Circulando hacia la seguridad del paciente: realidad y deseo / The road to patient safety: facts and desire

Objetivo: Valorar diferencias entre necesidad e implementación de prácticas seguras recomendadas para la seguridad del paciente y utilidad del uso de señales de tráfico para promover su implementación. Método: El estudio constó de dos fases: 1) revisión de recomendaciones sobre prácticas seguras de diferentes organizaciones y 2) encuesta a una muestra de oportunidad de profesionales del ámbito asistencial, organizativo y académico de la seguridad del paciente de España y Latinoamérica para evaluar necesidad y la implementación percibida de las prácticas seguras y la utilidad de las señales para tal fin. Resultados: Se recibieron 365 cuestionarios. Todas las prácticas seguras identificadas fueron valoradas como necesarias (media y límite inferior del intervalo de confianza por encima de 3 sobre 5 puntos). Sin embargo, la implementación se valoró como insuficiente en seis de ellas: escritura ilegible, conciliación de medicación, estandarización de comunicación, sistemas de alerta rápida, aplicación de procedimientos por profesionales o equipos entrenados, y cumplimiento de voluntades del paciente al final de la vida. Mejorar cumplimiento de la higiene de manos, aplicación de precauciones de barrera, asegurar la identificación correcta de los pacientes y utilizar listados de verificación fueron las cuatro prácticas en las que más del 75% de los encuestados encuentran mayor grado de consenso sobre la utilidad de las señales de tráfico para mejorar su implementación. Conclusiones: Las diferencias entre necesidad percibida e implementación real de las prácticas seguras consideradas indican áreas de mejora. El lenguaje común de las señales de tráfico es un instrumento sencillo para mejorar su cumplimiento

Objective: To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. Method: The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. Results: 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. Conclusion: The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety

[The road to patient safety: facts and desire]. / Circulando hacia la seguridad del paciente: realidad y deseo.

OBJECTIVE: To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. METHOD: The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. RESULTS: 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. CONCLUSION: The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety.

Impact on Morbidity, Mortality, and Length of Stay of Hospital-Acquired Infections by Resistant Microorganisms.

BACKGROUND: Infections by multidrug-resistant organisms (MDROs) are a global threat and are particularly common in hospitals. This study was performed to assess the impact of hospital-acquired infections caused by MDROs on morbidity, mortality, and length of hospital stay. METHODS: This was a retrospective cohort study. A sample of adults aged ≥18 years with a respiratory, urinary, bloodstream, or surgical site infection caused by a multidrug-resistant (cases) or -sensitive (controls) microorganism was selected. Measurements included hospital mortality from all causes (total and 30 days after infection), length of stay (LOS), and 5 indicators of morbidity: intensive care or surgery admissions, number of diagnostic tests after infection, and hospital readmissions or visits to the emergency department within 30 days of discharge. RESULTS: The sample was composed of 324 cases and 676 control patients. Risk of hospital mortality from all causes (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.25-2.32) and 30 day-mortality after infection (HR, 1.77; 95% CI, 1.29-2.44) were higher in patients with an MDRO infection. Probability of readmission was also higher (odds ratio [OR], 2.17; 95% CI, 1.36-3.46) in the case group. Emergency department visits were only significantly higher in methicillin-resistant Staphylococcus aureus (OR, 2.80; 95% CI, 1.65-4.74) and in Escherichia coli-resistant infections (OR, 2.28; 95% CI, 1.32-3.96). Infections by MDRO were not associated with any other outcome. CONCLUSIONS: Hospital infections caused by MDROs increase mortality, readmissions, and in some cases, visits to the emergency department compared with those produced by susceptible strains. They do not appear to influence LOS nor the need for hospital admission, intensive care, surgery, or diagnostic tests.

La mayoría de los médicos cree que es bueno pasar por exámenes periódicos de recertificación / The majority of doctors believe that it is good to take periodic recertification examinations

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Perfil de los usuarios y motivos de demanda del Servicio de Urgencias extrahospitalario 061 / User profile and reasons to demand 061 emergency medical services

Objetivos: La demanda a los servicios de urgencias extrahospitalarios (SUE) ha aumentado en los últimos años. Los objetivos de este estudio son caracterizar a las personas usuarias del SUE 061 y valorar si su satisfacción con Atención Primaria (AP), estar esperando visita en atención especializada, su situación laboral y el conocimiento de otros servicios de urgencias, influyen en la demanda del 061. Método: Estudio de una muestra de los pacientes atendidos durante dos meses por el SUE 061. Sus características sociodemográficas y motivos de demanda se obtuvieron mediante un cuestionario telefónico de elaboración propia. Resultados: La tasa de respuesta fue del 32,3%. El perfil más frecuente de usuario del 061 fue el de una persona mayor y mujer que lo demandó por problemas respiratorios (36 sujetos, 27,9%). El domingo (27 usuarios, 20,9%) y el horario entre las 15 y 22 horas (59 personas, 45,7%) fueron los momentos de mayor frecuentación. La asistencia prestada por AP fue valorada positivamente; estaban esperando visita por un especialista 24 (18,6%); a ninguno le suponía un problema ausentarse del trabajo para ir al médico; y 68 (52,7%) entrevistados conocían otros servicios de urgencias. Conclusiones: Los usuarios del SUE 061 no utilizaron éste como puerta de entrada al sistema sanitario. Además de la gravedad de la patología, en su demanda existen otros factores (AU)

Background: Demand of out-of-hospital emergency medical services (EMS) has increased in the last few years. The objectives of the present study were to describe the profile of 061 EMS users, and to evaluate whether the degree of satisfaction with Primary Healthcare (PH), the fact of having to wait for specialized healthcare, the labour situation and the knowledge of other EMS could have any impact on the demand of 061. Methods: Study of a sample of 061 EMS users in a 2-month period. Socio-demographic factors and reasons for using this service were obtained using a specific telephone questionnaire. Results: The response rate was 32,3%. Users were most frequently elderly people and females, and the most common reason for calling was related to respiratory problems (36 users, 27,9%). The demand was greater on Sundays (27 users, 20,9%) and between 15 and 22 hours (59 users, 45,7%). The users positively valued the medical assistance by PH; 24 individuals (18,6%) were waiting to be seen by a specialist physician; being absent from work to visit a doctor was not a problem for any of the users; and 68 (52,7%) users had knowledge about other EMS. Conclusions: 061 was not used as a first option to get into the health care system. In addition to the severity of the disease, several external factors play a role in the demand of this medical service (AU)