Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology.

OBJECTIVE: To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS: The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS: The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION: A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Descripción de factores contribuyentes en sucesos adversos relacionados con la seguridad del paciente y su evitabilidad / Description of contributing factors in adverse events related to patient safety and their preventability

OBJETIVO: Evaluar el grado en que los sucesos adversos (SA) ligados a la asistencia sanitaria alcanzan al paciente y su severidad. Analizar los factores contribuyentes a la aparición de SA, la relación con el daño provocado y el grado de evitabilidad. DISEÑO: Estudio descriptivo retrospectivo. Emplazamiento: Servicio de Atención Primaria de Porriño desde enero de 2014 a abril de 2016. Participantes y/o contexto: Se incluyeron notificaciones de SA en el Sistema de Notificación y Aprendizaje para Seguridad del Paciente (SiNASP). MÉTODO: Variables de medida: incidente adverso (IA) si no alcanzó al paciente o no produjo daño, evento adverso (EA) si llegó al paciente con daño. Grado de daño clasificado como mínimo, menor, moderado, crítico y catastrófico. Evitabilidad registrada como escasa evidencia de ser evitable, 50% evitable y sólida evidencia de ser evitable. nálisis de datos: porcentajes y test de chi-cuadrado para variables cualitativas; p < 0,05 con SPSS.15 Fuente de datos: SiNASP. Consideraciones éticas: autorizado por el Comité de Ética de Investigación (2016/344). RESULTADOS: Se registraron 166 SA (50,0% hombres, 46,4% mujeres; edad media: 60,80 años). El 62,7% alcanzaron al paciente. EA: 45,8% produjeron daño mínimo y 2,4%, daño crítico. Los profesionales fueron factor contribuyente en el 71,7% de los EA, encontrándose tendencia a la asociación entre deficiente comunicación y ausencia de protocolos con el daño producido. Grado de evitabilidad: 96,4%. CONCLUSIONES: La mayoría de los SA alcanzaron al paciente, estando relacionados con la medicación, pruebas diagnósticas y errores de laboratorio. El grado de daño se asoció con problemas de comunicación, ausencia o deficiencia de protocolos y escasa cultura en seguridad

OBJECTIVE: To assess the extent of healthcare related adverse events (AEs), their effect on patients, and their seriousness. To analyse the factors leading to the development of AEs, their relationship with the damage caused, and their degree of preventability. DESIGN: Retrospective descriptive study. LOCATION: Porriño, Pontevedra, Spain, Primary Care Service, from January-2014 to April-2016. Participants and/or context: Reported AEs were entered into the Patient Safety Reporting and Learning System (SiNASP). METHOD: The variables measured were: Near Incident (NI) an occurrence with no effect or harm on the patient; Adverse Event (AE) an occurrence that affects or harms a patient. The level of harm is classified as minimal, minor, moderate, critical, and catastrophic. Preventability was classified as little evidence of being preventable, 50% preventable, and sound evidence of being preventable. Data analysis: percentages and Chi-squared test for qualitative variables; P < .05 with SPSS.15. Data source: SiNASP. Ethical considerations: approved by the Research Ethics Committee (2016/344). RESULTS: There were 166 recorded AEs (50.6% in males, and 46.4% in women. The mean age was 60.80 years). Almost two-thirds 62.7% of AEs affected the patient, with 45.8% causing minimal damage, while 2.4% caused critical damages. Healthcare professionals were a contributing factor in 71.7% of the AEs, with the trend showing that poor communication and lack of protocols were related to the damage caused. Degree of preventability: 96.4%. CONCLUSIONS: Most AEs affected the patient, and were related to medication, diagnostic tests, and laboratory errors. The level of harm was related to communication problems, lack of, or deficient, protocols and a poor safety culture

[Description of contributing factors in adverse events related to patient safety and their preventability]. / Descripción de factores contribuyentes en sucesos adversos relacionados con la seguridad del paciente y su evitabilidad.

OBJECTIVE: To assess the extent of healthcare related adverse events (AEs), their effect on patients, and their seriousness. To analyse the factors leading to the development of AEs, their relationship with the damage caused, and their degree of preventability. DESIGN: Retrospective descriptive study. LOCATION: Porriño, Pontevedra, Spain, Primary Care Service, from January-2014 to April-2016. PARTICIPANTS AND/OR CONTEXT: Reported AEs were entered into the Patient Safety Reporting and Learning System (SiNASP). METHOD: The variables measured were: Near Incident (NI) an occurrence with no effect or harm on the patient; Adverse Event (AE) an occurrence that affects or harms a patient. The level of harm is classified as minimal, minor, moderate, critical, and catastrophic. Preventability was classified as little evidence of being preventable, 50% preventable, and sound evidence of being preventable. DATA ANALYSIS: percentages and Chi-squared test for qualitative variables; P<.05 with SPSS.15. DATA SOURCE: SiNASP. Ethical considerations: approved by the Research Ethics Committee (2016/344). RESULTS: There were 166 recorded AEs (50.6% in males, and 46.4% in women. The mean age was 60.80years). Almost two-thirds 62.7% of AEs affected the patient, with 45.8% causing minimal damage, while 2.4% caused critical damages. Healthcare professionals were a contributing factor in 71.7% of the AEs, with the trend showing that poor communication and lack of protocols were related to the damage caused. Degree of preventability: 96.4%. CONCLUSIONS: Most AEs affected the patient, and were related to medication, diagnostic tests, and laboratory errors. The level of harm was related to communication problems, lack of, or deficient, protocols and a poor safety culture.