[Perceived quality of care by frequent paediatric healthcare users: A qualitative approach]. / Calidad percibida en población hiperfrecuentadora infantil: una aproximación cualitativa.

INTRODUCTION: Assessing the perceived quality of a healthcare department by its users is essential in a quality management system. In Paediatric Emergency Departments (PED), the demand for urgent care has increased in recent years, as well as an increase in frequent attendance. Paying attention to the opinions of these habitual users by means of qualitative methodology is particularly suitable for assessing the quality of care and identifying opportunities to improve the PED. METHODS: Two focus groups were held with parents of patients (with and without a chronic disease) who visited the PED on 10or more occasions per year in a third level hospital. RESULTS: The participants were satisfied overall with the PED. The treatment received was very positively valued, and they never felt that they had received poorer care due to being frequent users. As main strengths, they also highlighted the professional expertise, the friendliness of staff, the quality of information given, the medication received on discharge from hospital, and the follow-up carried out by the PED. The major improvement opportunities identified included: the contagion risks, the lack of coordination between different levels of care, and the need to improve the inclusion of families in the health care process. CONCLUSIONS: Due to the contributions made by these parents, several improvement strategies have been introduced, such as the implementation of sharing information protocols in shift changes, professional training courses, the establishment of a liaison person between the PED and Primary Care, and a proposal to the Hospital Management Department to assess the identified needs.

[Evaluation of effectiveness of corrective measures arising from incident notifications in a paediatric emergency department]. / Evaluación de la efectividad de acciones correctivas derivadas de la notificación de incidentes en urgencias pediátricas.

OBJECTIVE: To analyse the effectiveness of corrective measures arising from the analysis of safety incident notifications in the Paediatric Emergency Unit. METHODS: A quasi-experimental, prospective, and single-centre study was carried out between 2015 and 2018. In the first phase, incidents notified throughout one year were analysed. Corrective measures were then implemented for 5 specific kinds of incidents. These incidents were finally compared to those notified within 12 months after the implementation of those measures. Results were expressed as relative risk and relative risk reduction. RESULTS: A total of 1587 safety incidents were notified (0.9% of patients treated) between January 2015 and December 2017. After implementation of corrective measures, there was a decrease in all kinds of incidents notifications analysed. The incidents related to patient identification were reduced by 60.9% (RR 0.39, 95% CI; 0.25-0.60), and those regarding communication between professionals were reduced by 74.5% (RR 0.25, 95% CI; 0.12-0.55). Incidents related to sedation and analgesic procedures totally disappeared. No significant reduction was found in incidents concerning the triage system, or in those related to rapid intravenous rehydration procedures. CONCLUSIONS: The implementation of improvement actions arising from the analysis of voluntary notification of incidents is an effective strategy to improve patient effective strategy to improve.

[Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. / Impacto de una estrategia de mejora de calidad asistencial y gestión de riesgos en un servicio de urgencias pediátricas.

INTRODUCTION: Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS: A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS: The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION: It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.

Análisis de la metodología «trigger tools» en el servicio de urgencias de un hospital terciario / Applying trigger tools in a tertiary hospital emergency room

Introducción: La seguridad del paciente es esencial para garantizar la calidad sistencial. Los incidentes son habituales en la práctica clínica diaria; sin embargo, existen pocos estudios que analicen la incidencia de eventos adversos (EA) en la población pediátrica. Los trigger tools son señales de alerta que permiten sospechar la posibilidad de aparición de EA. El objetivo de este estudio era analizar la sensibilidad de esta herramienta adaptada a un servicio de urgencias pediátricas de un hospital de tercer nivel para la identificación de los EA. Pacientes y métodos: Se seleccionaron 29 triggers aplicables en nuestro medio. En total, se estudiaron 140 pacientes aleatorizados atendidos en el servicio de urgencias entre el 1 de enero y el 31 de julio de 2015. Resultados: Se registraron 48 triggers en 38 de las 140 historias revisadas. En ellas, finalmente se detectó algún EA en 9 historias (una de ellas con 2 triggers). Esto supone la identificación de EA en casi el 21% de las historias clínicas que incluyen triggers. El trigger detectado con más frecuencia, asociado a un mayor porcentaje de EA, fue «reingreso por el mismo motivo en menos de 72 horas tras el alta hospitalaria», seguido de «dosis inadecuada de fármacos». Conclusiones: Los trigger tools no han demostrado rentabilidad para la detección sistemática de EA en nuestro medio. El primer trigger mencionado antes parece tener mayor sensibilidad para detectar potenciales EA. Por ello, sería recomendable la evaluación sistemática de las historias en las que éste aparezca (AU)

Introduction: Patient safety is essential in health system. Incidents are common in daily clinical practice; however, few studies have analyzed the incidence of adverse events (AEs) in the pediatric population. The trigger tools are simple warning signs for suspecting AEs. The aim of this study was to know the sensitivity of this tool adapted to a pediatric emergency department in a tertiary referral hospital. Patients and methodology: 29 suitable triggers were selected. In total, we studied 140 randomized patients seen in the emergency room between 1 January and 31 July 2015. Results: 48 triggers were seen in 38 of the 140 clinical files. AEs were detected in 9 histories (one with 2 triggers), almost 21% of medical records that include triggers. The most frequently detected and associated with a higher percentage of AEs was «readmission for the same reason in less than 72 hours after hospital discharge» followed by «inadequate drug dosage». Conclusions: The trigger tools have not demonstrated profitability for screening of AEs in our hospital. The trigger «readmission for the same reason within 72 hours» seems to be more sensitive to detect potential AEs. Therefore, it would be reasonable to assess the records in which it appears (AU)