ABSTRACT
BACKGROUND: The Ministry of Health, Consumption and Social Welfare (MHCSW) since 2005 has been promoting, in collaboration with the Autonomous Communities (AC) and the Scientific Societies (SC), among them the Spanish Society for Healthcare Quality (SSHCQ), the Patient Safety Strategy (PSS). PSS 2015-2020 develops relevant aspects of patient safety (PS), such as risk management, reporting and learning systems (RLS), as well as promoting an adequate response when an adverse event (AE) unexpectedly occurs. The present work describes the current situation of the different AC in relation to these topics. MATERIAL AND METHODS: A Descriptive study, based on a survey developed ad hoc within the framework of the agreement between the MHCSW and SSHCQ, was conducted at national level. The questions' topics, prepared by consensus of the work team, considered the implementation of RLS and AE analysis, and legal protection for professionals involved in an AE in the AC. RESULTS: A total of 17 surveys were collected (16 AC and INGESA). All ACs had a RLS, a structure to support PS activities but very heterogeneous. Some ACs had a response plan to an AE and had established a coordination protocol with legal services to support patients and professionals involved in an AE. Some ACs had enacted some laws and regulations to facilitate PS culture. CONCLUSIONS: The ACs have risk management structures that lead the plans in PS, reporting and learning systems and have experience in the analysis of near miss and AE. However, a regulatory change that increases the legal safety of professionals to provide an adequate response to the AEs is a priority. This challenge should involve leaders of health organizations, scientific societies and professional associations, national and regional health authorities as it has been done in other European countries.
Subject(s)
Health Care Surveys/statistics & numerical data , National Health Programs/standards , Patient Safety/standards , Safety Management/standards , Humans , Medical Errors/prevention & control , Organizational Culture , Quality of Health Care , SpainSubject(s)
Accidents/psychology , Health Personnel/psychology , Medical Errors/psychology , Mental Health Services/organization & administration , Occupational Health Services/organization & administration , Patient Safety , Psychiatric Rehabilitation/organization & administration , Stress, Psychological/therapy , Humans , Retrospective Studies , Spain , Stress, Psychological/etiology , Stress, Psychological/psychologyABSTRACT
Objetivo: Diseño y validación de un mapa de riesgos de la atención urgente (MR) aplicable para todos los servicios de urgencias (SU) hospitalarios españoles. Material y métodos: Diseño de un MR utilizando la metodología del Análisis Modal de Fallos y Efectos (AMFE). El trabajo constó de cuatro fases: diseño, consenso (rondas de consultores mediante técnica Delphi), validación y diseño definitivo. Resultados: El MR definitivo recogió, tras su validación, 13 procesos, 118 subprocesos, 271 fallos posibles y 1.368 riesgos. Atendiendo a las puntuaciones de mediana del índice de probabilidad de riesgos (IPR), se elaboraron dos versiones reducidas: MR Recomendado, con los riesgos por encima de la mediana global de cada proceso, formado por 13 procesos, 108 subprocesos, 217 fallos posibles y 748 riesgos; y MR Imprescindible (con los riesgos >280 puntos de IPR), formado por 10 procesos, 54 subprocesos, 79 fallos posibles y 180 riesgos. Conclusión: El MR obtenido es una herramienta proactiva homogénea y validada, que analiza todos los procesos asistenciales urgentes y que permite la gestión de riesgos en cualquier SU (AU)
Objective: To design and validate an emergency care risk map (RM) which can be used in all the Spanish emergency departments (ED). Material and methods: To design a RM using the Failures Modes and Effects Analysis method (FMEA). The study has four phases: Design, consensus (using Delphi technique), validation and final design. Results: The final RM collected, after validation, a total of 13 processes, 118 subprocesses, 271 possible failures and 1,368 risks. Based on median scores risk odds ratio (IPR), we obtained two smaller versions: Recommended MR, with the risks above the overall median for each process, consists of 13 processes, 108 subprocesses, 217 possible failures and 748 risks; and Essential RM (with the risk >280 points IPR), consisting of a total of 10 processes, 54 subprocesses, 79 and 180 potential risks. Conclusion: The RM obtained is a proactive, homogeneous and validated tool, which analyzes all the emergency cares processes, and which allows risk management in every ED (AU)
