[Analysis of adverse events associated with interhospital transfer of critically ill patients. Safety checklist]. / Análisis de eventos adversos asociados al traslado intrahospitalario del paciente crítico. Listado de verificación.

INTRODUCTION: Mobilization entails a risk for critically ill patients. It is therefore important to design and apply the tools to detect any safety lapses and to improve the quality of patient healthcare. OBJECTIVES: To identify which adverse events (AE) are related to interhospital transfer of assisted patients and how enabling a protocol may prevent potential risks. MATERIAL AND METHOD: Descriptive, observational study. We analyzed 110 transfers during morning shift in an Intensive Care Unit at a reference hospital between January and March 2011. Variables related to underlying security factors were collected. RESULTS: The average transfer time was 37.16 minutes. 61.82% of the transfers were carried out on a scheduled basis. An 18.18% of AE were detected. In both cases, desaturation and hemodynamic instability made up to 2.7% of the cases. 5.5% of the cases were underlying factors related to monitoring during transfer, and those related to ventilation during transfer accounted for 2.7%. Not having all materials by the stretcher constituted 1.8%. We detected 31 AE for non-compliance with the protocol, that being a 27.15% of all transfers. CONCLUSIONS: Before each hospital transfer, a risk-benefit assessment is recommended in order to avoid potential alterations in the patient's pathophysiologic condition. Both the protocol and the safety checklist are key to detect underlying factors and improve security during interhospital transfers.

Factors affecting sleep quality in Intensive Care Units.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. / Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico.

AIM: A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN: A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING: The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS: Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire. RESULTS: Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS: The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.

Factors affecting sleep quality in Intensive Care Units. / Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos.

OBJECTIVE: To report sleep quality and identify related factors. DESIGN: A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING: The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS: Patients admitted between February 2016 and December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS: External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS: Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.

Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos / Factors affecting sleep quality in Intensive Care Units

Objetivos: Describir la calidad del sueño e identificar los factores que la afectan. Diseño Estudio observacional descriptivo y transversal realizado con una muestra de conveniencia de 129 pacientes. La diferencia entre los 3tiempos se calculó mediante la prueba de Wilcoxon y la correlación entre variables mediante la r de Spearman. Con análisis de regresión múltiple se relacionaron las variables independientes con «calidad del sueño». Ámbito Servicio de Medicina Intensiva de un hospital terciario. Participantes Pacientes ingresados en la unidad entre febrero de 2016 y diciembre de 2017. Intervenciones Administración de un cuestionario. Variables Ítems del cuestionario Freedman modificado, variables demográficas y de episodio. Resultados Los factores que más afectaron a la calidad del sueño en los 3tiempos de forma constante fueron el ruido y la luz. Hubo diferencias entre los 3 tiempos para los cuidados (p=0,005) y actividades de enfermería (p=0,019). Mediante el modelo de regresión múltiple se encontró que otros factores que influían en la calidad del sueño eran la edad (p=0,012), la ingesta habitual de alcohol (p=0,023), la administración de benzodiacepinas en UCI (p=0,01) y la comorbilidad (p=0,005). Resultaron diferencias significativas en somnolencia entre el alta y el primer día (p≤0,029), y entre el alta y la mitad de la estancia (p=0,001). Conclusiones La somnolencia disminuyó al final de la estancia. Aunque el ruido y la luz fueron los factores más molestos, solo los cuidados y actividades de enfermería resultaron significativos. La edad, la ingesta habitual de alcohol, la administración de benzodiacepinas en UCI y un mayor índice de comorbilidad interfieren negativamente en la calidad del sueño. (AU)

Objective: To report sleep quality and identify related factors. Design A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. Setting The Department of Intensive Care Medicine of a tertiary hospital. Participants Patients admitted between February 2016 and December 2017. Interventions Questionnaire administration. Variables Items of the modified Freedman questionnaire, and demographic and clinical variables. Results External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). Conclusions Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay. (AU)

Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico / Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients

OBJETIVO: Evaluar las características psicométricas del cuestionario Freedman modificado para la valoración del sueño en el paciente crítico. DISEÑO: Estudio psicométrico. Se exploró la validez de contenido mediante un grupo de expertos y la consistencia interna fue evaluada mediante el coeficiente alfa de Cronbach. Se realizó un análisis factorial para evaluar la validez de constructo; la estabilidad fue medida con análisis test-retest mediante el índice de correlación intraclases. Ámbito: Servicio de Medicina Intensiva de un hospital de referencia. PARTICIPANTES: Pacientes ingresados entre el 23 de febrero de 2016 y el 20 de diciembre de 2017. INTERVENCIONES: Administración de un cuestionario. VARIABLES: Ítems del cuestionario Freedman modificado. RESULTADOS: La pertinencia de los ítems y su definición obtuvieron valores superiores a 3, en una escala tipo Likert con valor máximo de 4 puntos. El alfa de Cronbach indicó un valor global de 0,933. El índice de correlación intraclases obtuvo valores superiores a 0,75 en la mayoría de los ítems del cuestionario. El análisis factorial obtuvo asociación entre las variables analizadas y los 4 factores. CONCLUSIONES: El cuestionario Freedman modificado presentó unas buenas características psicométricas. Puede resultar un instrumento fiable para evaluar la calidad del sueño en el paciente crítico, así como los factores ambientales relacionados

AIM: A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN: A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING: The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS: Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS: Questionnaire administration. VARIABLES: Items of the modified Freedman questionnaire. RESULTS: Item relevance and definition yielded scores > 3 (Likert scale maximum = 4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was > 0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS: The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors

Análisis de eventos adversos asociados al traslado intrahospitalario del paciente crítico. Listado de verificación / Analysis of adverse events associated with interhospital transfer of critically ill patients. Safety checklist

Introducción: La movilización supone un riesgo para el paciente gravemente enfermo. Es importante diseñar y aplicar herramientas para detectar fallos en la seguridad y mejorar la calidad asistencial. Objetivos: Identificar qué eventos adversos (EA) se relacionan con el traslado intrahospitalario asistido y cómo la cumplimentación de un protocolo puede prevenir potenciales riesgos. Material y método: Estudio observacional descriptivo. Se analizan 110 traslados realizados en turno de mañana en un servicio de medicina intensiva de un hospital de referencia, en el periodo comprendido de enero a marzo de 2011. Se recogieron variables relacionadas con factores latentes de seguridad y con eventos adversos. Resultados: La duración media por traslado fue de 37,16 min. Un 61,82% de los traslados se realizaron de forma programada. Se detectaron un 18,18% de EA. Desaturación e inestabilidad hemodinámica representaron en ambos casos un 2,7%. Los factores latentes relacionados con la monitorización de transporte representaron un 5,5% y los relacionados con la ventilación de transporte fueron un 2,7%. No disponer de todo el material en la camilla representó un 1,8%. Se detectan 31 EA que indican un incumplimiento del protocolo, esto representa un 27,15% del total de traslados. Conclusiones: Previamente a cada movilización se recomienda realizar una valoración riesgo/beneficio para prevenir potenciales alteraciones en la situación fisiopatológica del paciente. El protocolo y el listado de verificación son herramientas importantes para detectar factores latentes y mejorar la seguridad durante el traslado intrahospitalario

Introduction: Mobilization entails a risk for critically ill patients. It is therefore important to design and apply the tools to detect any safety lapses and to improve the quality of patient healthcare. Objectives: To identify which adverse events (AE) are related to interhospital transfer of assisted patients and how enabling a protocol may prevent potential risks. Material and method: Descriptive, observational study. We analyzed 110 transfers during morning shift in an Intensive Care Unit at a reference hospital between January and March 2011. Variables related to underlying security factors were collected. Results: The average transfer time was 37.16 minutes. 61.82% of the transfers were carried out on a scheduled basis. An 18.18% of AE were detected. In both cases, desaturation and hemodynamic instability made up to 2.7% of the cases. 5.5% of the cases were underlying factors related to monitoring during transfer, and those related to ventilation during transfer accounted for 2.7%. Not having all materials by the stretcher constituted 1.8%. We detected 31 AE for non-compliance with the protocol, that being a 27.15% of all transfers. Conclusions: Before each hospital transfer, a risk-benefit assessment is recommended in order to avoid potential alterations in the patient’s pathophysiologic condition. Both the protocol and the safety checklist are key to detect underlying factors and improve security during interhospital transfers