Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the ...quality of care.
This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs.
A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR CI95%: 2.15 1.07 to 4.52) versus absence and emergency admission (OR CI95%: 17.116.63 to 46.26) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR CI95%: 2.77 1.39 to 5.51), central venous catheter (OR CI95%: 2.58 1.33 to 5.00) and impaired mobility (OR CI95%: 2.241.35 to 3.71), versus absences. They were associated too with the stays in the intensive care unit (OR CI95%: 2.75 1.07 to 7.06) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE.
The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.
Key messages
Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.
Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.
Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.
This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care.
A retrospective cohort study analyzing ...the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed.
A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval CI, 71.0%-74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 5.3%; 95% CI, 4.1%-6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%-6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%-9.1%). In adult patients, the majority of AAEs (51/901 5.7%; 95% CI, 4.2%-7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 51.9%; 95% CI, 38.5%-65.2%) and pediatric patients (15/15 100%).
These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised.
NCT03482232.
To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC).
Retrospective cohort study.
Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, ...Catalonia, Madrid, Navarre, and Valencia.
A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients.
Number and severity of identified AAEs from February 2018 to September 2019.
A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients.
Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
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Puntos clave•Las intervenciones en seguridad del paciente, como las prácticas seguras, buscan reducir el número de incidentes para la seguridad de los pacientes, particularmente el ...número de eventos adversos evitables.•El número de eventos adversos evitables en atención primaria en España se ha duplicado con respecto a los datos aportados por el estudio APEAS (Estudio de la Seguridad de los Pacientes en atención primaria de Salud) realizado en 2008.•Uno de cada 30 eventos adversos evitables supone un daño grave y permanente en el adulto.
Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP).
Estudio retrospectivo de cohortes.
consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana.
Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres.
Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019.
Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p=0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos.
Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto.
To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC).
Retrospective cohort study.
Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia.
A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients.
Number and severity of identified AAEs from February 2018 to September 2019.
A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients.
Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the ...different types of masks.
To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed.
The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population.
In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.
Resumen Objetivo Analizar la adherencia al tratamiento de la infección tuberculosa (TIT) e identificar los factores de riesgo para su cumplimiento. Diseño Estudio observacional de cohortes ...históricas. Emplazamiento Hospital Universitari Sant Joan d’Alacant (Alicante). Participantes Todos los sujetos con una prueba de tuberculina (PT) realizada durante el estudio de contactos (EC) de tuberculosis durante 6 años. Resultados Se incluyeron en el análisis 764 contactos. El 59,7% de los 566 pacientes que terminaron el EC presentaron infección tuberculosa (IT). De los pacientes con IT, el 45,6% no iniciaron tratamiento y los factores asociados fueron: edad (36-65 años; RR: 5,8; IC 95%: 1,2-27,5 y > 65 años; RR: 11,3; IC 95%: 2,0-64,0), relación social con el caso índice de tuberculosis (RR: 2,2; IC 95%: 1,2-3,8) e induración de la PT (≥ 15 mm; RR: 0,5; IC 95%: 0,3-0,9). La tasa de cumplimiento fue del 80,4% entre los que comenzaron el TIT. La pauta de tratamiento 7-9H se asoció con mayor cumplimiento del TIT (RR: 12,7; IC 95%: 1,5-107,3). Conclusiones La tasa de cumplimiento del TIT fue elevada entre los que iniciaron tratamiento. Casi la mitad de los contactos con IT no iniciaron tratamiento y los factores asociados fueron: edad, relación social e induración de la PT. La pauta de tratamiento se asoció con mayor cumplimiento. Debemos conocer con precisión los factores asociados a la adherencia al tratamiento de la IT en cada área de salud y actuar sobre los grupos de riesgo, y de esta manera aproximar el control global de la tuberculosis.
Objective To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. Design Retrospective cohort study. Setting Twenty-four Spanish ...hospitals. Participants Patients of any age with a clinical record indicating an inpatient stay of >24 h and a discharge between 4 and 10 June 2005 (n = 5908). Intervention None. Main Outcome Measures Percentage of AEs considered preventable. Results We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8–6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). Conclusions In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.
1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus fortalezas y ...debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras.
Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español.
La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente).
La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad.
1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement.
A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language.
The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety).
The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception.
Resumen: Objetivo: 1) Determinar la percepción de seguridad que tienen los/las profesionales sanitarios/as y no sanitarios/as en un hospital universitario; 2) describir el clima de seguridad con sus ...fortalezas y debilidades; y 3) evaluar las dimensiones valoradas negativamente y establecer áreas de mejoras. Método: Estudio transversal y descriptivo realizado en el Hospital Universitario San Juan de Alicante en el que se recogen los resultados de la valoración del nivel de cultura de seguridad utilizando como instrumento de medición la encuesta Hospital Survey on Patient Safety Culture de la Agency for Healthcare Research and Quality adaptada al español. Resultados: La tasa de respuesta fue del 35,36%. El colectivo con mayor participación fue el médico (32,3%), y el servicio más implicado, el de urgencias (9%). El 86,4% tuvo contacto con el paciente. El 50% de los/las trabajadores/as calificó el clima de seguridad entre 6 y 8 puntos. El 82,8% no notificó ningún evento adverso en el último año. Los profesionales con mayor cultura de seguridad fueron los farmacéuticos, y los que tuvieron peor cultura, los celadores. No se identificó ninguna fortaleza de manera global. Hubo dos dimensiones que se comportaron como una debilidad: la 9 (dotación de personal) y la 10 (apoyo de la gerencia a la seguridad del paciente). Conclusiones: La percepción sobre seguridad del paciente es buena, aunque mejorable. No se han identificado fortalezas. Las debilidades identificadas son dotación de personal, apoyo de la gerencia a la seguridad del paciente, cambios de turno y transición entre servicios, y percepción de seguridad. Abstract: Objective: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. Method: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. Results: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). Conclusions: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception.
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