In-hospital mortality rates after CABG by autonomous regions in Spain.

PURPOSE: The paper's purpose is twofold: to provide a predictive model for estimating in-hospital mortality rates after coronary artery bypass grafting (CABG) in Spanish autonomous regions (AR) after adjusting relevant factors; and to determine whether there is a difference between expected and observed mortality rates. DESIGN/METHODOLOGY/APPROACH: All patients registered in a minimum basic data set (MSBD) undergoing CABG between 2000 and 2004 were selected. After bivariate analysis to explore associations between in-hospital death and other variables, a multivariate analysis using logistic regression was conducted. The predictive model was evaluated using calibration and discrimination techniques. Standardized mortality ratios by AR were calculated. FINDINGS: The expected Spanish in-hospital mortality rate after CABG was 7.68 and the observed rate was 7.69 deaths per 100 operations. Discrimination obtained with the model resulted in an area under the curve of 0.70 (95 per cent CI, 0.69-0.71). When each AR's mortality rate is calculated and compared with the observed rate, some ARs present an observed mortality rate higher or lower than the expected rate according to adjusted variables in the model. RESEARCH LIMITATIONS/IMPLICATIONS: The MSBD registry does not contain patients' critical data, such as arterial damage severity, or in which hospital procedures were performed. PRACTICAL IMPLICATIONS: There are factors related to individual patient variation, financial resources or healthcare quality in different ARs, which should be investigated in follow-up studies. ORIGINALITY/VALUE: The paper shows that, although the global expected mortality rate is almost the same as the observed Spanish mortality rate, this similarity disappears when AR rates are compared.

Development and validation of a questionnaire to assess satisfaction with hospital emergency care.

OBJECTIVE: To develop and validate a questionnaire to determine satisfaction with the hospital emergency department. DESIGN: Cross-sectional study to validate a telephone questionnaire designed in Spanish by a panel of experts. SETTING: The emergency department of Hospital Gregorio Marañón, a tertiary level hospital of the Spanish national health system. PARTICIPANTS: A sample of 651 emergency department patients completed the questionnaire. MAIN OUTCOME MEASURES: The psychometric properties of the questionnaire were evaluated; namely, construct, criterion validity, predictive validity and internal consistency. RESULTS: Two dimensions--comfortable service and personalised service--were identified from the exploratory factor analysis, and these accounted for 63% of the variance. Both factors showed a positive correlation with the global assessment items 'global satisfaction with the attention received in the emergency ward' and 'Would you recommend this emergency department?' The predictive validity of the questionnaire was assessed by means of discriminant analysis, which showed that 66.7% of patients were correctly classified. Internal consistency measured by Cronbach's alpha resulted in a value greater than 0.80 for both dimensions. CONCLUSIONS: This questionnaire fulfils the necessary psychometric properties to be considered a useful and reliable tool for measuring patient satisfaction with hospital emergency services.

LQAS usefulness in an emergency department.

PURPOSE: This paper aims to explore lot quality assurance sampling (LQAS) applicability and usefulness in the evaluation of quality indicators in a hospital emergency department (ED) and to determine the degree of compliance with quality standards according to this sampling method. DESIGN/METHODOLOGY/APPROACH: Descriptive observational research in the Hospital General Universitario Gregorio Marañón (HGUGM) emergency department (ED). Patients older than 15 years, diagnosed with dyspnoea, chest pain, urinary tract colic or bronchial asthma attending the HGUGM ED from December 2005 to May 2006, and patients admitted during 2005 with exacerbation of chronic obstructive pulmonary disease or acute meningitis were included in the study. Sample sizes were calculated using LQAS. Different quality indicators, one for each process, were selected. The upper (acceptable quality level (AQL)) and lower thresholds (rejectable quality level (RQL)) were established considering risk alpha = 5 per cent and beta = 20 per cent, and the minimum number of observations required was calculated. FINDINGS: It was impossible to reach the necessary sample size for bronchial asthma and urinary tract colic patients. For chest pain, acute exacerbation of chronic obstructive pulmonary disease, and acute meningitis, quality problems were detected. The lot was accepted only for the dyspnoea indicator. ORIGINALITY/VALUE: The usefulness of LQAS to detect quality problems in the management of health processes in one hospital's ED. The LQAS could complement traditional sampling methods.