Eventos adversos en los servicios de Urgencias. Revisión de reconsultas como fuente de datos / Adverse events in emergency departments. Review of reconsultations as a data source

Objetivo: Identificar los posibles eventos adversos que ocurren en un Servicio de Urgencias mediante la revisión de casos de pacientes que vuelven a consultar en el mismo. Método: Estudio retrospectivo de la información clínica de los pacientes que retornan a Urgencias en un plazo inferior a una semana, en octubre de 2006, con el fin de identificar problemas ocurridos en la primera asistencia. La revisión la realizaron médicos adjuntos del mismo servicio, previa medida de la fiabilidad, comprobando la concordancia interobservador. Para el contraste de proporciones se ha utilizado el test de chi cuadrado. Resultados: Se estudiaron 311 casos. De ellos, 203 casos (79,6%) acudieron no citados y por una causa relacionada con la primera visita. En el 83,7% de ellos la evolución fue mala. Se revisaron las causas de mala evolución, siendo la más frecuente la «evolución natural del proceso» con 75 casos (44,1%), seguida de problemas en el tratamiento con 73 (42,9%). Se valoró si hubo consecuencias para el paciente, evidenciándose en 36 casos (21,2%). De estos 36 casos, 11 se calificaron como evitables (30,5%) por los evaluadores y un 1% de fallos claros en la actuación en pacientes que retornaron a Urgencias. Resultados: En el apartado de si había habido un claro fallo en la primera actuación, a juicio de los evaluadores, se calificaron como tal 3 casos, dos con consecuencias para el paciente y uno, sin consecuencias. Conclusiones: En las condiciones del estudio, la evaluación interna de las reconsultas permite identificar los eventos adversos ocurridos y conocer sus causas. Esto podría facilitar el aprendizaje y la mejora de la cultura de seguridad (AU)

Objective: To identify potential adverse events that occur in an emergency department by reviewing cases of patients who make repeat visits. Method: A retrospective study of clinical data of patients returning to the emergency department within a period of less than one week in October 2006 with the aim of identifying problems that occurred in the first visit. The review was conducted by senior doctors of the same service who measured the reliability of the first intervention, by checking between observer agreement. The Chi square test was used to calculate the comparison ratios. Results: We studied 311 cases. Of these, 203 cases (79.6%) returned to the department without been given a previous appointment and for a reason connected with the first visit. The progress was poor in 83.7% of cases. We reviewed the causes of the poor outcomes, with the most frequent being "natural progress of the process" in 75 cases (44.1%), followed by problems in treatment in 73 cases (42.9%). The effects on the patient were evaluated, and it was shown that there were consequences for the patient in 36 cases (21.2%). Of these 36 cases, 11 were considered as avoidable (30.5%) by the evaluators and 1% of clear failures in performance in patients returning to emergency rooms. Results: In the part of if, in opinion of the evaluators, there had been a clear failure in the first performance zoned like such 3 cases, two with consequences for the patient and 1 without consequences. Conclusions: In the conditions of the study, the internal evaluation of the reconsultas allows to identify the adverse events occurred and know his causes. This could facilitate the learning and the improvement of the culture of security (AU)

[Adverse events in emergency departments. Review of reconsultations as a data source]. / Eventos adversos en los servicios de Urgencias. Revisión de reconsultas como fuente de datos.

OBJECTIVE: To identify potential adverse events that occur in an emergency department by reviewing cases of patients who make repeat visits. METHOD: A retrospective study of clinical data of patients returning to the emergency department within a period of less than one week in October 2006 with the aim of identifying problems that occurred in the first visit. The review was conducted by senior doctors of the same service who measured the reliability of the first intervention, by checking between observer agreement. The Chi square test was used to calculate the comparison ratios. RESULTS: We studied 311 cases. Of these, 203 cases (79.6%) returned to the department without been given a previous appointment and for a reason connected with the first visit. The progress was poor in 83.7% of cases. We reviewed the causes of the poor outcomes, with the most frequent being "natural progress of the process" in 75 cases (44.1%), followed by problems in treatment in 73 cases (42.9%). The effects on the patient were evaluated, and it was shown that there were consequences for the patient in 36 cases (21.2%). Of these 36 cases, 11 were considered as avoidable (30.5%) by the evaluators and 1% of clear failures in performance in patients returning to emergency rooms. In the part of if, in opinion of the evaluadores, there had been a clear failure in the first performance zoned like such 3 cases, two with consequences for the patient and 1 without consequences. CONCLUSIONS: In the conditions of the study, the internal evaluation of the reconsultas allows to identify the adverse events occurred and know his causes. This could facilitate the learning and the improvement of the culture of security.

Cycles triggered with GnRH agonist: exploring low-dose HCG for luteal support.

The aim of this study in patients at risk of ovarian hyperstimulation syndrome (OHSS) was to determine the efficacy and safety of luteal support using human chorionic gonadotrophin (HCG) after triggering ovulation with gonadotrophin-releasing hormone (GnRH) agonist in IVF/intracytoplasmic sperm injection antagonist cycles. A total of 192 OHSS-risk patients, following a GnRH antagonist protocol (0.25mg/day cetrorelix) during recombinant FSH stimulation, were triggered with 1.5mg s.c. leuproreline for ovulation. A total of three boluses of HCG were used for luteal support, 1000IU (group A, n=44), 500IU (group B, n=115) or 250IU (group C, n=33) every third day, starting the day after oocyte retrieval. For the reproductive outcome, main variables were biochemical and clinical pregnancy rates, and for OHSS, the variables were the numbers of moderate and severe OHSS cases. Overall pregnancy rate was 51.8% and clinical pregnancy rate was 43.4%. This study observed eight cases of moderate (4.2%) and seven of severe OHSS (3.6%). Six out of the seven (85.7%) severe cases were late-onset OHSS, related to pregnancy. In conclusion, GnRH agonist single dose for triggering ovulation and low doses of HCG used as luteal-phase support seem to secure a normal pregnancy outcome without increasing the OHSS risk.