness of establishing a modified WHO SSC on the safety and quality of care of the neurosurgical patient in a third-level university hospital. MATERIAL AND METHODS: The SSC was applied to a series of 400 scheduled surgeries between May 2009 and May 2010. During the initial 6 months, 183 surgical procedures were performed (group 1). All adverse events detected in this period were studied with a root-cause analysis methodology (RCA) and, according to its results, corrective measures were introduced. After that, 217 procedures were performed (group 2). RESULTS: We recorded 51 events in 44 surgeries (11%). We were able to correct 88.23% of them before surgery was initiated, avoiding any consequence in the normal management of the case. In Group 1, incidents were noted in 15.3% of the procedures. The RCA suggested that 37.8% of the events had a human cause, followed by problems related to material resources and equipment in 29.7%, and organisational reasons in 21.6%. Incidence of events was reduced in group 2 to 7.4% (P=.01). Corrective measures prevented the appearance of perioperative events in 1 out of 13 procedures. CONCLUSIONS: The SSC is an effective tool for improving safety in neurosurgical patients, which can be established in surgical departments of any hospital without increasing healthcare costs or operative time.

Implantación de la lista de verificación quirúrgica de la Organización Mundial de la Salud modificada para el paciente neuroquirúrgico: experiencia inicial en 400 casos / Establishment of a modified surgical safety checklist for the neurosurgical patient: Initial experience in 400 cases

Introducción: Las complicaciones de los procedimientos diagnósticos y terapéuticos, así como los errores asociados a éstos, son una causa importante de morbilidad. En un intento de minimizarlos, la Organización Mundial de la Salud (OMS) ha propuesto una serie de medidas aplicables tanto a pacientes médicos como quirúrgicos. Entre estas últimas destaca la lista de verificación quirúrgica (LVQ), un breve cuestionario que, sin incrementar el gasto hospitalario, resulta accesible a todos los centros quirúrgicos y es adaptable a las necesidades de cada uno de ellos. Objetivos: Valorar la efectividad de la implantación de la LVQ de la OMS modificada en la mejora de la seguridad del paciente neuroquirúrgico y de la calidad de su atención en un hospital universitario de tercer nivel. Material y métodos: La LVQ fue aplicada a una serie de 400 cirugías programadas entre mayo de 2009 y mayo de 2010. Durante los primeros 6 meses se realizaron 183 procedimientos quirúrgicos (grupo 1). Los incidentes detectados durante este período fueron sometidos a un análisis causa-raíz (ACR), introduciéndose medidas correctoras de acuerdo con sus resultados. Doscientas diecisiete cirugías fueron realizadas en los 6 meses posteriores (grupo 2).Resultados: Aparecieron 51 incidencias que afectaron a 44 procedimientos (11%). El 88,2% de estas incidencias pudieron ser subsanadas precozmente, sin repercusión sobre la cirugía. En el grupo 1 se produjeron incidencias en el 15,3% de las intervenciones. El ACR demostró causas-raíz de origen humano en el 37,8%, problemas de equipamiento (..) (AU)

Introduction: Adverse events during diagnostic and therapeutic procedures and medical errors associated with them are an important source of patient morbidity. In an attempt to reduce these, the WHO has proposed a series of measures applicable to medical and surgical patients. Within these last ones is the surgical safety checklist (SSC), a brief questionnaire that does not increase healthcare costs, is accessible to all surgical centres and can be adapted to each specific environment. Objectives: To evaluate the effectiveness of establishing a modified WHO SSC on the safety and quality of care of the neurosurgical patient in a third-level university hospital. Material and methods: The SSC was applied to a series of 400 scheduled surgeries between May 2009 and May 2010. During the initial 6 months, 183 surgical procedures were performed (group 1). All adverse events detected in this period were studied with a root-cause analysis methodology (RCA) and, according to its results, corrective measures were introduced. After that, 217 procedures were performed (group 2).Results: We recorded 51 events in 44 surgeries (11%). We were able to correct 88.23% of them before surgery was initiated, avoiding any (..) (AU)

[An adverse event continuous surveillance system in surgical services of the autonomous region of Cantabria (Spain)]. / Sistema de vigilancia continua de eventos adversos en los servicios quirúrgicos de Cantabria.

OBJECTIVE: To design a continuous surveillance system for adverse events (AEs) in surgical services in the Autonomous Community of Cantabria. Through homogeneous methodology, this system will provide the information needed to prevent and control AEs and avoid their recurrence. MATERIAL AND METHODS: We performed a prospective study of the population undergoing inpatient surgery in our service. The methodology used was an adapted version of the IDEA (Identification of Adverse Events) project. Surgeons had access to an intranet website and introduced the data by using a personal login. A web application allowed feedback through report-generation. RESULTS: During the pilot phase, limited collection of variables requiring calculations and of those related to location and causality was observed. Assessment of the system indicated the need for simplification to obtain valid and useful information, as well as the need to provide help windows. The system was redesigned with two data input screens and currently allows for automatic report generation of registered AEs. Information was gathered on 70% of the patients and an incidence of 11.2 AEs/100 admissions was found. Of these, 47% were defined as surgical complications. CONCLUSIONS: Establishing a continuous surveillance system for AEs is feasible if professionals participate in the process, data input is easy and feedback from the system is rapid and useful for implementing corrective measures. This system can be considered highly useful for obtaining information on AEs and consequently on the potential areas of improvement in surgical activity in Spanish hospitals.

Sistema de vigilancia continua de eventos adversos en los servicios quirúrgicos de Cantabria / An Adverse Event Continuous Surveillance System in Surgical Services of the Autonomous Region of Cantabria (Spain)

Objetivo: Diseñar un sistema de vigilancia continua de efectos adversos (EA) en los servicios quirúrgicos de Cantabria para conocer, mediante una metodología homogénea, la información necesaria para orientar la prevención y el control de los EA y que sea una fuente de aprendizaje para evitar su recurrencia. Material y métodos: Estudio prospectivo de la población que ingresa y es intervenida en el servicio. La herramienta utilizada es un servidor SQL con bases de datos relacionadas, con acceso a través de web utilizando la intranet del hospital y códigos de seguridad establecidos para todos los usuarios. Nace de la metodología del proyecto IDEA adaptada. Resultados: En la prueba piloto se detecta una baja cumplimentación de las variables que requieren cálculo y de las de localización y causalidad. Esta valoración indica la necesidad de simplificar para obtener información factible y de utilidad, así como la necesidad de incorporar ventanas de ayuda. El sistema se ha rediseñado en dos pantallas de introducción de datos y permite la elaboración automática de informes generales y específicos de los EA registrados. La tasa de consignación alcanza casi el 70%, y se ha encontrado una incidencia de 11,2 EA/100 ingresos, de los que el 47% se definió como complicaciones quirúrgicas. Conclusiones: La implantación de un sistema de vigilancia continua de EA es posible si los profesionales participan, la herramienta es simple y la información que reciben del sistema es rápida y útil para implantar medidas correctoras. Así, se puede considerarla una herramienta de extraordinario valor para obtener información sobre los EA y, en consecuencia, de las potenciales áreas de mejora en la actividad quirúrgica de nuestros hospitales (AU)

Objective: To design a continuous surveillance system for adverse events (AEs) in surgical services in the Autonomous Community of Cantabria. Through homogeneous methodology, this system will provide the information needed to prevent and control AEs and avoid their recurrence. Material and methods: We performed a prospective study of the population undergoing inpatient surgery in our service. The methodology used was an adapted version of the IDEA (Identification of Adverse Events) project. Surgeons had access to an intranet website and introduced the data by using a personal login. A web application allowed feedback through report-generation. Results: During the pilot phase, limited collection of variables requiring calculations and of those related to location and causality was observed. Assessment of the system indicated the need for simplification to obtain valid and useful information, as well as the need to provide help windows. The system was redesigned with two data input screens and currently allows for automatic report generation of registered AEs. Information was gathered on 70% of the patients and an incidence of 11.2 AEs/100 admissions was found. Of these, 47% were defined as surgical complications (AU)