Effect of patient safety strategies on the incidence of adverse events.

OBJECTIVE: This study aims to estimate the incidence of adverse events (AEs) and avoidable AE in four hospital services before and after applying strategies for patient safety. DESIGN: Retrospective study of two cohorts (2006 and 2009). SETTING: General Surgery, Internal Medicine, Intensive Care Unit and Oncology services. PARTICIPANTS: A sample of 365 patients (2006) and 232 in 2009 randomly selected from the services previously cited. INTERVENTIONS: Strategies to improve patient safety (e.g. hand-hygiene campaign). MAIN OUTCOME MEASURES: Analyses were made of the change in the incidence and type of AE and avoidable AE, number of procedures and additional days of hospital stay, and the concordance between two recording systems. RESULTS: The incidence of patients with AE was 20.8% in 2006 compared with 28.9% in 2009 (P < 0.05). Oncology had twofold more AE than did General Surgery [odds ratio (OR) = 2.07, 95% confidence interval (CI): 1.12-3.86] for the same length of stay and number of extrinsic risk factors. In 2006, 84.6% were considered avoidable, compared with 57.1% of 2009 (P < 0.001). There was no difference in the average length of additional stay. In 2006, there were more additional procedures compared to 2009 (OR = 2.75, 95% CI: 1.28-6.06). A concordance of 61% was found for the detection of AE with the two recording systems. CONCLUSIONS: An increased incidence in AEs was found after the strategies, while avoidable AE decreased, as did additional treatments and procedures. The measures implemented constitute a further step in reducing avoidance and a greater awareness of recording AEs in the discharge report.

[Evaluation of a health care programme with nursing tutor in a hospital traumatological facility in a hospital, Granada, Spain, 2004]. / Evaluación de un programa de atención sanitaria con enfermera tutora en cirugía de traumatologia en un hospital de Granada, 2004.

BACKGROUND: The current trend in patient care is towards a more humanized and higher-quality healthcare. The objective of the present study was to evaluate the results of implementing a programme of healthcare with a reference nurse who welcomes the patient at hospital admission, visits regularly during hospital stay, and resolves doubts and problems. METHODS: Quasi-experimental study (149 cases and 454 non-tutored controls) in patients admitted for scheduled trauma surgery at the Virgen de las Nieves University Hospital, Granada. Sociodemographic and clinical data were gathered at admission. At 15 days after discharge, patients were administered with an interviewer-administered Zung score and an ad hoc questionnaire on satisfaction with different healthcare aspects during hospital stay and understanding of information received. Bivariate analyses and linear and multivariate logistic regression analyses were performed with a study of confounding variables. RESULTS: For the outcome variable anxiety level non-tutored patients had a B coefficient of 2.64 (p<0,01) in the multivariate linear regression analysis controlling for the other variables in the final model: sex, presence of informal career, professional activity, days of hospital stay and understanding of health information. For the outcome variable inadequate understanding information non-tutored patients showed an odds ratio of 3.48 in the multivariate analysis controlling for educational level and presence of informal career. Satisfaction with he friendliness of health care personnel and with the hospital setting did not significantly difference, although the percentage of dissatisfied patients was higher in the non-tutored group: 15% vs 11% (p= 0.34) and 18% vs 12 % (p= 0.11) respectively. CONCLUSIONS: The implemented continued care programme proved effective for these patients, increasing their understanding of information received and reducing anxiety levels.

Evaluación de un programa de atención sanitaria con enfermera tutora en cirugía de traumatología en un hospital de Granada, 2004 / Evaluation of a health care programme with nursing tutor in a hospital traumatological facility in a hospital. Granada, Spain, 2004

Fundamento: La tendencia actual en la atención al paciente es hacia un aumento de la calidad en los servicios sanitarios. El objetivo de este trabajo fue evaluar los resultados de la aplicación de un programa de atención sanitaria a través de una enfermera de referencia que acogía al paciente al ingreso hospitalario, le visitaba regularmente durante su estancia y le resolvía dudas y problemas. Métodos: Estudio cuasi-experimental realizado en pacientes (149 casos y 454 controles) ingresados para cirugía traumatológica en el Hospital Virgen de las Nieves de Granada. Al ingreso se recogieron variables sociodemográficas y clínicas. A los 15 días tras el alta se les administró la "Escala heteroevaluada de ansiedad de Zung" y un cuestionario ad hoc sobre la satisfacción con diferentes aspectos de la atención sanitaria durante la estancia en el hospital y la comprensión de la información recibida. Se realizó análisis bivariante y análisis de regresión lineal y regresión logística multivariante con estudio de variables confundentes. Resultados: Para la variable nivel de ansiedad los pacientes no tutorizados en el análisis de regresión lineal multivariante tenían un coeficiente B=2,64 (p<0,01), controlando por la otras variables en el modelo final: sexo, presencia de cuidador informal actividad profesional, días de estancia, y comprensión de la información sanitaria. Para la variable de resultado insuficiente comprensión de la información los pacientes no tutorizados tenían una Odds Ratio de 3,48 en el análisis de regresión logística multivariante controlando por educación y presencia de cuidador informal. La satisfacción con la amabilidad del personal y con el medio hospitalario no se modificó significativamente aunque el porcentaje de insatisfacción fue mayor en el grupo no tutorizado, 15% frente a 11% (p= 0,34), y 18% frente a 12% (p=0,11) respectivamente. Conclusiones: El programa de atención continuada aplicado se ha manifestado eficaz para los pacientes, aumentando la comprensión de la información y disminuyendo los niveles de ansiedad (AU)

Background: The current trend in patient care is towards a more humanized and higher-quality healthcare. The objective of the present study was to evaluate the results of implementing a programme of healthcare with a reference nurse who welcomes the patient at hospital admission, visits regularly during hospital stay, and resolves doubts and problems. Methods: Quasi-experimental study (149 cases and 454 non-tutored controls) in patients admitted for scheduled trauma surgery at the Virgen de las Nieves University Hospital, Granada. Sociodemographic and clinical data were gathered at admission. At 15 days after discharge, patients were administered with an interviewer-administered Zung score and anad hoc questionnaire on satisfaction with different healthcare aspects during hospital stay and understanding of information received. Bivariate analyses and linear and multivariate logistic regression analyses were performed with a study of confunding variables. Results: For the outcome variable anxiety level non-tutored patiens had a B coeficient of 2.64 (p<0,01) in the multivariate linear regression analisys controlling for the other variables in the final model: sex, presence of informal carer, professional activitiy, days of hospital stay and understanding of health information. For the outcome variable inadequate understanding information non-tutored patients showed an odds ratio of 3.48 in the multivariate analysis controlling for educational level and presence of informal carer. Satisfaction with he friendliness of health care personnel and with the hospital setting did not significantly diference, although the percentage of dissatisfied patiens was higher in the non-tutored group: 15% vs 11% (p= 0.34) and 18% vs 12 % (p= 0.11) respectively. Conclusions: The implemented continued care programme proved effective for these patients, increasing their understanding of information received and reducing anxiety levels (AU)

Utilización de crema EMLA (Eutetic Mixture Local Anesthesia) previa a la anestesia por infiltración en la cirugía mayor ambulatoria del Sinus Pilonidal / Use of EMLA cream (Eutetic Mixture Local Anestesia) before infiltration of local anesthesia in Ambulatory Surgery for pilonidal disease

No disponible