The Colonoscopy Satisfaction and Safety Questionnaire (CSSQP) for Colorectal Cancer Screening: A Development and Validation Study.

Colonoscopy services working in colorectal cancer screening programs must perform periodic controls to improve the quality based on patients' experiences. However, there are no validated instruments in this setting that include the two core dimensions for optimal care: satisfaction and safety. The aim of this study was to design and validate a specific questionnaire for patients undergoing screening colonoscopy after a positive fecal occult blood test, the Colonoscopy Satisfaction and Safety Questionnaire based on patients' experience (CSSQP). The design included a review of available evidence and used focus groups to identify the relevant dimensions to produce the instrument (content validity). Face validity was analyzed involving 15 patients. Reliability and construct and empirical validity were calculated. Validation involved patients from the colorectal cancer screening program at two referral hospitals in Spain. The CSSQP version 1 consisted of 15 items. The principal components analysis of the satisfaction items isolated three factors with saturation of elements above 0.52 and with high internal consistency and split-half readability: Information, Care, and Service and Facilities features. The analysis of the safety items isolated two factors with element saturations above 0.58: Information Gaps and Safety Incidents. The CSSQP is a new valid and reliable tool for measuring patient' experiences, including satisfaction and safety perception, after a colorectal cancer screening colonoscopy.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge.

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

Interventions in health organisations to reduce the impact of adverse events in second and third victims.

BACKGROUND: Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims. METHODS: A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution's reputation (the third victim). RESULTS: A total of 406 managers and patient safety coordinators replied to the survey. Deficient provision of support for second victims was acknowledged by 71 and 61% of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organizations. Regarding third victim initiatives, 35% of hospital and 43% of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34% of cases. The degree of implementation of second and third victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1) (p < 0.001). CONCLUSIONS: Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge / Un cuestionario en espanol sobre seguridad del paciente para medir las actitudes y los conocimientos de los estudiantes de medicina y enfermería

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimatedfor each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

OBJETIVO: Diseñar y validar un cuestionario de evaluación de las actitudes y los conocimientos en materia de seguridad del paciente con una muestra de estudiantes de medicina y enfermería que reciben formación médica en Espana y en cuatro países de América Latina. MÉTODOS: En este estudio transversal se llevó a cabo una revisión bibliográfica y se encuestó a un total de 786 estudiantes de medicina y enfermería de ocho universidades de cinco países (Chile, Colombia, El Salvador, Espana y Guatemala) con objeto de elaborar y corregir un cuestionario en espanol sobre conocimientos y actitudes en materia de seguridad del paciente. El ámbito del cuestionario se basó en cinco dimensiones (factores) presentadas en estudios relacionados con la cultura de la seguridad del paciente encontrados en PubMed y Scopus. Con base en los cinco factores, se elaboraron 25 ítems reactivos. Se calcularon los índices de fiabilidad compuesta y alfa de Cronbach para cada factor, y se realizó un análisis factorial confirmatorio para evaluar la validez. Tras una prueba piloto se corrigió el cuestionario mediante modelos confirmatorios, el cálculo de la máxima probabilidad y la matriz de variancia-covariancia (como insumo). Se utilizaron modelos de regresión lineal múltiple para confirmar la validez externa, considerando las variables relacionadas con la cultura de seguridad del paciente como variables dependientes y los cinco factores como variables independientes. RESULTADOS: El instrumento final fue una encuesta autoadministrada mediante escala de Likert estructurada en cinco puntos ("Cuestionario de Seguridad del Paciente para Estudiantes Latinos"), que consta de 21 ítems agrupados en cinco factores. Los índices de fiabilidad compuesta (prueba estadística de alfa de Cronbach) calculados para los cinco factores fueron aproximadamente de 0,7 o superiores. Los resultados de los análisis de regresión lineal múltiple indicaron un buen ajuste del modelo (índice de bondad de ajuste: 0,9). Las correlaciones ítem-total fueron superiores a 0,3 en todos los casos. La validez convergente y discriminatoria fue adecuada. CONCLUSIONES: El cuestionario disenado y validado en este estudio evalúa las actitudes y los conocimientos de los estudiantes de enfermería y medicina en materia de seguridad del paciente. Este instrumento podría utilizarse para evaluar indirectamente si los estudiantes de disciplinas de la salud están adquiriendo, y por lo tanto, es probable que pongan en práctica, las habilidades profesionales consideradas actualmente como más apropiadas para la seguridad del paciente.

The aftermath of adverse events in Spanish primary care and hospital health professionals.

BACKGROUND: Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. METHODS: A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. RESULTS: A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio -OR- 1.1, 95% Confidence Interval -CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings. CONCLUSIONS: Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon.

Oversights, confusions and misinterpretations related to self-care and medication in diabetic and renal patients.

OBJECTIVE: To analyse information about the errors made by diabetic and renal patients based on information provided by professionals (general practitioners, specialists, and nurses) and the patients themselves. SUBJECTS AND METHODS: A descriptive study was carried out by interviewing 199 patients and 60 professionals from the Spanish provinces of Alicante and Madrid. The interview explored the frequencies and types of oversights, confusions, and misinterpretations and the factors that contributed to them. RESULTS: Among the 199 patients, 59 (29.5%) and 42 (70%) of the 60 professionals considered that patients frequently made errors that affected the success of their treatment. There were no differences in the frequency of the reported errors based on gender (p = 0.7), educational level (p = 0.9), or marital status (p = 0.5). The most commonly reported errors were taking the wrong medication (n = 70; 35%) and mixing up medicines (n = 15; 7.5%). Diabetics who had not been adequately informed, compared to renal patients, reported a higher number of errors (p = 0.02). CONCLUSIONS: Patient errors were frequent because of communication failures and confusions. Diabetic patients had a higher chance of committing an error than renal patients. Patient education must include clear and personalized instructions for improving self-care and reducing risks when using medicines.

Diseño y validación de la escala RSC-HospitalES para medir responsabilidad social corporativa / Design and validation of the CSR-Hospital-SP scale to measure corporate social responsibility

Objetivo: Diseñar y validar una escala (RSC-HospitalES) para conocer la percepción que los profesionales sanitarios tienen de los enfoques en responsabilidad social corporativa (RSC) de su hospital. Método: Revisión de la literatura para identificar escalas de RSC de referencia y delimitar dimensiones a evaluar. Versión inicial de 25 elementos. Se seleccionó una muestra de conveniencia de cómo mínimo 224 profesionales sanitarios de cinco hospitales públicos de cinco comunidades autónomas. Se analizaron efecto suelo y techo, consistencia interna, fiabilidad y validez de constructo. Resultados: Respondieron 233 profesionales. RSC-HospitalES contiene 20 elementos agrupados en cuatro factores. Correlaciones ítem-total superiores a 0,30, cargas factoriales superiores a 0,50, varianza explicada del 59,57%, alfa de Cronbach de 0,90 y coeficiente de Spearman-Brown de 0,82. Conclusiones: RSC-HospitalES es una herramienta pensada para aquellos hospitales que ponen en marcha mecanismos de rendición de cuentas y que promueven enfoques de dirección socialmente responsables (AU)

Objective: To design and validate a scale (CSR-Hospital-SP) to determine health professionals" views on the approach of management to corporate social responsibility (CSR) in their hospital. Methods: The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed. Results: A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82. Conclusion: The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches (AU)

[Design and validation of the CSR-Hospital-SP scale to measure corporate social responsibility]. / Diseño y validación de la escala RSC-HospitalES para medir responsabilidad social corporativa.

OBJECTIVE: To design and validate a scale (CSR-Hospital-SP) to determine health professionals' views on the approach of management to corporate social responsibility (CSR) in their hospital. METHODS: The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed. RESULTS: A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82. CONCLUSION: The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches.

A study of the prevalence of adverse events in primary healthcare in Spain.

BACKGROUND: Healthcare practices involve risks for patients, but there has been little research to date on the occurrence of adverse events (AE) in primary care (PC). The frequency of AE in PC in Spain, the factors that contribute to their occurrence, their severity and their preventability, were analysed. METHODS: Observational cross-sectional study was carried out in 48 PC centres in 16 regions of Spain. PC professionals were asked to assess whether the AE was caused by the healthcare or if it was an expectable consequence of the patient's underlying condition. A total of 452 healthcare professionals who attended 96 047 consultations were involved. RESULTS: A total of 773 AE were identified, so that the point prevalence of AE was 0.8% [95% confidence interval (CI) 0.76-0.85]. A majority of AE (64.3%) were considered preventable and only 5.9% were severe, usually related to medication [odds ratio (OR) = 4.6; 95% CI 2.1-10.3]. The most frequent causal factor of the AE was associated with medication (adverse drug reactions and medication errors), but problems in communication and management were at the root of many of the AE. Nurses reported more preventable AE (OR = 1.9; 95% CI 1.2-2.8). CONCLUSION: In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.

Que hacen y que deben hacer los pacientes diabeticos para evitar errores con el tratamiento ? / What do diabetic patients and what should they do to avoid errors in the course of treatment?

Objetivo: Describir que hacen los pacientes diabeticos para evitar errores con el tratamiento y presentar consejos para incrementar la seguridad. Metodos Estudio descriptivo de conductas de pacientes diabeticos tratados con insulina para minimizar errores y de consejos de los profesionales para mejorar la seguridad. Se reclutaron aleatoriamente 99 pacientes de 3 centros de salud y 2 hospitales. Adicionalmente, se conto con una muestra de oportunidad de 33 medicos y enfermeros. Resultados Informar de todas las prescripciones (p=0,005), revisar dudas antes de la consulta (p=0,009) y el cumplimiento de la dieta (p=0,02) fueron las unicas precauciones informadas por los pacientes que se relacionaron con un menor numero de errores de los propios pacientes. Las mujeres siguen mejor en casa las indicaciones sobre los controles de glucemia (odds ratio 0,07, intervalo de confianza [IC] del 95%: 0,1-0,6) y recurren a pastilleros para evitar errores (odds ratio: 0,23; IC 95%: 0,1-0,6) con mas frecuencia que los hombres. La informacion de alergias es mas frecuente entre varones (odds ratio: 5,03; IC 95%: 1,4-17,5). Los pacientes con un curso mas prolongado tienden a no proporcionar informacion a su medico sobre otros (..) (AU)

Objective: To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety. Methods: A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed. Results: Information of all prescriptions (p = 0.005),review of doubts before the visit(p = 0,009),and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95%CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors ( -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%).Conclusions: Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety (AU)

[What do diabetic patients and what should they do to avoid errors in the course of treatment?]. / ¿Qué hacen y qué deben hacer los pacientes diabéticos para evitar errores con el tratamiento?

OBJECTIVE: To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety. METHODS: A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed. RESULTS: Information of all prescriptions (p = 0.005), review of doubts before the visit (p = 0,009), and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95% CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors (ß -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%). CONCLUSIONS: Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety.

Derechos de los pacientes. Algo más que una cuestión de actitud / Patients’ rights. More than a question of attitude

ObjetivoAnalizar si determinados derechos de los pacientes (Ley 41/2002 de autonomía del paciente [LAP]) son conocidos entre los profesionales de la medicina.Material y métodoEncuesta a profesionales de hospitales y de atención primaria con situaciones problema extraídas de sentencias judiciales y de la LAP.ResultadosUn 78% dijo conocer la LAP. El 53% sabrían explicar qué son las voluntades anticipadas. A la situación problema sobre derecho a la intimidad respondieron correctamente el 88%. El 57% acertó cuál es la mayoría de edad sanitaria. El 70% aplicó correctamente el derecho del paciente a no ser informado. Sólo un 38% respondió correctamente a los tres problemas planteados. Los aciertos son más frecuentes (odds ratio: 2,4–3,4) entre quienes dicen conocer la LAP.ConclusionesAl menos uno de cada diez profesionales podrían ver comprometida su seguridad jurídica por desconocimiento de la LAP. Los jóvenes entre 16 y 18 años tienen más difícil que se respete su derecho a la autonomía como pacientes. La información previa sobre la LAP ayuda a un mejor cumplimiento(AU)

ObjectivesTo analyze hospital and primary care physicians’ knowledge of certain patients’ rights recently modified by Spanish Law 41/2002 (law of patient autonomy).Material and methodsWe performed a voluntary survey of hospital and primary care physicians who were presented with three problem situations drawn from court decisions and the law of patient autonomy.ResultsAmong interviewed physicians, 78% were familiar with the law of patient autonomy. Fifty-three percent knew how to explain what advance wills are. Eighty-eight percent responded correctly to the problem situation concerning the right to privacy. Fifty-seven percent knew the legal age of consent for healthcare. Seventy percent correctly applied patients’ right not to be informed. Only 38% responded correctly to all three problem situations. Correct responses were more frequent (odds ratio: 2.4–3.4) among physicians who were familiar with the law of patient autonomy.ConclusionsAt least one out of every 10 physicians could be legally compromised by lack of knowledge of the law of patient autonomy. Patients’ rights were most likely to be jeopardized in patients aged between 16 and 18 years old. Prior information on the law of patient autonomy contributes to greater compliance(AU)

[Patients' rights. More than a question of attitude]. / Derechos de los pacientes. Algo más que una cuestión de actitud.

OBJECTIVES: To analyze hospital and primary care physicians' knowledge of certain patients' rights recently modified by Spanish Law 41/2002 (law of patient autonomy). MATERIAL AND METHODS: We performed a voluntary survey of hospital and primary care physicians who were presented with three problem situations drawn from court decisions and the law of patient autonomy. RESULTS: Among interviewed physicians, 78% were familiar with the law of patient autonomy. Fifty-three percent knew how to explain what advance wills are. Eighty-eight percent responded correctly to the problem situation concerning the right to privacy. Fifty-seven percent knew the legal age of consent for healthcare. Seventy percent correctly applied patients' right not to be informed. Only 38% responded correctly to all three problem situations. Correct responses were more frequent (odds ratio: 2.4-3.4) among physicians who were familiar with the law of patient autonomy. CONCLUSIONS: At least one out of every 10 physicians could be legally compromised by lack of knowledge of the law of patient autonomy. Patients' rights were most likely to be jeopardized in patients aged between 16 and 18 years old. Prior information on the law of patient autonomy contributes to greater compliance.

El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad / Hospital clinical safety from the patient's point of view: Validation of a safety perception questionnaire

Background: Approximately 10 percent of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency Results: The questionnaire was answered by 384 patients, yielding a response rate of 29 percent. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10 percent) reported a possible adverse event. In 19 cases (5.8 percent), it was due to medication errors and in 19 (6.1 percent), to surgical procedures. In seven cases (2.3 percent), both errors coincided (2.3 percent). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

[Hospital clinical safety from the patient's point of view: validation of a safety perception questionnaire]. / El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad.

BACKGROUND: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. AIM: To determine the perception on clinical safety among patients discharged from a hospital. MATERIAL AND METHODS: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency. RESULTS: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%), both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). CONCLUSIONS: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

El contexto de la gestión de riesgos de la asistencia sanitaria / The context of risk management in healthcare

No disponible

Incidencia e impacto de los efectos adversos en dos hospitales / Incidence and impact of adverse events in two hospitals

Objetivos: Presentar los resultados preliminares del proyecto IDEA relativos a la incidencia e impacto de los efectos adversos (EA) en dos de los hospitales incluidos en el estudio. Material y método: Diseño: estudio de cohortes prospectivo realizado durante el primer trimestre de 2004 en dos servicios de dos hospitales de la Comunidad Valenciana. Muestreo consecutivo. Sujetos: pacientes de más de 14 años, ingresados más de 24 h en los servicios seleccionados, en total, 673 sujetos. Medidas principales: proporción de alerta de EA (formulario de cribado positivo) e incidencia acumulada de EA identificados (cuestionario modular para su confirmación y caracterización). Resultados: La incidencia de alertas fue de un 34,7% para el hospital A (servicio de cirugía general) y de un 31% en el hospital B (servicio de medicina interna). La incidencia de EA fue del 16,1 y el 5,6%, respectivamente. El 42,1% de los EA del hospital A y el 16,7% del hospital B fueron considerados evitables, independientemente de la gravedad de sus consecuencias. Conclusiones: Los sistemas de vigilancia de alerta de los EA se han mostrado muy diferentes en los servicios estudiados. La variabilidad en la práctica clínica condiciona la identificación de los EA al revisar las historias clínicas

Objectives: To present the preliminary results of the IDEA project relating to the effect and impact of adverse events in two of the hospitals included in the study. Material and method: Design: prospective cohort study carried out in the first quarter of 2004 in two wards of two hospitals of the Autonomous Community of Valencia (Spain). Sampling: consecutive. Subjects: patients more than 14 years old, hospitalized for more than 24 hours in the selected wards. The total number of subjects was 673. Main measurements: proportion of adverse event alerts (positive detection questionnaire) and the accumulated incidence of identified adverse events (modular questionnaire for confirmation of AE and their characterization). Results: The incidence of alerts was 34.7% in hospital A (general surgery ward) and 31% in hospital B (internal medicine ward). The incidence of adverse events was 16.1% and 5.6% respectively. A total of 42.1% of the adverse events in hospital A and 16.7% of those in hospital B were avoidable, independently of the seriousness of their consequences. Conclusions: The adverse event surveillance systems differed between the two wards studied. Variability in clinical practice affects identification of adverse events on reviewing medical records

[Factors determining patients' choice of hospital]. / Determinantes de la elección del hospital por parte de los pacientes.

OBJECTIVE: To identify the best way to inform patients about centers and services so that they can make a responsible choice, and to identify which factors determine patients' decisions. SUBJECTS AND METHODS: Data on three illnesses (breast cancer, benign prostatic hypertrophy, and cataracts) in three fictitious hospitals were shown to patients. The data were presented to 1,259 subjects through four different means: a brochure including a table, a brochure with a bar graph, three brochures with tables, and three brochures with bar graphs. Data on each of the hospitals included: professional profiles, medical and surgical outcomes, side effects, patients' and relatives' satisfaction, and hospital complaints. The subjects completed a questionnaire evaluating the information received. RESULTS: Most patients (88%) preferred to receive full information and to share decision-making with their physician. Sixty-four percent of the patients chose the hospital with the best medical or surgical outcomes. Patients preferred the data presented through a brochure with a table (p < 0.001). Three factors were identified with severe illness (satisfaction, outcomes and complaints) and two factors with non-severe illness (satisfaction and outcomes). Men paid more attention to medical and surgical outcomes (p < 0.001), relapses (p < 0.001), and side effects (p < 0.001). When performing comparisons, health professionals paid greater attention to medical and surgical outcomes than to patients' and relatives' satisfaction (t range between 0.40 and 0.90, p < 0.01). CONCLUSIONS: Differences were found in the need for information and in comprehension depending on the way information was presented and on the type of disease. Gender and health knowledge seem to be predictors of patients' information needs when choosing a hospital.