Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud / A set of quality and safety indicators for hospitals of the «Agencia Valenciana de Salud»

Objetivos: Elaborar un conjunto de indicadores de calidad y seguridad en el contexto de los hospitales de la Agencia Valenciana de Salud. Material y métodos: Se utilizó la técnica Metaplan® para identificar propuestas sobre sostenibilidad y enfermería. Se empleó el catálogo de la Sociedad Española de Calidad Asistencial como punto de partida para los indicadores clínicos. Utilizando la Técnica Delphi 207 profesionales fueron invitados a participar en el proceso para identificar los indicadores más fiables y factibles. Finalmente, la propuesta resultante fue validada por los directivos de 12 hospitales, teniendo en cuenta la variabilidad, objetividad, factibilidad, fiabilidad y sensibilidad de los indicadores. Resultados: La tasa de participación osciló entre el 66,67 y 80,71%. De los 159 indicadores de la propuesta inicial se priorizaron y seleccionaron 68 (21 económicos o de gestión, 22 de cuidados de enfermería y 25 clínicos). De ellos 3 eran comunes a las 3 categorías y 2 no cumplían los criterios específicos de la fase de validación, por lo que el conjunto final consta de 63 indicadores. Conclusiones: Se ha elaborado un conjunto de indicadores de calidad y seguridad. El sistema de información actual permite su monitorización (AU)

Objectives: To prepare a set of quality and safety indicators for Hospitals of the «AgenciaValenciana de Salud». Material and methods: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking in to account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Results: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. Conclusions: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems (AU)

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"]. / Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud.

OBJECTIVES: To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud¼. MATERIAL AND METHODS: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare¼ was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. RESULTS: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. CONCLUSIONS: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.

Utilización de recursos sanitarios y costes asociados al diagnóstico y tratamiento de cada episodio de trombosis venosa profunda y sangrado en pacientes intervenidos de cirugía ortopédica de cadera o rodilla / Use of health resources and costs associated with the diagnosis and treatment of each episode of deep vein thrombosis and bleeding in patients undergoing orthopaedic surgery for hip or knee

Objetivo. Conocer la utilización de recursos sanitarios y los costes asociados al diagnóstico y tratamiento de la trombosis y sangrado en pacientes intervenidos de artroplastia primaria total de cadera (ATC) o rodilla (ATR), durante 3 meses de seguimiento. Pacientes y método. Estudio observacional de carácter multicéntrico y retrospectivo, realizado a partir de los registros médicos de pacientes pertenecientes a 3 centros hospitalarios-públicos españoles (año 2010). Se consideraron aleatoriamente 3 grupos de pacientes: a) control (sin complicaciones hospitalarias); b) sangrado, y c) trombosis. Se incluyeron variables generales, de utilización de recursos y sus costes. Análisis estadístico: regresión logística y ANCOVA, p<0,05. Resultados. Se incluyeron pacientes ≥ 40 años y que hubieran recibido profilaxis anticoagulante. Se incluyó un total de 141 pacientes (control: 60; sangrado: 60; y trombosis: 21). La edad media fue de 68,7 (DE: 10,4) años y el 68,1% fueron mujeres. La ATR fue la técnica más frecuente (71,6%). El riesgo de sangrado se relacionó con la edad (OR=1,1) y el de trombosis con la EPOC (OR=1,8), p<0,05. El promedio de días de estancia de los grupos de trombosis, sangrado y control fue de 13,9; 11,5 y 7,4 días, respectivamente, p<0,001). Los costes totales fueron: 10.484,3 €; 8.766,4 €, y 6.496,1 €, respectivamente, p<0,05. Todos los resultados agrupados fueron comparables entre ellos según el hospital analizado y el tipo de artroplastia. Conclusiones. Los costes más elevados se producen en los pacientes que habían desarrollado una trombosis y sangrado, respectivamente. Los costes se relacionaron con la prolongación de los días de estancia y las infecciones intrahospitalarias (AU)

Objective. To determine the use of healthcare resources and costs associated with the diagnosis and treatment of thrombosis and bleeding patients who have undergone elective hip or knee replacement surgery, in routine clinical practice conditions. Patients and methods. This multicentre observational and retrospective study extracted data from the medical records of three Spanish public hospitals (2010). Patients ≥ 40 years who had received prophylaxis-anticoagulation were included. They were randomised into three groups: a) control (no hospital complications), b) bleeding, and c) thrombosis. General variables, use of resources and costs were analysed. Statistical analysis: logistic regression and ANCOVA for model correction, (P<.05) was included. Results. A total of 141 patients (control: 60; bleeding: 60; and thrombosis: 21), with a mean age 68.7 (SD: 10.4) years, and 68.1% females were identified. Hip arthroplasty was more frequent (71.6%). The bleeding risk was associated with age (OR=1.1) and thrombosis with COPD (OR=1.8); P<.05). The average length of stay for the thrombosis, bleeding and control groups was 13.9, 11.5 and 7.4 days, respectively; P<.001). The total costs for each group were €10,484.3; €8,766.4 and €6,496.1 respectively; P<.05. All grouped results were comparable between them according to the hospital analysed and the type of replacement. Conclusions. Costs were higher for thrombosis and bleeding patients, respectively. Costs were associated with length of stay and hospital-acquired infections (AU)

Sistema de triaje y evaluación de Urgencias pediátricas / Pediatric Emergency Department trige system

En las últimas décadas, se a registrado un aumento progresivo de las consultas a los Servicios de Urgencias hospitalarios. De ahí surge la necesidad de optimizar la organización de los mimos e instaurar sistemas de clasificación de los pacientes. El objetivo del trabajo es evaluar el funcionamiento de nuestro servicio y del sistema de triaje de Manchester en nuestro medio. Material y métodos. Se realizó una revisión de historias clínicas de las urgencias pediátricas atendidas durante el año 2009. Se registraron datos descriptivos y epidemiológicos y se estudiaron indicadores de calidad definidos por la SEUP e indicadores relacionados con el sistema de triaje. Resultados. El número total de urgencias atendidas fue de 23.173. el 32,7% de ellas han sido atendidas en el último trimestre del año, con una clara afluencia máxima en las últimas horas de la tarde. Con respecto a los indicadores de calidad, se cumplen los estándares en clasificación de pacientes, peticiones de radiología, porcentaje de ingresos y de readmisión. El 95,3% de los pacientes se clasificaron en los niveles 4 y 5. Existe una adecuada correlación entre el nivel de gravedad, el porcentaje de exploraciones complementarias y la tasa de hospitalización. Discusión. La utilización de un sistema de triaje informatizado es fundamental tanto para la selección de aquellos pacientes que requieren ser atendidos con mayor celeridad como para poder valorar la calidad de nuestros servicios de urgencias, los cuales se hallan colapsados mayoritariamente por patología banal (AU)

During the last decades, a progressive increase of the episodes visited in the emergency services has been reported. Thereefore, the optimization of the organization of these services in essential. The objective of this article is to evaluate the working our pediatric emergency unit and the applicability of the Manchester's triage system. Material and methods. We did a review of the Pediatric Urgency episodes visited during 2009. Descriptive and epidemiologic characteristics were registered and quality indicators defined by the SEUP and other quality indicators about the triage system were examinated. Results. The total number of episodes visited in the emergency services was 23, 173, 32,7% of them were visited during the last trimester of the year and mostly in the afternoon. The quality indicators reached were the standard of classification, the solicitude of radiology, the percentage of hospitalization and the percentage of readmitted patients. 95,3% of the patients were classified as level 4 and 5. It existed a good correlation between gravity level, percentage of complementary explorations and hospitalization rate. Conclusion. The use of a computerized triage system is essential in order to select those patients who have to be visited quickly and for the evaluation of the working of the emergency services (AU)

[Use of health resources and costs associated with the diagnosis and treatment of each episode of deep vein thrombosis and bleeding in patients undergoing orthopaedic surgery for hip or knee]. / Utilización de recursos sanitarios y costes asociados al diagnóstico y tratamiento de cada episodio de trombosis venosa profunda y sangrado en pacientes intervenidos de cirugía ortopédica de cadera o rodilla.

OBJECTIVE: To determine the use of healthcare resources and costs associated with the diagnosis and treatment of thrombosis and bleeding patients who have undergone elective hip or knee replacement surgery, in routine clinical practice conditions. PATIENTS AND METHODS: This multicentre observational and retrospective study extracted data from the medical records of three Spanish public hospitals (2010). Patients ≥ 40 years who had received prophylaxis-anticoagulation were included. They were randomised into three groups: a) control (no hospital complications), b) bleeding, and c) thrombosis. General variables, use of resources and costs were analysed. STATISTICAL ANALYSIS: logistic regression and ANCOVA for model correction, (P<.05) was included. RESULTS: A total of 141 patients (control: 60; bleeding: 60; and thrombosis: 21), with a mean age 68.7 (SD: 10.4) years, and 68.1% females were identified. Hip arthroplasty was more frequent (71.6%). The bleeding risk was associated with age (OR=1.1) and thrombosis with COPD (OR=1.8); P<.05). The average length of stay for the thrombosis, bleeding and control groups was 13.9, 11.5 and 7.4 days, respectively; P<.001). The total costs for each group were €10,484.3; €8,766.4 and €6,496.1 respectively; P<.05. All grouped results were comparable between them according to the hospital analysed and the type of replacement. CONCLUSIONS: Costs were higher for thrombosis and bleeding patients, respectively. Costs were associated with length of stay and hospital-acquired infections.

Validez de la escala MNA como factor de riesgo nutricional en pacientes geriátricos institucionalizados con deterioro cognitivo moderado y severo / Validation of score in MNA scale like nutritional risk factor in institutionalized geriatric patients with moderate and severe cognitive impairment

Introducción: La valoración geriátrica integral incluye el examen del apartado nutricional debido a la alta prevalencia de desnutrición en este tipo de pacientes; especialmente en los pacientes con deterioro cognitivo asociado. Las escalas de cribado del estado nutricional presentan preguntas de autopercepción subjetiva de difícil respuesta en pacientes mayores con demencia. Objetivo: Estudiar la especificidad, el valor predictivo positivo y la sensibilidad de la escala MNA para la detección de malnutrición en pacientes diagnosticados de enfermedad de Alzheimer con deterioro cognitivo avanzado. Material y métodos: Se diseñó un estudio descriptivo poblacional con una muestra de 52 pacientes mayores de 70 años, institucionalizados, con enfermedad de Alzheimer grado moderado y severo. Se estudió la sensibilidad, especificidad y valor predictivo positivo de la escala MNA respecto a los parámetros de malnutrición del American Institute of Nutrition (AIN). Resultados: Los valores de sensibilidad, especificidad y valor predictivo positivo son 60%, 94,7% y 93,8% respectivamente. Existe una correlación significativa (p < 0,001) ente la puntuación obtenida en la escala MNA y la escala de riesgo de caídas Tinneti (r = 0,577), de función Barthel (r = 0,742), de valoración cognitiva MEC (r = 0,651) y los niveles de creatinina (r = 0,402). Más del 50% de la muestra presentó al menos un parámetro de malnutrición AIN alterado. Conclusiones: La escala MNA presenta una menor sensibilidad y especificidad en estos pacientes. El diseño de una escala de valoración nutricional sin valoraciones subjetivas y sólo con parámetros objetivos podría mejorar la eficacia de la misma en ancianos institucionalizados con deterioro cognitivo moderado y severo (AU)

Introduction: comprehensive geriatric assessment includes examination of the nutritional status given the high prevalence of hyponutrition in this kind of patients, particularly in patients with associated cognitive impairment. Scales for screening the nutritional status include questions on self-perception difficult to answer by demented elder patients. Objective: To study the specificity, the positive predictive value, and the sensitivity of the MNA scale to detect malnutrition in patients diagnosed with Alzheimer's disease with advanced cognitive impairment. Material and methods: a population-based descriptive study with a sample of 52 patients older than 70 years, institutionalized, and with moderate-severe Alzheimer's disease was designed. The sensitivity, specificity, and positive predictive value of MNA scale were studied regarding the parameters on malnutrition of the American Institute of Nutrition (AIN). Results: the sensitivity, specificity, and positive predictive values were 60%, 94.7%, and 93.8%, respectively. There was a significant correlation (p < 0.001) between the score obtained with the MNA Scale and the Tinneti's Risk of Fall Scale (r = 0.577), the Barthel's function (r = 0.742), the MCT cognitive assessment (r = 0.651), and creatinine levels (r = 0.402). More than 50% of the sample presented at least one malnutrition parameter altered. Conclusions: the MNA Scale presents lower sensitivity and specificity in these patients. Designing a nutritional assessment scale without subjective evaluations and only with objective parameters might improve its efficiency in institutionalized elderly patients with moderate-severe cognitive impairment (AU)

[Validation of MNA scale score as a nutritional risk factor in institutionalized geriatric patients with moderate and severe cognitive impairment]. / Validez de la escala MNA como factor de riesgo nutricional en pacientes geriátricos institucionalizados con deterioro cognitivo moderado y severo.

INTRODUCTION: comprehensive geriatric assessment includes examination of the nutritional status given the high prevalence of hyponutrition in this kind of patients, particularly in patients with associated cognitive impairment. Scales for screening the nutritional status include questions on self-perception difficult to answer by demented elder patients. OBJECTIVE: To study the specificity, the positive predictive value, and the sensitivity of the MNA scale to detect malnutrition in patients diagnosed with Alzheimer's disease with advanced cognitive impairment. MATERIAL AND METHODS: a population-based descriptive study with a sample of 52 patients older than 70 years, institutionalized, and with moderate-severe Alzheimer's disease was designed. The sensitivity, specificity, and positive predictive value of MNA scale were studied regarding the parameters on malnutrition of the American Institute of Nutrition (AIN). RESULTS: the sensitivity, specificity, and positive predictive values were 60%, 94.7%, and 93.8%, respectively. There was a significant correlation (p < 0.001) between the score obtained with the MNA Scale and the Tinneti's Risk of Fall Scale (r = 0.577), the Barthel's function (r = 0.742), the MCT cognitive assessment (r = 0.651), and creatinine levels (r = 0.402). More than 50% of the sample presented at least one malnutrition parameter altered. CONCLUSIONS: the MNA Scale presents lower sensitivity and specificity in these patients. Designing a nutritional assessment scale without subjective evaluations and only with objective parameters might improve its efficiency in institutionalized elderly patients with moderate-severe cognitive impairment.