Estudio de percepción de seguridad en pacientes aislados y no aislados en un hospital de agudos y análisis de concordancia con su identificación por los profesionales / Study of perception of security in isolated and non-isolated patients in an acute hospital and concordance analysis with their identification by the professionals

Objetivo: Evaluar la percepción del paciente sobre la ocurrencia de incidentes relacionados con la seguridad (IRS) y eventosadversos (EA) en pacientes sometidos a precauciones de transmisión (pacientes aislados) y pacientes no aislados durante suingreso hospitalario y compararlo con los identificados por los profesionales sanitarios en la revisión de las historias clínicas en unhospital público universitario de agudos de la provincia de Alicante.Metodología: Estudio transversal mediante encuesta telefónica a pacientes aislados y no aislados con cuestionario validado depercepción de seguridad sobre la ocurrencia de IRS y EA y posterior análisis de concordancia mediante coeficiente Kappa con losidentificados por el personal sanitario en la revisión de historias clínicas.Resultados: Los pacientes aislados respecto a los no aislados, manifestaron haber tenido menos complicaciones médicas poralguna medicación y estas eran poco graves. Por el contrario, manifestaron tener algo más de complicaciones médicas porintervenciones quirúrgicas y ser poco graves. Finalmente, opinaron haber padecido más eventos adversos, respecto a los noaislados. Las diferencias no fueron estadísticamente significativas. En los resultados del índice de concordancia (índice Kappa),de identificación de EA de los pacientes durante su ingreso, y los identificados por los profesionales sanitarios en la revisión de lashistorias clínicas, se observó una fuerza de concordancia leve (Kappa= 0,061).Discusión: Los resultados de nuestro estudio pueden estar influenciados por una escasa información a los pacientes sobre suproceso clínico (diagnóstico, tratamientos y efectos adversos, etc...), esto podría ser la causa del bajo nivel de detección porlos pacientes de los incidentes relacionados con la seguridad que hayan podido suceder durante su ingreso hospitalario...(AU)

Objective: To evaluate the perception of the patient about the occurrences of IRS and AE in patients subjected to transmissionprecautions (isolated patients) and non-isolated patients during their hospital admission and compare it with those identified bythe health professionals in the review of the medical records in a public university hospital for acute care in the province of Alicante.Methodology: Cross-sectional study using a telephone survey in isolated and non-isolated patients with a validated questionnaire in the perception of safety on the occurrence of IRS and AEs and subsequent concordance analysis using the Kappa coefficient withthe identifiers by the health personnel in the review of medical records.Results: The isolated patients compared to the non-isolated ones, stated that they had fewer medical complications due to anymedication and these were not serious. On the contrary, they stated that they had slightly more medical complications fromsurgical interventions and that they were not very serious. Finally, they thought they had suffered more adverse events, comparedto those not isolated. The differences were not statistically significant. In the results of the concordance index (Kappa index), forthe identification of AEs of the patients during their admission, and those identified by the health professionals in the review of themedical records, a slight strength of concordance was discovered (Kappa= 0.061).Discussion: The results of our study may be influenced by insufficient information given to patients about their clinical process(diagnosis, treatments and adverse effects, etc...), this could be the cause of the low level of detection by patients of incidentsrelated to the security that may have happened during their hospital admission...(AU)

[Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013]. / Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013.

OBJECTIVE: To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. METHODS: This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. RESULTS: We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient's stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). CONCLUSIONS: The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event.

[Identification of adverse events in hospitalised influenza patients]. / Identificación de eventos adversos en pacientes hospitalizados por gripe.

OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

Evaluación del estudio de contactos de tuberculosis en el Departamento de Salud 17 de Alicante / Assessment of tuberculosis contact tracing in the 17th health area in Alicante

Objetivo: Evaluar el estudio de contactos (EC) de tuberculosis realizado en nuestro servicio y analizar la demora en el diagnóstico y en la notificación de los casos de tuberculosis y el retraso en el inicio del EC. Material y métodos: Se realizó un estudio observacional retrospectivo de los casos índices de tuberculosis y sus contactos declarados, además de la adecuación del manejo de los contactos estudiados, y se calculó la demora en el diagnóstico y la notificación de los casos de tuberculosis y la demora en el inicio del estudio de contactos. Resultados: La tasa global de tuberculosis encontrada fue de 10,91 por 100.000 habitantes durante el total de años de estudio. Se identificaron 128 casos de tuberculosis y 635 contactos. Para todos los casos de tuberculosis, la mediana de la demora diagnóstica total fue de 45 días, de la demora en la declaración de tres días y de la demora en el inicio del estudio de contactos de 9,5 días. Entre los contactos evaluados se diagnosticaron ocho nuevos casos de tuberculosis. En el 94,5% de los contactos estudiados el manejo fue adecuado. Conclusión: El manejo de los contactos de tuberculosis fue en su mayor parte adecuado. La demora diagnóstica para los casos de tuberculosis fue elevada, mientras que el retraso en la notificación de los casos de tuberculosis y en el inicio del estudio de contactos, estuvieron en límites normales (AU)

Objective: To assess the tuberculosis (TB) contact investigations conducted in our Department and to analyze the delay in diagnosis and reporting of TB cases and the delay in starting the contacts investigations. Methods: We carried out a retrospective observational study of the reported tuberculosis index cases and their contacts. We analyzed the adequacy of management of contacts investigations and calculated the delay in diagnosis and reporting of TB cases in addition to the delay in the onset of contacts study. Results: The overall rate of tuberculosis found was 10.91 per 100,000 inhabitants during the total years of study. We identified 635 contacts of 128 tuberculosis cases. The median from total diagnostic delay was 45 days, from delay in the notification three days and from delay in the start of contact investigations 9,5 days for all TB cases. Among the assessed contacts were diagnosed eight new TB cases during contact investigations. In the 94.5% of studied contacts the management was adequate. Conclusion: The management of TB contacts was mostly adequate. The delay in diagnosis for tuberculosis cases was elevated. The delay in the notification of tuberculosis cases and the delay in the start of contacts investigations were found within normal limits (AU)

Estudio de eventos adversos en sanidad privada. Proyecto Confianza de seguridad del paciente / Study of adverse events in private healthcare. Confidence project for patient safety

Objetivos. Investigar e identificar áreas y problemas prioritarios de la seguridad del paciente y analizar las características de los pacientes y de la asistencia que se asocian a la aparición de eventos adversos (EA). Método. Estudio de cohortes retrospectivo en el que para identificar los EA se revisó la historia clínica (HC) de los pacientes hospitalizados en ocho centros comprometidos con el proyecto. Se recogió información de todos los pacientes atendidos entre el 15 y el 30 de noviembre de 2009. Resultados. De los 927 pacientes, en 40 pacientes se detectó alguna lesión, y en 23 de ellos la asistencia sanitaria estaba relacionada. Así, el porcentaje de pacientes con algún EA relacionado con la asistencia sanitaria fue del 2,48% (intervalo de confianza del 95%, 1,43%-3,54%). La edad, la comorbilidad y los dispositivos invasivos explican la aparición de EA. Se consideró leves al 33,3% (8 EA), moderados al 33,3% (8) y graves al 33,3% (8). Se consideró evitable al 50% de los EA. Conclusiones. La frecuencia hallada de EA es menor, posiblemente debido al diseño del estudio y la idiosincrasia de los pacientes atendidos: edad, comorbilidad y uso de dispositivos invasivos. Los EA encontrados presentan impacto y evitabilidad parecidos a los detectados en el sector público(AU)

Objectives. To investigate and identify priority areas and issues of patient safety and analyse which patient and health care characteristics are related to Adverse Events (AE). Methods. Retrospective cohort study to identify AE reviewing medical records of in-patients. Information was obtained from all patients attended between 15 and 30 November 2009 in eight facilities committed to the project. Results. Of the 927 patients, 40 patients had any injury, of which 23 were related to healthcare. Thus, the percentage of patients with any AE associated with health care was 2.48% (95%CI, 1.43%-3.54%). Age, comorbidity and use of invasive devices explained the occurrence of an AE. Of these, 33.3% (8 AE) were considered slight, 33.3% (8) moderate and 33.3% (8) severe. Half (50%) of AE were considered preventable. Conclusions. The frequency of AE found was low, possibly due to study design and the idiosyncrasy of the patients: age, comorbidity and use of invasive devices. The AE found have a similar impact and preventability as those identified in public sector(AU)

[Study of adverse events in private healthcare. Confidence project for patient safety]. / Estudio de eventos adversos en sanidad privada. Proyecto Confianza de seguridad del paciente.

OBJECTIVES: To investigate and identify priority areas and issues of patient safety and analyse which patient and health care characteristics are related to Adverse Events (AE). METHODS: Retrospective cohort study to identify AE reviewing medical records of in-patients. Information was obtained from all patients attended between 15 and 30 November 2009 in eight facilities committed to the project. RESULTS: Of the 927 patients, 40 patients had any injury, of which 23 were related to healthcare. Thus, the percentage of patients with any AE associated with health care was 2.48% (95%CI, 1.43%-3.54%). Age, comorbidity and use of invasive devices explained the occurrence of an AE. Of these, 33.3% (8 AE) were considered slight, 33.3% (8) moderate and 33.3% (8) severe. Half (50%) of AE were considered preventable. CONCLUSIONS: The frequency of AE found was low, possibly due to study design and the idiosyncrasy of the patients: age, comorbidity and use of invasive devices. The AE found have a similar impact and preventability as those identified in public sector.

Revisión sistemática de la literatura acerca de la seguridad de los pacientes hospitalizados en servicios médicos / Systematic literature review on patient safety in medical departments

La seguridad del paciente es un tema de alto interés. En todos los escenarios de la atención sanitaria existe riesgo de eventos adversos (EA) y la determinación de su incidencia se ha descrito prácticamente en todas las especialidades médicas. Objetivo. Conocer la incidencia reportada en la literatura médica de eventos adversos en servicios médicos. Diseño y metodología. Búsqueda exhaustiva en bases de datos biomédicas con diversas estrategias, en revista de impacto y en artículos relacionados. Resultados. Se revisaron 17.437 entradas. Después de la lectura de resúmenes y artículos, y de aplicar criterios de inclusión y exclusión previamente definidos, se seleccionaron 10 artículos que registraban la incidencia de eventos adversos en servicios médicos. La mayoría de los estudios correspondió a cohortes históricas, con identificación de EA por cribado y análisis de registro clínico por revisión estructurada. Ninguno de ellos tenía como objetivo final notificar la incidencia de eventos adversos o caracterizarlos. La incidencia reportada en servicios médicos fue de 3,6% hasta 21,7%. Las definiciones de eventos adversos y las formas de detección fueron similares pero las pocas diferencias encontradas pusieron en riesgo la comparabilidad. Conclusión. No hay estudios dirigidos a la cuantificación de los eventos adversos en servicios médicos ni a su caracterización. Ninguno define lo que es un servicio médico, aunque los resultados que notifican están dentro de los valores publicados para los sistemas sanitarios. Es necesaria una mayor investigación en este área(AU)

Patient safety is an issue of interest. All scenarios of health care have a risk of adverse events (AE) and determination of its incidence has been reported in virtually all medical specialties. Objective. To determine the incidence reported in the medical literature of adverse events in medical departments. Design and methods. An exhaustive search of biomedical databases using different strategies, search in high impact journals and a manual search of related articles. Results. We reviewed 17,437 entries. After reading the abstracts and articles, and applying previously defined inclusion and exclusion criteria, we selected 10 articles that reported the incidence of adverse events in medical departments. Most studies corresponded to a historical cohort, had used an AE screening to identify high risk patients, and had used a structured review to check clinical records. None of them had as their ultimate objective to report on the impact of adverse events or characterize them. The incidence reported in medical departments ranged from 3.6% to 21.7%. The definitions of adverse events and forms of detection were similar; however the few differences put the comparability at risk. Conclusion. No studies were aimed at quantifying or characterising the adverse events in health care. None of them defined what constitutes a medical department, although the results reported are within the published values for health systems. Further research is needed in this area(AU)

Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos / Factors that contribute to health care associated infections: how to prevent them

Objetivo. Identificar las características de los pacientes y de la asistencia asociadas con la infección relacionada con la atención sanitaria (IRAS) y determinar si existen diferencias entre las evitables (IRASE) y las que no lo son. Método. Estudio de cohortes retrospectivo basado en tres estudios españoles de eventos adversos ligados a la hospitalización. Se revisaron las historias clínicas valorando si la asistencia era la causante de IRAS e IRASE. Resultados. El 2,3% de los pacientes del estudio presentó una o más IRAS. El 60,2% fueron IRASE. Los que presentaron IRAS eran mayores que el resto, y presentaron mayor número de factores de riesgo intrínseco y extrínseco. Se observaron diferencias entre los pacientes que presentaron IRAS o IRASE en la presencia de algún factor de riesgo intrínseco. Los factores que mejor explicaron IRAS fueron distintos para cada una de las localizaciones más frecuentes. En el caso de las IRAS: catéter urinario (OR=2,4), catéter venoso central (OR=1,8) y sonda nasogástrica (OR=1,9); servicio de ingreso quirúrgico (OR=1,6) y estancia hospitalaria >1 semana (OR=7,5). Las estrategias identificadas para evitar IRAS fueron: técnica aséptica adecuada (25,5%), correcto seguimiento de los protocolos de sondaje vesical (20%) y de los cuidados y la valoración de vulnerabilidad de los pacientes (16,5%). Conclusiones. Entre los pacientes que presentaron IRAS y los que no presentaron se encontraron características diferenciadas. La evitabilidad es un juicio de valor independiente del de causalidad y se relaciona con si se han aplicado de forma correcta o no los protocolos. Identificar estos puntos en la asistencia permite establecer estrategias de mejora de la asistencia(AU)

Objective. To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. Method. A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. Results. A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). Conclusion. Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care(AU)

[Systematic literature review on patient safety in medical departments]. / Revisión sistemática de la literatura acerca de la seguridad de los pacientes hospitalizados en servicios médicos.

UNLABELLED: Patient safety is an issue of interest. All scenarios of health care have a risk of adverse events (AE) and determination of its incidence has been reported in virtually all medical specialties. OBJECTIVE: To determine the incidence reported in the medical literature of adverse events in medical departments. DESIGN AND METHODS: An exhaustive search of biomedical databases using different strategies, search in high impact journals and a manual search of related articles. RESULTS: We reviewed 17,437 entries. After reading the abstracts and articles, and applying previously defined inclusion and exclusion criteria, we selected 10 articles that reported the incidence of adverse events in medical departments. Most studies corresponded to a historical cohort, had used an AE screening to identify high risk patients, and had used a structured review to check clinical records. None of them had as their ultimate objective to report on the impact of adverse events or characterize them. The incidence reported in medical departments ranged from 3.6% to 21.7%. The definitions of adverse events and forms of detection were similar; however the few differences put the comparability at risk. CONCLUSION: No studies were aimed at quantifying or characterising the adverse events in health care. None of them defined what constitutes a medical department, although the results reported are within the published values for health systems. Further research is needed in this area.

[Factors that contribute to health care associated infections: how to prevent them]. / Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos.

OBJECTIVE: To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. METHOD: A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. RESULTS: A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). CONCLUSION: Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care.