Análisis retrospectivo de las suspensiones quirúrgicas y de los factores influyentes durante 8 años / Retrospective analysis of suspended surgeries and influencing factors during an 8-year period

Introducción: El objetivo principal es la descripción y análisis de las suspensiones quirúrgicas y sus causas de nuestro hospital desde el año 2010 hasta la actualidad. Como objetivo secundario evaluamos la efectividad de una serie de medidas de mejora. Métodos: Se realizó un estudio retrospectivo analizando pacientes que estaban programados para ser intervenidos y que finalmente se suspendieron. Se realizó un análisis modal de fallos y efectos (AMFE) para analizar las causas de las suspensiones y sus consecuencias, las barreras existentes y las posibles medidas que se han implantado con el paso del tiempo. Las causas se clasificaron en atribuibles al paciente, causas administrativas y causas médicas. Resultados: Se programaron 105.403 intervenciones, en las que se originaron 3.867 suspensiones (3,66%). Entre los factores que influyen en las suspensiones describimos la especialidad quirúrgica, los pacientes ASA 4, los pacientes ancianos, los pacientes ambulatorios y los intervenidos durante el invierno. Las causas más frecuentes fueron la infección o fiebre (17,6%) dentro de las causas médicas, la falta de tiempo (26,8%) en cuanto a las administrativas, y la no comparecencia dentro de las causas del paciente (6,3%). Las causas evitables fueron el 64,8% frente al 35,2% de causas inevitables. En el análisis multivariante encontramos como factores de riesgo la edad, el turno, la estación y el servicio quirúrgico. Conclusiones: Las cancelaciones quirúrgicas tienen repercusiones a nivel de consumo de recursos materiales y humanos. Cualquier actuación para intentar reducirlas deberá ser nuestra prioridad futura para disminuir la incidencia de las mismas y mejorar la calidad asistencial

Introduction: The main objective was the description and analysis of suspended surgeries and their causes for suspension at our hospital from the year 2010 to the present. As a secondary objective, we evaluated the effectiveness of a series of measures for improvement. Methods: A retrospective study was conducted to analyze patients who were scheduled to undergo surgery that was finally suspended. A Failure Mode and Effects Analysis (FMEA) was carried out to analyze the causes of the suspensions and their consequences, any existing barriers and possible measures that have been implemented over time. The causes were classified as attributable to the patient, administrative causes and medical causes. Results: 105,403 surgeries were scheduled, 3,867 of which were suspended (3.66%). Factors that influenced the suspensions included: surgical specialty, ASA 4 patients, elderly patients, ambulatory patients and surgeries scheduled during the winter. The most frequent medical cause was infection or fever (17.6%), while the most frequent administrative and patient causes were lack of time (26.8%) and no-show (6.3%), respectively. The avoidable causes were 64.8% versus 35.2% unavoidable causes. In the multivariate analysis, risk factors included age, shift, season and surgical service. Conclusions: Surgical cancellations have repercussions on the consumption of material and human resources. Any means to reduce their incidence should be our future priority in order improve the quality of care

Retrospective analysis of suspended surgeries and influencing factors during an 8-year period. / Análisis retrospectivo de las suspensiones quirúrgicas y de los factores influyentes durante 8 años.

INTRODUCTION: The main objective was the description and analysis of suspended surgeries and their causes for suspension at our hospital from the year 2010 to the present. As a secondary objective, we evaluated the effectiveness of a series of measures for improvement. METHODS: A retrospective study was conducted to analyze patients who were scheduled to undergo surgery that was finally suspended. A Failure Mode and Effects Analysis (FMEA) was carried out to analyze the causes of the suspensions and their consequences, any existing barriers and possible measures that have been implemented over time. The causes were classified as attributable to the patient, administrative causes and medical causes. RESULTS: 105,403 surgeries were scheduled, 3,867 of which were suspended (3.66%). Factors that influenced the suspensions included: surgical specialty, ASA 4 patients, elderly patients, ambulatory patients and surgeries scheduled during the winter. The most frequent medical cause was infection or fever (17.6%), while the most frequent administrative and patient causes were lack of time (26.8%) and no-show (6.3%), respectively. The avoidable causes were 64.8% versus 35.2% unavoidable causes. In the multivariate analysis, risk factors included age, shift, season and surgical service. CONCLUSIONS: Surgical cancellations have repercussions on the consumption of material and human resources. Any means to reduce their incidence should be our future priority in order improve the quality of care.

Eficacia y seguridad de la endoscopia gastrointestinal durante un programa de entrenamiento de sedación específico para no anestesiólogos / Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists

Introducción: la sedación es un componente fundamental para mejorar la calidad de la sedación. Para su correcta realización es necesaria una formación adecuada. Hemos realizado un estudio con el objetivo de comparar la efectividad y la seguridad de la sedación, así como la satisfacción del paciente, cuando la sedación fue realizada por gastroenterólogos con y sin entrenamiento específico en sedación Métodos: se realizó un programa de formación a un grupo de gastroenterólogos (grupo entrenado, n = 4) y se compararon los resultados con los de otro grupo no entrenado (n = 3). Se incluyeron pacientes ASA 1-3 que se sometieron a sedación administrada por un gastroenterólogo con midazolam y fentanilo durante un periodo de 30 meses. La seguridad se evaluó en términos de tasas de complicaciones; la efectividad, como la tasa de procedimientos endoscópicos completados; y la satisfacción del paciente, mediante una encuesta telefónica el día después del procedimiento. Resultados: en total, 3.475 pacientes fueron sedados por gastroenterólogos durante el periodo de estudio. Se encontraron diferencias significativas a favor del grupo entrenado en la comparación de pruebas completadas (5,6% vs. 8,9%), una menor incidencia de sedación excesiva (1,3% vs. 8,61%) y de hipoxemia (0,72% vs. 2,49%) y menor incidencia de dolor después del procedimiento (1,8% vs. 4,3%). La satisfacción del paciente excedió el 99,5% y no hubo diferencias significativas entre ambos grupos Conclusiones: nuestro programa de formación en sedación mejora los resultados frente a quienes no han realizado dicha formación específica en términos de efectividad y de seguridad

Introduction: sedation is a key component for the improvement of sedation quality. A correct administration requires appropriate training. We performed a study to compare sedation effectiveness, safety and patient satisfaction when administered by gastroenterologists, with and without specific training. Methods: a training program enrolled a group of gastroenterologists (trained group, n = 4) and their results were compared to those from a non-trained group (n = 3). ASA 1-3 patients who had undergone sedation by a gastroenterologist using midazolam and fentanyl were included over a period of 30 months. Safety was assessed in terms of the complication rate, effectiveness was assessed via the rate of completed endoscopic procedures and patient satisfaction was evaluated via a phone interview the day after the procedure. Results: a total of 3,475 patients were sedated by gastroenterologists during the study period. Significant differences were found that favored the trained group for completed procedures (5.6% vs 8.9%). A lower rate of excessive sedation (1.3% vs 8.61%), hypoxemia (0.72% vs 2.49%) and post-procedural pain (1.8% vs 4.3%) were also achieved. Patient satisfaction surpassed 99.5% and there were no significant differences between groups. Conclusions: our sedation training program improved the effectiveness and safety outcomes when compared to sedation administered by gastroenterologists without this specific training

Estudio descriptivo de monitorización de un programa de calidad de sedación por no anestesiólogos / A descriptive monitoring study of a non-anesthetist sedation quality program

Introducción: la sedación mejora sensiblemente la calidad de la endoscopia digestiva, aunque puede tener complicaciones graves. Métodos: protocolo multidisciplinar en base a la joint comission que defina el protocolo de sedación por no anestesiólogos. Se excluyen pacientes ASA 4 o con vía aérea difícil, pruebas complejas y sedación profunda. Controlamos la calidad en base al análisis de 9 indicadores. También se monitorizan las pruebas incompletas para valorar eficacia. Resultados: la seguridad del paciente se establece en base a una incidencia de complicaciones muy baja, con una incidencia de eventos respiratorios de 1,07. Además, se encuentra una baja incidencia de hipotensión y bradicardia, al igual que del dolor durante y después de la endoscopia y una incidencia menor del 0,5% de ingresos no esperados. Los indicadores de calidad medidos nos indican la evolución de los resultados del programa. Conclusiones: la monitorización continuada de los programas de sedación en endoscopia permiten controlar las diferentes dimensiones de la calidad e implementar medidas que mejoren el proceso

Introduction: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. Methods: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. Results: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. Conclusions: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement

Effectiveness and safety of gastrointestinal endoscopy during a specific sedation training program for non-anesthesiologists.

INTRODUCTION: sedation is a key component for the improvement of sedation quality. A correct administration requires appropriate training. We performed a study to compare sedation effectiveness, safety and patient satisfaction when administered by gastroenterologists, with and without specific training. METHODS: a training program enrolled a group of gastroenterologists (trained group, n = 4) and their results were compared to those from a non-trained group (n = 3). ASA 1-3 patients who had undergone sedation by a gastroenterologist using midazolam and fentanyl were included over a period of 30 months. Safety was assessed in terms of the complication rate, effectiveness was assessed via the rate of completed endoscopic procedures and patient satisfaction was evaluated via a phone interview the day after the procedure. RESULTS: a total of 3,475 patients were sedated by gastroenterologists during the study period. Significant differences were found that favored the trained group for completed procedures (5.6% vs 8.9%). A lower rate of excessive sedation (1.3% vs 8.61%), hypoxemia (0.72% vs 2.49%) and post-procedural pain (1.8% vs 4.3%) were also achieved. Patient satisfaction surpassed 99.5% and there were no significant differences between groups. CONCLUSIONS: our sedation training program improved the effectiveness and safety outcomes when compared to sedation administered by gastroenterologists without this specific training.

A descriptive monitoring study of a non-anesthetist sedation quality program.

INTRODUCTION: sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. METHODS: a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. RESULTS: patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. CONCLUSIONS: ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.