ABSTRACT
Introducción. El análisis causa-raíz es una técnica cualitativa caracterizada por un proceso secuencial de preguntas orientadas a la prevención de un evento centinela, al buscar conocer e incidir en los diversos componentes que rodean al acto mismo. La leucemia linfoblástica aguda es el cáncer más común en los niños. Debido a su manejo multidisciplinario, es susceptible de generar diversos errores latentes que ponen en riesgo la vida de los pacientes. Métodos. Se realizó un estudio de análisis causa-raíz a nivel nacional, con la participación de siete hospitales afiliados al Seguro Popular. Un panel de expertos analizó el expediente de un paciente pediátrico con leucemia linfoblástica aguda que hubiera fallecido recientemente en cada uno de los centros participantes. Los resultados se describieron y jerarquizaron para, finalmente, identificar las posibles recomendaciones para mejorar la atención al paciente. Resultados. Se consideró que en cuatro de los siete casos las causas de muerte eran prevenibles. Los problemas en la atención fueron relacionados con el manejo heterogéneo de complicaciones infecciosas y hematológicas. Los distintos centros hospitalarios compartieron la mayor parte de los problemas identificados, especialmente los referentes a la falta de personal capacitado y a la insuficiencia de productos hemáticos. Conclusiones. El estudio sienta la base para conocer las deficiencias en los distintos hospitales y propone el análisis de la información para la creación de comités de mejora. El análisis causa-raíz es una herramienta útil dentro de las unidades médicas, para identificar potenciales deficiencias en los procesos de atención.
Background: Root cause analysis is a qualitative technique characterized by a sequential order of questions to prevent errors by the acknowledgment and management of its diverse components. Acute lymphoblastic leukemia is the most common cancer in children. Due to the necessity of a multidisciplinary approach, it can be the target of diverse latent errors, which jeopardize the life of the patient. Methods: We developed a study including seven national institutions affiliated with the Seguro Popular insurance program. We conducted a summary of the clinical records of the most recent death of a pediatric patient with ALL at each institution. Clinical files were analyzed by an expert panel. Results were described and prioritized in order to recommend improvements for care. Results: We considered that 4/7 deaths were preventable. Problems in patient care are related to mismanagement of infectious and hematological complications. Many of the results obtained in the analysis are shared by the institutions with particular emphasis on lack of personnel and insufficient training as well as deficiency of blood products. Conclusions: This study will become the starting point to acknowledge the deficiencies among the different institutions and invites an analysis of the information to create committees for better care practices and to consider RCA as a useful tool within each medical institution to identify deficiencies in the care process.
ABSTRACT
Introducción. La evaluación es un componente esencial del proceso enseñanza-aprendizaje que motiva y dirige al alumno hacia sus objetivos y permite a los docentes conocer si los educandos poseen la destreza y el grado de conocimientos necesarios para una práctica profesional competente. En medicina no existe el método ideal de evaluación, por eso se recomienda el uso de diversos instrumentos como el Examen Clínico Objetivo Estructurado (ECOE) que ha mostrado su utilidad para evaluar las destrezas clínicas. El objetivo de este trabajo fue describir la experiencia de docentes y alumnos en la elaboración y la aplicación de un ECOE en un hospital pediátrico. Métodos. Se preparó un ECOE de 20 estaciones que se aplicó en un estudio piloto a 20 alumnos (2 residentes de primer año, 7 de segundo y 11 de tercero). Para cada estación se definieron los criterios de evaluación y el punto de corte. Con los datos obtenidos se calcularon los promedios por estación y por año de residencia. Resultados. El ECOE se llevó a cabo durante 2 horas con 20 minutos. Las estaciones aprobadas por los alumnos, de manera global, fueron doce. El valor promedio de las 20 estaciones fue 6.53, con una desviación estándar (DE) de 0.62 [R1 = 6.13 (DE 0.43), R2 = 6.26 (DE 0.60) y R3 = 6.76 (DE 0.59)]. Conclusiones. El ECOE es un método válido y confiable que permite evaluar la competencia clínica de manera integral. La experiencia de su uso en programas de posgrado ha sido limitada; sin embargo, el presente estudio muestra que es una herramienta factible que puede resultar de gran valor tanto para los pediatras en formación como para sus profesores.
Background. Assessment is an essential component of the teaching-learning process that stimulates and leads learners towards their goals and allows teachers to ascertain whether the students have acquired the necessary knowledge and clinical skills to be professionally competent. In medicine, the ideal assessment method does not exist; therefore, the use of several assessment instruments is advised; among them, the Objective Structured Clinical Examination (OSCE) has proven its advantage assessing clinical skills. The aim of this work is to describe the experience of teachers and learners developing and applying an OSCE in a children's hospital. Methods. Twenty OSCE stations were designed and applied in a pilot study. The assessment criteria for each station were defined. Individual marks were recorded and means for each station and year of residency were calculated (two first-year residents, seven second-year residents and 11 third-year residents). Results. The OSCE lasted 2 h and 20 min. Overall, 12 stations were accredited. The overall mean was 6.53, standard deviation (SD) 0.62; the mean for first-year residents was 6.13 (SD 0.43), for second-year residents 6.26 (SD 0.60) and 6.76 for third-year residents (SD 0.59). Conclusions. The OSCE isa valid and reliable method that permits an integral evaluation of clinical competence. The experience with this instrument has been limited to assessing postgraduate students. This study, however, shows that it is a useful tool that may be valuable for resident pediatricians and their professors.
ABSTRACT
Background: There is a high degree of misinformation given to the relatives of patients treated in the Ambulatory Pediatrics Unit at the Hospital Infantil de México Federico Gómez. The factors that contribute to this problem are diverse. Therefore, the practice implications as inadequacies in physician/patient communication lead to poor knowledge about a patient's illness and treatment. Attempts to improve the delivery of information may improve patient satisfaction and treatment compliance. The aim of this study was to quantify the percentage of patients' relatives who know the diagnosis, prognosis, and treatment of the patient's principal illness. Methods: Using a face-validated questionnaire designed by the investigators, we inquired into the extent of information about the illness and treatment given to the relatives of patients attending the Ambulatory Pediatrics Unit at the Hospital Infantil de México Federico Gómez. Results: Only 81, 75, and 68% of the participants were able to name the patient's illness, the affected organ, and the prognosis, respectively. The therapeutic drugs were correctly named by 85% of the participants. Only 72% of the relatives of patients who previously underwent surgery knew the name of the surgical procedure and 66% were able to briefly describe the procedure. Conclusions: This study shows that communication between parents and pediatricians is limited. The implementation of new measures adapted to the individual case of each institution can contribute to improve the situation.