Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión / Opinion survey on information, communication and treatment in an Emergency Department

Objetivo. Conocer aspectos concretos acerca de la información y la comunicación con los usuarios de los servicios de urgencias hospitalarias y el trato recibido en ellos a través de una encuesta telefónica. Métodos. Estudio prospectivo en 2 servicios de urgencias hospitalarias de Salamanca. Se incluyeron en el estudio 400 pacientes (edad media 56,4 ± 20,5 años; 58,4% mujeres). Se realizó una encuesta telefónica con 19 ítems. Doce de ellos recogían las respuestas en escala tipo Likert, con puntuaciones de 1 (muy mal) a 5 (muy bien). El resto permitían responder «sí» o «no». Resultados. El 86% de los pacientes evaluaron positivamente el trato recibido por los profesionales en general, el 92% el respeto mostrado, el 87% el trato de los médicos y el 71% el trato recibido por enfermería. El 27,5% no recuerda haber recibido información del personal del punto azul (profesionales especialmente capacitados para dar información). Se encontró significación estadística (p = 0,045) en relación a la amabilidad y respeto mostrado por enfermería. La mayoría de los pacientes que fueron ingresados en el área de observación del servicio de urgencias no fueron informados sobre los horarios de visita (p = 0,003). Conclusiones. La percepción del trato recibido por los pacientes es buena, mientras que en relación a la información y comunicación es ostensiblemente mejorable y podría ser evaluada utilizando la encuesta que proponemos, ya que permite detectar y utilizar los puntos débiles de estos aspectos de la asistencia sanitaria como lanzaderas de las iniciativas de implementación (AU)

Objective. To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. Methods. A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4 ± 20.5 years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer 'yes' or 'no'. Results. The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P = .045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P = .003). Conclusions. Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives (AU)

[Opinion survey on information, communication and treatment in an Emergency Department]. / Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión.

OBJECTIVE: To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. METHODS: A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4±20.5years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer "yes" or "no". RESULTS: The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P=.045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P=.003). CONCLUSIONS: Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives.

Organización y disponibilidad de recursos para la asistencia toxicológica en los servicios de urgencias de los hospitales españoles / Organisation and resources availability for toxicological care at the emergency outpatient clinics of the Spanish hospitals

Introducción: La mayoría de los intoxicados agudos acaban siendo asistidos en los Servicios de Urgencias Hospitalarios (SUH), constituyendo este ámbito adecuado para evaluar el tipo de organización, los recursos y la asistencia prestada a estos enfermos. Método: Se envió una encuesta por correo a los SUH de 176 hospitales españoles, la cual constaba de siete apartados: características del hospital, disponibilidad de analítica toxicológica urgente las 24 horas, disponibilidad de un botiquín toxicológico, formación específica de postgrado/continuada, investigación clínica, información toxicológica y calidad asistencial (método preferente de descontaminación digestiva e intervalo eficaz para su aplicación en 3 situaciones clínicas). Resultados: El índice de respuestas fue del 43,7%. El 54,5% de los SUH usaban un test en orina para el diagnóstico analítico rápido. La disponibilidad de analítica cuantitativa de los parámetros útiles para el tratamiento fue del 61,9% en hospitales de nivel III. Sólo el 31,4% de las sustancias del botiquín toxicológico estaban disponibles en el 100% de los hospitales. Los quelantes eran accesibles en el 60% y compuestos de aplicación inmediata variaban según el nivel del Hospital entre el 63 y el 90%. El 72,5% de los médicos habían asistido a algún curso de postgrado, el 25,6% había publicado algún trabajo toxicológico y el 59,5% alguna comunicación a un congreso. Disponían de protocolos de intoxicaciones el 87%. El 94,8% de los centros utilizaban como fuente de información el Servicio de Información Toxicológica ubicado en Madrid. El 86,7% de los SUH señalaron al lavado gástrico como método preferente de descontaminación digestiva. Los intervalos de descontaminación correctamente contestados oscilaron entre el 18,7 y el 38,7%. Conclusiones: Es necesario realizar un consenso sobre analítica toxicológica, dotación mínima de antídotos y tiempo en que deben estar disponibles ambos, en función del nivel asistencial del hospital. También debe valorarse la implantación de programas específicos de formación de postgrado/reciclaje, y la redacción y difusión de guías por parte de las Sociedades Científicas, para evitar actitudes rutinarias en el tratamiento del intoxicado agudo (AU)

Background: Most cases of acute intoxication are finally referred to the Hospital Emergency Outpatient Clinics (HEOC), and this is the adequate environment for assessing the type of organisation, the resources and the care provided to these patients. Methods: A questionnaire was mailed to the HEOCs of 176 Spanish hospitals; the questionnaire encompassed seven areas: characteristics of the hospital, 24-hour availability of emergency toxicologic analysis services, availability of a toxicologic “ready-use box”, soecific postgraduate/continuing training of the personnel, clinical research, toxicologic information and quality of care. Results: The response index was 43.7%. Fifty-four point five per cent of the HEOCs used an urine test for rapid toxicologic diagnosis. Availability of quantitative analysis of parameters useful in therapy was 61.9% at level- III hospitals. Only 31.4% of the substances prescribed for the toxicologic “ready-use box” were immediately available in 100% of the hospitals. Chelating agents were accessible in 60%, and immediate-use compounds availability varied between 63% and 90% in the various hospitals. Seventy-two point five per cent of the physicians had attended some postgraduate course; 25.6% had already published some paper on toxicologic subjects, and 59.5% had presented communications at Meeting. Intoxication management protocols were available in 87%; in 94.8% of the Centres the source for emergency information was the Toxicologic Information Service in Madrid. Eighty-six point seven per cent of the HEOCs named gastric lavage as the preferred method for digestive tract decontamination. The questions regarding the decontamination intervals were correctly answered in 18.7% to 38.7% of the cases. Conclusions: A consensus must be reached regarding toxicologic analyses, minimum antidote availability and the period for availability of both. Furthermore, the implementation of specific postgraduate training/recycling programmes and the Guidelines of Scientific Societies should be considered (AU)

[An epidemiological study of acute intoxications and provision of medical-cabinet antidotes]. / Estudio epidemiológico sobre intoxicaciones agudas y dotación de botiquines de antídotos.

OBJECTIVES: The aims of this work is to know first, the characteristics of the cases of acute intoxication seen in the emergency room of he "Hospital Clínico de Salamanca", Spain; and second, the existence of first-aid antidote kits, their location within the hospital, and their supplies in relation of the level of assistance being provided in hospitals in the region of "Castilla-León". METHODS: All cases of acute intoxication attended in the Emergency Room in he "Hospital Clínico de Salamanca" during one year (from June 1993 through May 1994) were studied prospectively. A descriptive analysis of several variables was performed including age, sex, monthly distribution, causes, toxic substances involved, route of exposure, clinical manifestations, treatment, department in witch patients were admitted and clinical evolution. Additionally, a questionnaire was sent to physicians in charge of emergency services of hospital in "Castilla-León" regarding the existence, location an equipment of first-aid antidote units. RESULTS: A total of 425 cases of acute intoxication were attended, representing 0.69% of all cases seen in the emergency room, during the mentioned period. The age range with the highest incidence was 20-30 years, representing 28.94% of the cases of acute intoxication. 51.3% of cases corresponded to male individuals, although in the 20-30 year range 63.11% were females. February was the month with the highest incidence. With regard to etiology, accidental exposure was the most common, representing 60.47% of cases, while among females 49.28% of cases of intoxication were self inflicted. The toxic substances most frequently involved were alcoholic drinks (23%) and benzodiazepines (17.16%). Recreation and opiate drugs represented 16.23% of the cases. The route of exposure was oral ingestion in 81% of cases and the most common clinical manifestation were of neurologic type which were present in 48% of patients attended. 25% of patients were admitted, representing 0.80% of admissions from the Emergency Room, with the intensive care unit and the Department of Psychiatry (32% of cases in each one) being the areas in which the highest number of patients were hospitalized. The number of patients that died was 2, which represents 0.47% of intoxicated patients attended. In 40% of hospital of the region there is a specific location within the Emergency Room for the first aid antidote drug kit. There is a good correlation between the levels of assistance of hospitals of Castilla-León and the supplies of the first aid antidote kit in the Emergency Room as well as in the Pharmacy Unit.

Estudio epidemiológico sobre intoxicaciones agudas y dotaciónde botiquines de antídotos / Epidemiological study in acute intoxication and provision of medical cabinet´s antidites

Objetivo: El objetivo de éste trabajo es conocer las características de la población que es atendida por Intoxicaciones Agudas en nuestra comunidad así como la existencia de los diversos botiquines de antídotos, su ubicación dentro del hospital y su dotación dependiendo del nivel asistencial que prestan. Métodos: Se examinaron por un lado las 425 intoxicaciones que fueron atendidas en el Servicio de Urgencias del Hospital Clínico de Salamanca y además se realizó una encuesta en los servicios de urgencia de los hospitales de nuestra región. Se procedió a estudiar prospectivamente las intoxicaciones agudas atendidas durante el periodo Junio-93 a Mayo-94. Se hace un análisis descriptivo de las variables, edad, sexo, distribución mensual, etiología, tóxicos implicados, vía de entrada, manifestaciones clínicas, tratamiento impuesto, evolución de los pacientes y donde quedaron hospitalizados los que necesitaron ingreso. Resultados: Las intoxicaciones agudas supusieron el 0,69% del total de las urgencias atendidas en dicho periodo. El grupo de edad con mayor incidencia fue el de 20-30 años con el 28,94% del total. El sexo masculino es el más frecuente con el 51,30%, aunque en el grupo de 20-30 años el sexo femenino obtiene el 63,11%. El mes de Febrero fue el de mayor incidencia. Dentro de la etiología, las accidentales fueron las más frecuentes con el 60,47% de los casos; mientras que dentro del grupo de sexo femenino las de etiología autolesiva supusieron el 49,28% de dicho grupo. Los tóxicos más frecuentemente implicados fueron el Alcohol con el 23% y las Benzodiacepinas con el 17,16%. Las drogas de abuso supusieron el 16,23 del total. La vía de entrada fue en el 81% de los casos la Digestiva y las manifestaciones más frecuentes las Neurológicas que las presentaron el 48% de los pacientes asistidos. El 25% de los pacientes fueron ingresados, lo que supone el 0,80 del total de ingresos urgentes, siendo la UCI y la planta de hospitalización de Psiquiatría, ambos con el 32%, donde más pacientes ingresaron. El número de fallecimientos fue de 2, que supone el 0,47% del total de pacientes intoxicados atendidos. En el 40% de los casos existe un lugar determinado dentro del servicio de urgencias, para la medicación específica del botiquín de antídotos (AU)

[Preventable adverse drug effects at an emergency department]. / Evitabilidad de los acontecimientos adversos inducidos por medicamentos detectados en un Servicio de Urgencias.

OBJECTIVE: To determine the incidence and evaluate the preventability of adverse drug events (ADE) associated with visits to the Emergency Department at our hospital and subsequent hospital admissions. METHODS: A six-month observational study was conducted at an Emergency Department in a University Teaching Hospital (October 15th, 1995, to April 15th, 1996). The parameters influencing the preventability were identified by means of a multivariate logistic regression analysis. RESULTS: A total of 776 ADEs (2.25%) were detected out of a total of 33,975 patients attended at the Emergency Department; 178 patients were admitted. A total of 322 cases (43.3%) were classified as preventable and were graded as mild (37.1%), moderate (32.5%), severe (27.4%), and fatal (3%). The logistic regression analysis showed that preventability was related to drugs with a narrow therapeutic index (NTI) (OR: 10.12; 95%CI: 5.36-19.07), type A ADE (OR: 4.65; 95%CI: 2.79-7.78), age > or = 65 years (OR: 3.04; 95%CI: 2.13-4.34) and self-administered medication (OR: 2.2; 95%CI: 1.32-3.65). Among admitted patients, oral anticoagulants, NSAIDs, digoxin, diuretics, and insulin caused adverse events which were considered as preventable in more than 50% of cases. The errors most frequently associated with preventable ADEs included inappropriate therapy monitoring (22.5%), increased doses with NTI drugs (22.3%), absence of preventive therapy (14.3%), excessive dose according to patient's characteristics (13.4%), and inappropriate self-administered medication (10%). CONCLUSIONS: The incidence of preventable ADEs (medication errors) is high and its severity is higher than that of non-preventable ADEs. A prompt development and implementation of measures leading to avoiding prescription errors and inappropriate treatment monitoring, the factors identified as responsible for preventable ADEs, is clearly warranted.

[Fatal paraquat poisoning]. / Intoxicación fulminante por paraquat.

Paraquat is a potent bipiridilium herbicide, largely used by farmers. Is very toxic in the concentrated liquid form supplied. When ingested, even a minimum quantity, can be letal. We present a case of a 69 years old man who intencionaly ingested 60 ml of paraquat and 20 ml of NaOH. Tow hours after the ingestion, the patient wes admited to the emergency service. He was treated with gastrointestinal lavage, activated charcoal, füller's hearth, catárticos, fluid and electrolytes, mannitol, dopamine and haemoperfusion. Despite therapy, the patient developed a multiple organic failure and died fiveteen hours after admission. Clinical course and therapeutical management are described of this deliberale self poisoning infrequently reported in Spain.