¿Debería ser la Seguridad del Paciente un área de conocimiento de la Medicina Preventiva y Salud Pública? / No disponible

No disponible

[Critically ill patient isolation: risk or protection?] / Aislamiento del paciente crítico: ¿riesgo o protección?

INTRODUCTION: Isolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. MATERIAL AND METHODS: A retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. RESULTS: The study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. CONCLUSIONS: PSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

¿Están asociadas la carga asistencial y la seguridad del paciente? / Is there a relationship between patient safety and workload

Objetivo: La finalidad del estudio fue la estimación del grado en que los médicos consideran que la carga de trabajo puede generar problemas en la seguridad de los pacientes (SP). Metodología: Estudio descriptivo realizado mediante cuestionario remitido electrónicamente a médicos de hospitales públicos del Servicio Aragonés de Salud. Resultados y conclusión: Se obtuvo una tasa de respuesta del 9% (177 respuestas válidas; N: 1.600 médicos). Un 48,6% opinaba que durante el último año, al menos una vez a la semana, la presión asistencial excedió de lo que podría considerarse como una atención médica segura. El 28% consideró que durante el último año tuvo que atender a demasiados pacientes. El 17% afirmó que no había sido posible registrar en la historia clínica la totalidad de los resultados importantes de las exploraciones realizadas. Los resultados ponen de manifiesto la preocupación de los profesionales por el impacto de la carga asistencial sobre la repercusión en la calidad de la asistencia y la seguridad del paciente

Objective: The aim of this study was to estimate the degree to which physicians consider that the workload can reduce patient safety. Methodology: Descriptive study carried out by means of a questionnaire sent electronically to doctors from public hospitals of Aragón (Spain). Results and conclusion: A response rate of 9% was obtained (177 valid responses, N: 1.600 doctors). A 48.6% think that during the last year, at least once a week, the workload of care has exceeded what they consider a safe medical care. A 28% of the respondents,during the last year, has had to attend to too many patients. 17% affirm that it has not been possible to record in the clinical history all the important results of the explorations carried out. The results highlight the professionals concern about the impact of the workload on patient safety and quality of care

Sesgo de género en textos académicos, ¿también en los de Salud Pública? / Gender bias in the authorship of academic books, also in public health textbooks?

Justificación y objetivos: Las desigualdades de género persisten en las actividades de investigación y educación. Hemos analizado la evolución de las desigualdades de género en diferentes libros de texto de Salud Pública de uso habitual en España y Europa para la formación inicial de los diferentes grados en ciencias de la salud y para la de postgrado y especializada. Métodos: Estudio descriptivo donde se analiza la presencia de mujeres, tanto en la faceta de autoras de capítulo, como en la de directoras o editoras en diferentes ediciones publicadas desde 1988 hasta 2016 de libros nacionales e internacionales de uso habitual. Resultados: En la mayor parte de libros analizados se observa un marcado predominio de hombres en la autoría como colaboradores a pesar de un incremento mantenido de la presencia de mujeres. La razón hombre/mujer todavía es más desigual cuando se analiza el papel de las mujeres como editoras o directoras de las ediciones. Conclusiones: Aunque existe una tendencia al incremento del número de autoras, las cifras no son suficientes y proporcionan una falsa sensación de equidad. Existe por lo tanto un sesgo de género que carece de una explicación lógica, y que traduce la mayor dificultad de las mujeres para progresar en la carrera investigador

Background: Gender inequalities persist in research and university education. This is remarkable in the field of public health, where issues such as equity and the study of social inequalities and their relation to public health are key components. We analyse the evolution of gender inequalities in various public health manuals and textbooks commonly used in graduate and postgraduate training in Spain and Europe. Methods: This descriptive study examined the presence of women as chapter authors and editorial directors in 13 editions of 4 public health manuals and textbooks published between 1988 and 2016, and analysed temporal trends in the male/female ratio of authors and editorial directors. Results: Our data reveal a marked predominance of male authors and collaborators in most books analysed, despite a progressive increase in the number of female contributors in successive editions. Analysis of the male/female ratio of autors and editorial directors reveals even greater inequality. Conclusion: Despite a trend indicating an increase in the number of female authors over time, these data create a false sense of gender equity, given the marked disparity observed at the level of editorial directors. Our findings reveal a strong gender bias that lacks a logical explanation, and renders the greater adversity faced by women seeking to progress in their research careers

Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013) / Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)

Objetivos: Analizar la evolución de la prevalencia de úlceras por presión entre los años 2006 a 2013. Conocer los principales factores de riesgo asociados a las mismas. Método: Estudio descriptivo en el que se analizaron las series de prevalencia 2006-2013 de úlceras por presión del estudio de prevalencia de las infecciones nosocomiales en España del Hospital Clínico Universitario de Zaragoza. Resultados: La prevalencia media de úlceras por presión en los 5.354 pacientes del período de estudio fue de 4,5% (IC95% = 3,9-5,0%). No se encontraron diferencias significativas en la distribución ni en la tendencia a lo largo del período estudiado. La prevalencia aumentó al 5,0% (IC95% = 4,4-5,6% al eliminar de la muestra los pacientes con estancia inferior a 24 horas y los de servicios de bajo riego (Pediatría, Obstetricia y Psiquiatría), pero tampoco había diferencias en su distribución ni tendencia anual (p > 0,05). Los factores asociados a las úlceras fueron la edad, los días de ingreso, la presencia de coma, sonda urinaria, desnutrición, infección y el servicio de ingreso. Conclusiones: La edad, la estancia hospitalaria, la presencia de coma, desnutrición, infección, sonda urinaria y el ingreso en determinadas unidades constituyen marcadores independientes de riesgo de los pacientes con úlceras por presión. No se aprecia una tendencia en la prevalencia de úlceras por presión que sugiera algún efecto de las diferentes estrategias de intervención implantadas en el período de estudio, aunque esta ausencia de hallazgos podría ser debida a las limitaciones de los datos empleados (AU)

Objectives: To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. Method: A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. Results: The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI = 3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI = 4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p > 0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. Conclusions: Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study (AU)

[Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)]. / Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013).

OBJECTIVES: To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. METHOD: A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. RESULTS: The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI=3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI=4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p>0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. CONCLUSIONS: Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study.

[Identification of adverse events in hospitalised influenza patients]. / Identificación de eventos adversos en pacientes hospitalizados por gripe.

OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

Identificación de eventos adversos en pacientes hospitalizados por gripe / Identification of adverse events in hospitalised influenza patients

Objetivos: Testar la fiabilidad interobservador de la guía de cribado y del formulario modular de revisión (MRF2) para identificar eventos adversos (EA). Comparar la incidencia de EA entre un grupo de pacientes sometidos a precauciones de aislamiento de contacto y gotas por gripe frente a un grupo de pacientes no aislados. Método: Estudio de casos y controles anidados en una cohorte. Los casos son 50 pacientes sometidos a precauciones de aislamiento por gripe, y los controles son 50 pacientes ingresados y no aislados. Resultados: La incidencia de EA varía entre el 10 y el 26% por efecto del observador (26% [IC 95%: 17,4-34,60%]; 10% [IC 95%: 4,12-15,88%]; 23% [IC 95%: 14,75-31,25%]). Es siempre menor en la cohorte expuesta al aislamiento que en la no expuesta, y esa diferencia alcanza significación estadística cuando aplicamos el criterio de máxima exigencia en la definición de caso. La concordancia respecto del cribado fue buena (porcentaje simple de concordancia superior al 76%; índice Kappa entre 0,29 y 0,81). La concordancia respecto de la identificación precisa de EA relacionado con la asistencia fue menor (porcentaje de concordancia entre el 50 y el 93,3%; índice Kappa de 0,20 a 0,70). Conclusiones: Antes de realizar un estudio epidemiológico sobre EA hay que analizar la fiabilidad interobservador para mejorar la precisión de los resultados y, por ende, la validez del estudio. Los revisores presentan diferentes grados de concordancia. El índice Kappa muestra niveles elevados para la guía de cribado, no así para la identificación de EA. Sin una buena metodología no se pueden garantizar los resultados alcanzados y, consecuentemente, las decisiones tomadas a partir de ellos. Por tanto, los investigadores han de ser garantes del método utilizado y este debe acercarse lo más posible al óptimo alcanzable (AU)

Objective: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. Methods: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. Results: The AE incidence ranges from 10 to 26% depending on the observer (26% [95% CI: 17.4%-34.60%], 10% [95% CI: 4.12%-15.88%], and 23% [95% CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). Conclusions: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable (AU)

Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales / Use of ineffective practices in primary health care: professional opinions

Objetivo. Estimar la frecuencia de prácticas inefectivas en la atención primaria (AP) en función de la opinión de profesionales clínicos, así como valorar la importancia, consecuencias y factores que pueden estar contribuyendo a su mantenimiento. Material y métodos. Encuesta de opinión online a una muestra de conveniencia de 575 profesionales de la AP seleccionados a partir de artículos publicados en los últimos años de las revistas Atención Primaria y Semergen. Resultados. Respondieron 212 encuestados (37%). Para el 70,6% (IC 95%: 64,5-73,7) el problema de las prácticas inefectivas resultó frecuente o muy frecuente en AP y la importancia fue valorada con una puntuación media de 7,3 (DE = 1,8) sobre 10. Las principales consecuencias de las prácticas inefectivas fueron poner en peligro la sostenibilidad del sistema (48,1%; IC 95%: 41,2-54,9) y el daño a los pacientes (32,1%; IC 95%: 25,7-38,5). Contribuyeron a su mantenimiento los propios pacientes (28%; IC 95%: 22,6-35,0), la carga de trabajo (26,4%; IC 95%: 20,3-32,5) y la falta de formación continuada (19,3%; IC 95%: 13,9-24,7). Los procesos clínicos con mayor grado de utilización inadecuada fueron la prescripción de antibióticos en determinadas infecciones, la periodicidad del cribado del cáncer de cérvix, el control farmacológico de la diabetes tipo 2, la utilización de psicofármacos en ancianos y el uso de analgésicos en pacientes con hipertensión o insuficiencia renal. Conclusiones. La utilización de intervenciones inefectivas en AP fue apreciada como un problema muy relevante que afectaría a muchos pacientes, pondría en peligro la sostenibilidad del sistema y causaría daño a los pacientes (AU)

Objective. To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. Material and methods. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. Results. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD] = 1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. Conclusions. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients (AU)

[Use of ineffective practices in Primary Health Care: professional opinions]. / Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales.

OBJECTIVE: To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. MATERIAL AND METHODS: An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. RESULTS: A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. CONCLUSIONS: The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients.

Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS).

BACKGROUND: Interest in patient safety (PS) is growing exponentially, fuelled by epidemiological research unveiling the extent of unsafe care. However, there is little information about the frequency of harm in developing and transitional countries. To address this issue, the authors performed a study known as the Iberoamerican Adverse Event Study, through a collaborative between the governments of Argentina, Colombia, Costa Rica, Mexico and Peru, the Spanish Ministry of Health, Social Policy and Equality, the Pan American Health Organization and the WHO Patient Safety. METHODS: The study used a cross-sectional design, involving 58 hospitals in the five Latin American countries, to measure the point prevalence of patients presenting an adverse event (AE) on the day of observation. All inpatients at the time of the study were included. RESULTS: A total of 11 379 inpatients were surveyed. Of these, 1191 had at least one AE that the reviewer judged to be related to the care received rather than to the underlying conditions. The estimated point prevalence rate was 10.5% (95% CI 9.91 to 11.04), with more than 28% of AE causing disability and another 6% associated with the death of the patient. Almost 60% of AE were considered preventable. CONCLUSIONS: The high rate of prevalent AE found suggests that PS may represent an important public-health issue in the participating hospitals. While new studies may be needed to confirm these results, these may already be useful to inspire new PS-improvement policies in those settings.

Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica / IBEAS design: adverse events prevalence in Latin American hospitals

Objetivos. Describir las características y metodología del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica, que persigue realizar una aproximación a la magnitud, trascendencia e impacto de los eventos adversos (EA); identificar áreas y problemas prioritarios de la seguridad del paciente; incrementar la masa crítica de profesionales involucrados en la seguridad del paciente e incorporar a la agenda de los países objetivos y actividades para mejorar la seguridad del paciente. Método. Estudio sobre la seguridad de los pacientes. Ámbito: 35 hospitales de 5 países: Argentina, Colombia, Costa Rica, México y Perú, a través del análisis de los efectos adversos identificados. Diseño de prevalencia utilizando la revisión de la historia clínica. Resultados. Se describen las implicaciones en el uso del diseño transversal en el estudio de EA, tanto en los recursos necesarios como en la validez interna y en la utilidad para la gestión de riesgos sanitarios. Conclusiones. El diseño transversal es eficiente en tiempo y recursos y fácil de realizar, y aunque no permite estudiar la totalidad del episodio de hospitalización, ha demostrado ser capaz para sostener un sistema de vigilancia. Debido a un posible sesgo de supervivencia, los EA que ocasionen un ingreso se verán sobrerrepresentados, y también aquellos relacionados con la infección nosocomial o los que sean difícilmente identificables si no se ve al paciente. La comunicación con el personal de planta (mientras el paciente está hospitalizado) favorece el juicio de la causalidad del efecto adverso y de su evitabilidad(AU)

Objectives. To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. Methods. A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. Results. The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. Conclusions. The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention(AU)

[IBEAS design: adverse events prevalence in Latin American hospitals]. / Diseño del estudio IBEAS: prevalencia de efectos adversos en hospitales de Latinoamérica.

OBJECTIVES: To describe the methodological characteristics of the IBEAS study: adverse events prevalence in Latin American hospitals, with the aim of analysing the magnitude, significance and impact of adverse events (AE); to identify the main problems associated with patient safety AE; to increase the capacity of professionals involved in patient safety; and the setting up of patient safety agendas in the participating countries. METHODS: A patient safety study launched in 35 Latin American hospitals through the analysis of AE in 5 countries: Argentina, Colombia, Costa Rica, Mexico and Peru, using a cross-sectional study using a review of clinical records as the main method. RESULTS: The implications of using a cross-sectional design when studying AE are described, in terms of resources required, internal validity and usefulness related to risk management. CONCLUSIONS: The cross-sectional design seems an efficient methodology in terms of time and resources spent, as well as being easy to carry out. Although the cross-sectional design does not review the all hospital episodes, it is able to provide a reliable estimate of prevalence and to support a surveillance system. Because of a possible survival bias, it is likely that the AE which led to hospital admissions will be overestimated, as well as the health related infections or those adverse events which are difficult to identify if the patient is not examined (e.g. contusions). Communication with the ward staff (if the patient is still hospitalised) help in finding the causality and their prevention.

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.

¿Nos creemos de verdad la necesidad de la participación del paciente? / Do we really believe in the need for patient participation?

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La investigación sobre seguridad del paciente: necesidades y perspectivas / Research on patient safety: needs and perspectives

Una atención sanitaria segura requiere aplicar procedimientos y prácticas con demostrada efectividad para reducir la aparición de fallos, errores y resultados adversos y también generar nuevos conocimientos sobre los factores que contribuyen a mejorar la seguridad del paciente. Los resultados adversos y la seguridad del paciente no son conceptos distintos, sino las dos caras de una misma moneda: el riesgo asistencial. Debemos procurar que la prioridad de sanitarios y gestores sea la seguridad del paciente antes que las consecuencias de su deterioro. Son áreas fundamentales de investigación: estimar la magnitud y las características del riesgo clínico, comprender los factores que contribuyen a la aparición de resultados adversos, evaluar el impacto de los resultados adversos en el sistema sanitario e identificar soluciones efectivas, factibles y sostenibles para lograr una atención segura. Las cuestiones clave al elaborar proyectos de investigación sobre seguridad del paciente son: los objetivos del proyecto, su prioridad, la calidad de los datos e información, los recursos disponibles y la metodología. El estudio de la seguridad del paciente y los resultados adversos precisa de dos perspectivas complementarias: una colectiva, fundamentada en el método epidemiológico y orientada a cuantificar los riesgos asistenciales, y otra individual, basada en métodos cualitativos, encaminada a analizar las causas y los factores contribuyentes. Para mejorar la investigación sobre seguridad del paciente son necesarios: mejores sistemas de información, mayor colaboración entre los países desarrollados y países en transición y formación y difusión amplia de experiencias y resultados de los proyectos (AU)

A safe health care system requires applying procedures and practices that have demonstrated effectiveness in reducing errors, faults and adverse events in health care, but it also needs to update its knowledge on the factors that contribute to improve patient safety. Adverse events and patient safety are two sides of the same coin, clinical risk. We must ensure that the priority of health managers and providers is aimed at patient safety more than adverse events. They are some fundamental areas of research in patient safety: to estimate the magnitude and features of the clinical risk, to understand the factors contributing to the appearance of adverse events, to evaluate the impact of adverse events on health care system and to identify effective, feasible and sustainable solutions to achieve a safe health care. Key points of patient safety research projects are: aims of research, priority, data and information quality, available resources and methodology. The study of the patient safety and adverse events needs two complementary perspectives: a collective one, based on epidemiological methods and aimed at quantifying the risks in healthcare, and an individual one, based on qualitative methods, to analyze causes and factors contributing to adverse events. Several things are required to improve the patient safety research: better data and information systems, greater collaboration in training between developed and transitional countries, and wider dissemination of experiences and results of the projects. Key points of patient safety research projects are: aims of research, priority, data and information quality, available resources and methodology. The study of the patient safety and adverse events needs two complementary perspectives: a collective, based on epidemiological method and guided to quantifying the risks of healthcare, and another individual, based on qualitative methods, to analyze causes and contributing factors of adverse events. To improve the patient safety research are necessary: better data and information systems, bigger collaboration between developed and transitional countries training and wide dissemination of experiences and results of the projects (AU)