Stroke treatment outcomes in hospitals with and without Stroke Units. / Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus.

INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department.

A set of care quality indicators for stroke management. / Conjunto de indicadores de calidad asistencial en el abordaje del ictus.

OBJECTIVE: This study proposes a set of quality indicators for care outcomes in patients with acute cerebral infarction. These indicators are understandable and relevant from a clinical viewpoint, as well as being acceptable and feasible in terms of time required, ease of data capture, and interpretability. METHOD: The method consisted of reaching consensus among doctors after having reviewed the literature on quality indicators in stroke. We then designed and conducted a field study to assess the understandability and feasibility of the set of indicators. RESULTS: Consensus yielded 8 structural indicators, 5 process indicators, and 12 result indicators. Additionally, standards of reference were established for each indicator. CONCLUSION: This set of indicators can be used to monitor the quality care for stroke patients, identify strengths, and potentially to identify areas needing improvement.

Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology.

PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.

Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study. / Recursos y necesidades asistenciales en el tratamiento anticoagulante de los pacientes con fibrilación auricular no valvular. Estudio SAMOA.

INTRODUCTION AND OBJECTIVES: To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. METHODS: We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. RESULTS: A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. CONCLUSIONS: The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients' follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal.

Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus / Stroke treatment outcomes in hospitals with and without Stroke Units

INTRODUCCIÓN: La capacidad organizativa en términos de recursos y circuitos asistenciales que permiten acortar el tiempo de respuesta ante un nuevo caso de ictus es clave para obtener un buen resultado. En este estudio se compararon el abordaje terapéutico y los resultados del tratamiento de centros de asistencia tradicional (equipos de ictus, sin Unidad de Ictus) y con Unidad de Ictus. MÉTODOS: Estudio de tipo prospectivo, cuasiexperimental (sin aleatorización de las unidades analizadas) para realizar comparaciones entre 2 centros con Unidad de Ictus y 4 centros con atención tradicional por Neurología, sobre una selección de indicadores consensuados para monitorizar la calidad de la atención en ictus. Participaron 225 pacientes. Además, se utilizaron cuestionarios autoadministrados para recoger la valoración del servicio y la asistencia sanitaria recibida por parte de los pacientes. RESULTADOS: Los centros con Unidad de Ictus mostraron menores tiempos de respuesta tras el inicio de los síntomas, tanto al tiempo para llegar al centro, como para el diagnóstico por imagen considerando la hora de llegada del paciente al hospital. La capacidad de respuesta para aplicar tratamiento con trombólisis intravenosa fue mayor entre los hospitales con Unidad de Ictus frente a los centros con atención tradicional por Neurología. CONCLUSIÓN: Los centros con Unidad de Ictus mostraron un mejor ajuste a los estándares de tiempos de respuesta de referencia en el ictus, calculados en el estudio Quick frente a los centros con atención tradicional por Neurología

INTRODUCTION: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. METHODS: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. RESULTS: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. CONCLUSION: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department

Conjunto de indicadores de calidad asistencial en el abordaje del ictus / A set of care quality indicators for stroke management

Objetivo: Mediante este estudio se propone un conjunto de indicadores de calidad del resultado en la atención con infarto cerebral agudo. El conjunto de indicadores se caracteriza por ser comprensible, relevante desde el punto de vista clínico-asistencial, aceptable y factible en términos de tiempos de dedicación, facilidad de captura del dato y sencillez de su interpretación. Método: Tras la revisión de la literatura sobre indicadores de calidad en ictus, se llevó a cabo una metodología de consenso entre profesionales. Posteriormente, se diseñó y ejecutó un estudio de campo para valorar su comprensión y factibilidad. Resultados: Se han consensuado 8 indicadores de estructura, 5 de proceso y 12 de resultado. Además, se han establecido estándares de referencia para cada uno. Conclusión: Este conjunto de indicadores permite monitorizar el nivel de calidad de la atención sanitaria, identifican fortalezas y posibilita la identificación de áreas de mejora en la atención a los pacientes con ictus

Objective: This study proposes a set of quality indicators for care outcomes in patients with acute cerebral infarction. These indicators are understandable and relevant from a clinical viewpoint, as well as being acceptable and feasible in terms of time required, ease of data capture, and interpretability. Method: The method consisted of reaching consensus among doctors after having reviewed the literature on quality indicators in stroke. We then designed and conducted a field study to assess the understandability and feasibility of the set of indicators. Results: Consensus yielded 8 structural indicators, 5 process indicators, and 12 result indicators. Additionally, standards of reference were established for each indicator. Conclusion: This set of indicators can be used to monitor the quality care for stroke patients, identify strengths, and potentially to identify areas needing improvement

[Patient safety in extra-hospital emergencies]. / La seguridad en los cuidados de los pacientes en las emergencias extrahospitalarias.

UNLABELLED: One of the biggest challenges for the public health sector is to ensure the clinical safety of the patient, which is affected by mistakes made in pre-hospital emergency care. A culture of safety is encouraged and health professionals have tools at their disposal to help them maintain that safety. OBJECTIVE: [corrected] We propose as a hypothesis that compliance with safety standards in for the care of patients using extra-hospital emergency systems improves care and minimize risks. Our goal is to build a tool that enables us to measure the safety quality for patients in need of non-hospital emergency services. METHOD: To create this tool we have taken the SENECA study as a basis, and using the European Quality Model of the European Foundation of Quality Management (EFQM). The indicators were created using the Delphi Method. RESULTS: A total of 74 indicators were proposed, 9 of which were proposed by the panelists, and 44% being accepted. A definitive tool of 41 indicators was created. The most notable indicators were; "The expiry dates of consumable material and drugs that are stored in the units are controlled" grouped in "Alliances and resources", and "Patients who do not adhere to treatment due to unresolved doubts" grouped in "Key results". CONCLUSIONS: The use of the EFQM model to build the assessment tool allows information to be appropriately structured and to organize safety standards and indicators of security in a consistent manner. This methodology helped to propose a suitable tool for measuring patient safety in an extra-hospital situation. The application of this tool will identify areas for improvement related to the patient safety.

Recursos y necesidades asistenciales en el tratamiento anticoagulante de los pacientes con fibrilación auricular no valvular. Estudio SAMOA / Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study

Introducción y objetivos. Conocer, en diferentes especialidades médicas, el proceso asistencial del paciente anticoagulado con fibrilación auricular no valvular, así como determinar los recursos disponibles y necesarios e identificar áreas de mejora potenciales en la atención a estos pacientes. Métodos. Se realizó una encuesta transversal a médicos de atención primaria y especializada implicados en la atención al paciente anticoagulado. Los cuestionarios se referían al proceso asistencial, a la indicación y prescripción del tratamiento anticoagulante, y a las barreras y carencias existentes en torno a estos pacientes. Resultados. Un total de 893 médicos participaron en el estudio, de los cuales 437 pertenecían a atención primaria y 456 a atención especializada (mayoritariamente cardiólogos). El 42% de los médicos de familia indicaron que ellos mismos valoraban y prescribían el tratamiento anticoagulante y el 66% realizaban el seguimiento regular de los pacientes. En ambos ámbitos asistenciales los médicos pusieron de manifiesto la ausencia de protocolos estandarizados y se evidenció una falta de control de calidad del tratamiento. Conclusiones. El papel de atención primaria en la gestión de los pacientes anticoagulados ha crecido respecto a informes anteriores. Las respuestas de los médicos participantes sugieren la existencia de notables lagunas en la estandarización del proceso asistencial y de varias áreas de mejora en el seguimiento de estos pacientes. Promover la formación sobre los fármacos anticoagulantes de acción directa sigue siendo fundamental (AU)

Introduction and objectives. To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. Methods. We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. Results. A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. Conclusions. The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients’ follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal (AU)

[Intrahospital transportation of critically ill children]. / Traslado intrahospitalario del niño críticamente enfermo.

The intrahospital transport of a critically ill child is always a risky procedure. While it is being done, some complications which can worsen their initial situation may appear, so the benefits that this transport can provide must outweigh the possible risks. Preparing the patient and succeeding in performing a safe transport need the use of the proper equipment and human resources. Its degree of complexity and preparation must be proportional to the situation of instability of the patient and to the probability of increasing such instability, which implies performing a careful evaluation of the child and its real and potential needs previously. We also state some general ideas about the way of preparing and performing this kind of intrahospital transport in its different stages.

[Incidence of decubitus ulcers in an intensive care unit]. / Incidencia de las úlceras por presión en una Unidad de Cuidados Intensivos.

Decubitus ulcers are an important problem which must be known by health professionals in general and by nurses in particular. Its prevention is one of the basic care in Nursing. This care becomes especially relevant in patients who are admitted into Intensive Care Units. The objectives of the study are to know the incidence rate of patients who develop decubitus ulcers during their stay in the Unit and the proposal to introduce measures aiming to decrease its incidence. In general, the study proves that 17% of patients develop decubitus ulcers during their hospitalization and that 31.8% of patients who are catalogued as risk patients develop ulcers. The preventive measures introduced are the reassessment and application of prevention and treatment of decubitus ulcers protocols, the creation of improvement groups where these problems are approached, perfecting courses about decubitus ulcers, clinical sessions where strategies are unified, graphic divulging measures (notices, etc.) and antiscaric materials such as heelers, small cushions for head support, pillows, etc.

La seguridad en los cuidados de los pacientes en las emergencias extrahospitalarias / Patient safety in extra-hospital emergencies

Uno de los grandes retos de la sanidad mundial es la seguridad clínica del paciente. En la asistencia prehospitalaria urgente y emergente se producen errores que afectan a la seguridad. Se fomenta la cultura de seguridad y se ponen herramientas a disposición del profesional. Objetivo. Planteamos como hipótesis que el cumplimiento de estándares de seguridad en la atención a los pacientes que utilizan los sistemas de emergencia extrahospitalaria mejora la atención y minimiza sus riesgos. Nos trazamos como objetivo confeccionar un instrumento que permitiese evaluar la calidad de la seguridad del paciente que requiere de los servicios de emergencias extrahospitalarias. Método. Para la creación de esta herramienta nos hemos basado en el estudio SÉNECA, utilizando como base el Modelo Europeo de Calidad de la European Foundation of Quality Management (EFQM). La creación de los indicadores se realizó mediante metodología Delphi. Resultados. Se propusieron 74 indicadores, de los cuales 9 fueron propuestos por los panelistas, aceptandose el 44%. Creándose una herramienta definitiva de 41 indicadores. Los indicadores más destacados fueron; «Se controlan las caducidades del material fungible y fármacos que se almacenan en las unidades» agrupado en «alianzas y recursos» y «pacientes que no cumplen el régimen terapéutico por dudas no resueltas» agrupado en «resultados claves». Conclusiones. La utilización del modelo EFQM para construir la herramienta de evaluación permite estructurar de manera adecuada la información y organiza los estándares e indicadores de seguridad de una manera coherente. La metodología utilizada permite proponer una herramienta adaptada para medir la seguridad del paciente extrahospitalario. La aplicación de esta herramienta permitirá identificar áreas de mejora relacionadas con la seguridad del paciente(AU)

One of the biggest challenges for the public health sector is to ensure the clinical safety of the patient, which is affected by mistakes made in pre-hospital emergency care. A culture of safety is encouraged and health professionals have tools at their disposal to help them maintain that safety. Objetive. We propose as a hypothesis that compliance with safety standards in for the care of patients using extra-hospital emergency systems improves care and minimize risks. Our goal is to build a tool that enables us to measure the safety quality for patients in need of non-hospital emergency services. Method. To create this tool we have taken the SENECA study as a basis, and using the European Quality Model of the European Foundation of Quality Management (EFQM). The indicators were created using the Delphi Method. Results. A total of 74 indicators were proposed, 9 of which were proposed by the panelists, and 44% being accepted. A definitive tool of 41 indicators was created. The most notable indicators were; “The expiry dates of consumable material and drugs that are stored in the units are controlled” grouped in “Alliances and resources”, and “Patients who do not adhere to treatment due to unresolved doubts” grouped in “Key results”. Conclusions. The use of the EFQM model to build the assessment tool allows information to be appropriately structured and to organize safety standards and indicators of security in a consistent manner. This methodology helped to propose a suitable tool for measuring patient safety in an extra-hospital situation. The application of this tool will identify areas for improvement related to the patient safety(AU)