Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto / Clinical safety audits for primary care centers. A pilot study

Objetivo: Detectar procesos organizativos, infracciones de normas o actuaciones profesionales que supongan niveles de inseguridad clínica. Diseño: Estudio descriptivo transversal mediante encuesta personalizada heteroadministrada de junio de 2008 hasta febrero de 2010. Emplazamiento: Trece de los 53 equipos de atención primaria (EAP) del ICS Costa de Ponent, Barcelona. Participantes: Trabajadores de 13 EAP agrupados en: director/a, adjunto/a, responsable del servicio de admisiones y médico/a centinela. Métodos: Selección no aleatoria, aparejando centros docentes/no docentes, urbanos/rurales, pequeños/grandes. Se evaluaron 33 indicadores: 15 de procedimientos, 9 de cultura y actitud, 3 de formación y 6 de comunicación. Criterios de exclusión: no colaboración. Resultados: Características de los 55 profesionales encuestados: 84,6% de centros urbanos, 46,2% docentes y 76,9% EAP grandes. Distribución por estamentos: 13 responsables de atención al usuario, 13 adjuntos de enfermería, 13 directores y 16 médicos centinelas. Nivel de inseguridad: < 50% respuestas afirmativas por indicador. Los EAP estudiados presentaron niveles de inseguridad en: recepción de nuevos profesionales médicos, administración de inyectables, sistema de recogida de domicilios por enfermería en fines de semana, interconsultas urgentes a especialistas, pacientes agresivos, presencia de incidentes críticos sobre las agendas de los médicos y barreras de comunicación en planes terapéuticos y con inmigrantes. Discusión y conclusiones: La seguridad clínica está en la agenda de los centros de salud. Las áreas detectadas de inseguridad son fácilmente abordables, y están consideradas en el futuro sistema de acreditación de la Generalitat de Catalunya. Los médicos centinelas son más críticos que los directores y los centros docentes, rurales y pequeños, refieren mejor percepción de seguridad (AU)

Objective: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. Design: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. Setting: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). Participants: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. Methods: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. Exclusion criteria: no collaboration. Results: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. Discussion and conclusions: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security (AU)

[Clinical safety audits for primary care centers. A pilot study]. / Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto.

OBJECTIVE: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. DESIGN: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. SETTING: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). PARTICIPANTS: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. METHODS: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. EXCLUSION CRITERIA: no collaboration. RESULTS: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. DISCUSSION AND CONCLUSIONS: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security.

Estudio comparativo mediante tomografía computarizada de la morfología de la sutura timpanoescamosa entre colesteatoma atical y oídos sanos / Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears

Introducción y objetivos: Habíamos observado, al intervenir oídos con colesteatoma, una mayor procidencia del extremo anterior de la sutura timpanoescamosa (STE). Queríamos averiguar si estos hallazgos correspondían a una especial morfología de la STE en los colesteatomas. Material y métodos: Realizamos un estudio retrospectivo, mediante tomografía computarizada (TC) preoperatoria, de la STE de pacientes intervenidos por colesteatoma entre enero de 2006 y diciembre de 2008. Se incluyó a pacientes mayores de 18 años, no intervenidos anteriormente, con TC realizada en el propio hospital e histología demostrativa de colesteatoma (n=31). Comparamos los hallazgos de la STE de estos 31 casos con los de 30 oídos sanos. El grupo sano incluyó 20 casos con colesteatoma unilateral (20 sanos/31 colesteatomas) y un grupo sano control estudiado con motivo de implante coclear (n=10). Se realizaron mediciones de la distancia en mm considerando dos puntos A y B de la STE (A era el más distal y B, el más proximal al extremo de la sutura). Seleccionamos los cortes de TC correspondientes a la máxima y la mínima separación de la STE. Resultados: Comparando las distancias máxima y mínima de la STE en los puntos A y B de todos los oídos, según estado patológico (sanos frente a colesteatoma), detectamos una menor distancia mínima A (p=0,036) y mínima B (p=0,014) en los oídos sanos respecto a los patológicos; no encontramos diferencias estadísticamente significativas de las distancias máximas A y B (p>0,05). Conclusiones: Este estudio aporta datos objetivos sobre un menor cierre de la STE en los casos de colesteatoma frente a oídos sanos. Relacionamos este hallazgo con la etiopatogenia del colesteatoma atical (AU)

Introduction and objectives: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. Material and methods: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. Results: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). Conclusions: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attical cholesteatoma (AU)

Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears.

INTRODUCTION AND OBJECTIVES: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. MATERIAL AND METHODS: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. RESULTS: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). CONCLUSIONS: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attic cholesteatoma.