RESUMEN La donación en asistolia (DA) tipo III de Maastricht o DA controlada es aquella en que el cese irreversible de la función circulatoria y respiratoria se produce tras la retirada de medidas de ...soporte vital. Dada la escasez de pulmones disponibles para trasplante, se está valorando cada vez con más frecuencia el inicio de programas con pulmones procedentes de DA. La extracción combinada tórax-abdomen en DA se lleva a cabo únicamente en doce centros en España, siendo todavía más excepcional el empleo combinado de extracción superrápida pulmonar con perfusión regional normotérmica abdominal. El primer caso de extracción pulmonar y abdominal en un donante en asistolia tipo III en Navarra con este tipo de técnicas de preservación supone un hito y el éxito alcanzado demuestra que es un procedimiento factible y seguro.
Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. ...However, implementation across specialties has not been assessed.
To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication.
Prospective Type 2 Hybrid effectiveness implementation study.
Residents from diverse specialties across 32 hospitals (12 community, 20 academic).
External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews.
Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality.
2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p < .05) and 17.5 to 9.3 minor events/person-year (p < .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p < .001, n = 4812) and written (10% vs. 74%, p < .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p < .001) and written (29% vs. 78%, p < .001) patient summaries, verbal (29% vs. 78%, p < .001) and written (24% vs. 73%, p < .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p < .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
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