Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit.

BACKGROUND: Trauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals. AIM: The aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs). STUDY DESIGN: A systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment. RESULTS: The initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care. CONCLUSIONS: There was a clear gap and large variability between the indicators, as well as low-quality evidence. Future studies will validate indicators using the Delphi method. RELEVANCE TO CLINICAL PRACTICE: Design a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.

Impact of the implementation of Identification-Situation-Background-Assessment-Recommendation (ISBAR) tool to improve quality and safety measure in a lithotripsy and endourological unit.

INTRODUCTION: A lack of professional communication and collaboration may be one of the main causes of medication errors. The objective was to evaluate the results of the implementation of ISBAR as a communication and safety tool in a Lithotripsy and Endourologic Unit of a tertiary public hospital. METHODS: A total of 457 patients were included in a retrospective study from 2014 to 2019. Patients were divided into two groups: group A (357 patients) in which an endourological procedure was performed before march of 2018 (without the implementation of ISBAR tool) and Group B (100 patients) with the implementation of ISBAR tool. The inclusion criteria were patients accepted for surgical intervention by anaesthesiology Department and operated in the period of the study. The variables analysed included number of procedures, global, intraoperative and postoperative complications rate, urinary infection or sepsis, NPR (FMEA), percentage of suspended surgical patients and hospital stay. RESULTS: The postoperative complications showed no significant differences between groups, but a trend to diminishing was seen in the complication in the group B. The sepsis reduced its incidence and it was close to significant difference. The operative time was shorter in group B 119,11min (114,63-123,59) vs 115,11min (109,63-121,67) p = 0,3. The reduction in the main postoperative complication (sepsis) explained the lower hospital stay for group B. The severe adverse events detected were reduced completely. CONCLUSIONS: ISBAR tool was an effective patient safety tool improving quality care. To provide safe patient care and improving quality is indispensable an effective communication flow.

Simulación clínica y seguridad en urgencias y emergencias: Emergency Crisis Resource Management (E-CRM) / Clinical simulations and safety in emergencies: Emergency Crisis Resource Management

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Decálogos de seguridad para el personal sanitario en emergencias extrahospitalarias terrestres / Safety in out-of-hospital land emergencies: ground rules for responders

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Características de las personas afectadas de fibrilación auricular en una consulta de cardiología / Characteristics of people affected by atrial fibrillation in a cardiology office

La Fibrilación auricular (FA) presenta una elevada prevalencia en los ancianos. Se plantea como objetivo describir las características de la población afectada y valorar las relaciones existentes entre los diferentes aspectos medibles. Metodología: Estudio descriptivo e inferencial con muestreo por conveniencia, seleccionando todos los pacientes con episodios de FA asociados a frecuencias cardíacas (FC) superiores a 80 ppm o que hayan revertido a ritmo sinusal, con el que se obtiene una muestra de 65 personas. Se han recopilado datos sociodemográficos, tipo de FA, variaciones en FC, visitas a urgencias y complicaciones. Los datos han sido analizados mediante el programa SPSS v.17.0. Resultados: La media de edad fue de 65 años. La FA paroxística se encuentra asociada a FC iniciales superiores a las del grupo de FA persistente, el cual se relaciona con edades más avanzadas. El grupo que acude a urgencias presenta FC iniciales superiores. Existen diferencias significativas, asociando directamente las consultas al servicio de urgencias con episodios de FA con FC elevadas que obliga a la derivación. A edades avanzadas, mayor asociación en el individuo de los factores de riesgo con los que esta se relaciona. Conclusiones: La FA es una de las arritmias más prevalentes, con un alto coste sanitario y con un empeoramiento de la calidad de vida, por lo que las actividades encaminadas a la detección precoz y tratamiento adecuado son fundamentales para su mejora

Atrial fibrillation (AF) has a high old prevalence. The main objective is describe and asses the characteristics of the population affected and the relationships between different measurable aspects. Methodology: Descriptive and inferential study with convenience sampling, selecting all patients with AF episodes associated with heart rate (HR) above 80 ppm or they have reverted to sinus rhythm, obtaining a sample of 65 people. Sociodemographic data have been collected, type of AF, variations in HR, emergency department visits and complications. Data were analyzed using SPSS v.17.0. Results: The mean age was 65 years. Paroxysmal AF is associated with higher initial HR group of persistent AF, which is related to older ages. The group attended the emergency department have higher initial heart rate. There are significant differences, associating directly to the emergency consultations with episodes of atrial fibrillation with high HRrequiring patient referral. At older ages, there is more association of individual risk factors with which it relates. Conclusions: The FA is one of the most prevalent arrhythmia with a high health costs and a deteriorating quality of life, being the key activities aimed at early detection and adequate treatment to improve it

Aspectos podológicos en la Encuesta Nacional de Salud / Podiatric issues in National Health Survey

Objetivo: la Encuesta Nacional de Salud (ENS) es el instrumento para detectar el nivel de salud de la población, por lo que se plantea como objetivo el análisis de las diferentes ediciones para valorar la presencia de los aspectos podológicos y de la figura del profesional de podología en la atención a las personas mayores. Metodología: se ha realizado un análisis de contenido de las diferentes ENS tras la recopilación de las diferentes ediciones (8). Después de la lectura en profundidad y análisis por parte de dos investigadores, se han cumplimentado las fichas de análisis y se han categorizado los diferentes transcriptores, y se ha realizado el análisis e interpretación de la información encontrada. Resultados: en las diferentes ediciones no aparece ninguna mención a la profesión de podología; sí que aparecen referencias a otras figuras como naturópatas, quiroprácticos, entre otros. En relación con los descriptores sobre las afecciones de los pies, solo aparece una referencia en la edición de 1987. No obstante, la referencia a aspectos podológicos es prácticamente inexistente. Conclusiones: la ENS es el instrumento básico para conocer el estado de salud de la población general, pero presenta limitaciones al omitir los aspectos podológicos que suponen una merma en el diagnóstico de las necesidades y, por consiguiente, en la calidad de vida de las personas, principalmente mayores. Al igual que ocurre con la cartera de servicios del SNS, obvia a los/as profesionales formados para la atención básica de los problemas podológicos en el equipo de salud

Aim: The National Health Survey (NHS) is the instrument to detect the level of population health so we set as our aim, the analysis of the different editions to assess the presence of podiatric aspects and the figure of the professional podiatry. Methodology: There has been a content analysis of the different ENS after the compilation of the different editions (8). After reading in depth analysis by two researchers have completed sheets are categorized analysis and different transcribers and performing the analysis and interpretation of information found. Results: In the different editions no mention of the profession of podiatry does not appear, appearing as references to other Naturopaths, Chiropractors, etc. Regarding descriptors regarding foot conditions, only appears a reference in the 1987 edition, being almost nonexistent the podiatric aspects. Conclusions: The ENS is essential to know the health status of the general population instrument nevertheless has limitations to obviate the podiatric aspects that represent a reduction in the quality of life of people. As is the case with the range of services of SNS, obvious to professionals trained for basic care of foot problems in the health care team

Manejo inicial del paciente agitado / Management of the agitated patient in the emergency department

Los pacientes agitados son una situación clínica a la que con relativa frecuencia se enfrentarlos médicos en su práctica clínica. En la primera valoración, además de tomarlas oportunas medidas de seguridad, debemos de hacer un diagnóstico de presunción basado en el origen de la agitación (causa orgánica, trastorno mental subyacente o manifestación de una ansiedad extrema). Ello facilitará una posible resolución mediante un abordaje verbal o por el contrario se procederá a la contención mecánica. En caso de que se tome esta última decisión, se debe planificar con antelación y realizarla con al menos 5 personas. Dicha maniobra suele ser el paso previo a la contención con sedación farmacológica con benzodiacepinas, neurolépticos o una pauta combinada de ambos. Es necesario tener en cuenta el riesgo que suponen estos pacientes para su entorno familiar, el personal que lo atiende o incluso su propia vida, por lo que son candidatos a ingresar en unidades de psiquiatría de forma voluntaria o involuntaria. Si optamos por esta última, debe realizarse al amparo de la Ley, así como las medidas de contención y sedación adecuadas. Todas estas maniobras tienen que estar reflejadas con nuestro informe para el psiquiatra de guardia, que es quien realiza el ingreso (AU)

Agitated patients must be managed fairly often in routine emergency department practice. After safety measures are taken during initial assessment, a tentative diagnosis based on the cause of agitation (physical condition, underlying mental disorder, or extreme anxiety) should be made. That diagnosis will facilitate possible resolution of the problem through dialog with the patient or through physical restraint. If restraint is chosen, the manner of proceeding should be planned and at least 5 persons should be involved. The restraining maneuver is usually followed by administration of benzodiazepines, neuroleptic agents, or a combination of both in order to assure sedation. It is important to remember that these patients pose a threat to their families, emergency room staff, and themselves; therefore, they are candidates for voluntary or involuntary admission to a psychiatric unit. If that is the course of action chosen, admission must comply with the law and adequate restraint and sedation should be prescribed. All such actions should be recorded in the emergency department’s report to the psychiatrist on duty, who will be the admitting physician (AU)