La voz de paciente: trazos para el desarrollo futuro / The patient's voice: outlines for future development

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Factores determinantes y coste económico del absentismo de pacientes en consultas externas / Determinants and economic cost of patient absenteeism in outpatient appointments

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Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department / Discrepancias sobre la calidad percibida entre los profesionales y los pacientes de un servicio de medicina nuclear

Purpose: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). Material and Methods: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as 'conformity' or 'non-conformity.' Results: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen’s Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). Conclusion: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients (AU)

Objetivo: Evaluar las discrepancias entre los profesionales y los pacientes de un Servicio de Medicina Nuclear sobre la calidad percibida. Material y métodos: Se realizó un estudio transversal utilizando 2 tipos de cuestionarios: un cuestionario validado para explorar experiencias y satisfacción de los pacientes y un cuestionario adaptado para evaluar la percepción de los profesionales. Ambos cuestionarios constaron de 25 preguntas categóricas (calidad de servicio), 2 con escala de Likert (satisfacción y recomendación) y una pregunta abierta. Se incluyeron 6 variables sociodemográficas (pacientes) y una sobre ámbito laboral (profesionales). Las preguntas categóricas fueron clasificadas como 'conformidad' o 'no conformidad'. Resultados: La tasa de respuesta fue del 36,7% para los pacientes y del 100% para los profesionales. La satisfacción alcanzó una media de 9 puntos para los pacientes y de 6,9 para los profesionales. La media de no-confomidades por persona fue de 2,8 para el grupo de pacientes y de 8,7 para el de profesionales. El valor Kappa de Cohen fue de 0,112 indicando un pobre acuerdo a la hora de clasificar los ítems en punto fuertes o áreas de mejora. De los 25 ítems, los pacientes y los profesionales coincidieron en 12 (48%). Conclusión: El grado de acuerdo entre los pacientes y los profesionales sobre la percepción de la calidad ofrecida fue bajo. Los pacientes puntuaron mejor la calidad ofrecida que los profesionales. Estos instrumentos son útiles para ayudar a las organizaciones sanitarias a detectar áreas de mejora y mejorar la calidad de servicio que se ofrece a los pacientes (AU)

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department.

PURPOSE: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as "conformity" or "non-conformity." RESULTS: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen's Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). CONCLUSION: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients.

The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study.

BACKGROUND: Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. METHODS: A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. RESULTS: Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). CONCLUSION: The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully.

Personalización del nivel de referencia: patrón oro para evaluar la calidad de servicio percibida / Personalizing the reference level: gold standard to evaluate the quality of service perceived

Objetivo: Conocer el punto de corte a partir del cual los clientes internos del servicio de medicina nuclear (MN) consideran que la calidad de servicio es buena (punto de corte personalizado). Material y método: Se realizó una encuesta a los profesionales que hubieran solicitado al menos 5 pruebas al servicio de medicina nuclear. Contestaron 71 médicos (tasa de respuesta del 30%). Se añadió al cuestionario una pregunta para que el usuario estableciera el punto de corte a partir del cual el encuestado considera que la calidad de servicio es buena. Se compararon las no conformidades, las áreas de mejora y los puntos fuertes de las 6 preguntas que medían la calidad de servicio (escala Likert de 0 al 10) con 2 dinteles de referencia: el punto de corte personalizado y el que propuso a priori el propio servicio. Test estadísticos: binomial y t de Student para datos pareados. Resultados: El servicio propuso el valor de 7 como punto de corte, mientras que el 68,1% de los encuestados propuso un valor superior a 7 puntos (media 7,9 puntos). Los 6 elementos de calidad percibida fueron considerados puntos fuertes con el punto de corte propuesto por el servicio de MN, mientras que fueron 3 los detectados con el punto de corte personalizado. El 13% de las valoraciones fueron no conformes con el punto de corte del servicio frente al 19,2% con el punto de corte personalizado, siendo las diferencias estadísticamente significativas (diferencia 6,44%; IC 95%: 0,83-12,06). Conclusiones: La imagen final de la calidad percibida por los clientes internos de un servicio es diferente si se utiliza el punto de corte que establece el servicio frente al que indica el propio individuo que responde al cuestionario (AU)

Objective: To know the cut off point at which in-house Nuclear Medicine Department (MND) customers consider that the quality of service is good (personalized cutoff). Material and method: We conducted a survey of the professionals who had requested at least 5 tests to the Nuclear Medicine Department. A total of 71 doctors responded (response rate: 30%). A question was added to the questionnaire for the user to establish a cutoff point for which they would consider the quality of service as good. The quality non-conformities, areas of improvement and strong points of the six questions measuring the quality of service (Likert scale 0 to 10) were compared with two different thresholds: personalized cutoff and one proposed by the service itself a priori. Test statistics: binomial and Student's t test for paired data. Results: A cutoff value of 7 was proposed by the service as a reference while 68.1% of respondents suggested a cutoff above 7 points (mean 7.9 points). The 6 elements of perceived quality were considered strong points with the cutoff proposed by the MND, while there were 3 detected with the personalized threshold. Thirteen percent of the answers were nonconformities with the service cutoff versus 19.2% with the personalized one, the differences being statistically significant (difference 95% CI 6.44%: 0.83-12.06). Conclusions: The final image of the perceived quality of an in-house customer is different when using the cutoff established by the Department versus the personalized cutoff given by the respondent (AU)

[Personalizing the reference level: gold standard to evaluate the quality of service perceived]. / Personalización del nivel de referencia: patrón oro para evaluar la calidad de servicio percibida.

OBJECTIVE: To know the cutoff point at which in-house Nuclear Medicine Department (MND) customers consider that the quality of service is good (personalized cutoff). MATERIAL AND METHOD: We conducted a survey of the professionals who had requested at least 5 tests to the Nuclear Medicine Department. A total of 71 doctors responded (response rate: 30%). A question was added to the questionnaire for the user to establish a cutoff point for which they would consider the quality of service as good. The quality non-conformities, areas of improvement and strong points of the six questions measuring the quality of service (Likert scale 0 to 10) were compared with two different thresholds: personalized cutoff and one proposed by the service itself a priori. Test statistics: binomial and Student's t-test for paired data. RESULTS: A cutoff value of 7 was proposed by the service as a reference while 68.1% of respondents suggested a cutoff above 7 points (mean 7.9 points). The 6 elements of perceived quality were considered strong points with the cutoff proposed by the MND, while there were 3 detected with the personalized threshold. Thirteen percent of the answers were nonconformities with the service cutoff versus 19.2% with the personalized one, the differences being statistically significant (difference 95% CI 6.44%:0,83-12.06). CONCLUSIONS: The final image of the perceived quality of an in-house customer is different when using the cutoff established by the Department versus the personalized cutoff given by the respondent.

Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria / Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera

Objetivo. Determinar el porcentaje de identificación global del ganglio centinela (GC) en el cáncer de mama, la evolución cronológica de este parámetro y la influencia de la introducción de una gammacámara portátil. Material y métodos. Estudio retrospectivo a partir de una base de datos prospectiva de 754 pacientes a las que se realizó biopsia selectiva del GC de forma consecutiva entre enero de 2003 y diciembre de 2011. La técnica fue mixta en periodo inicial y posteriormente con radiotrazador administrado intra-peritumoralmente. Hasta octubre de 2009 la exéresis del GC fue guiada por sonda y a partir de esta fecha se introdujo una gammacámara portátil para la detección intraoperatoria. Resultados. Se ha biopsiado el GC en 725 de 754 pacientes, siendo por tanto la eficacia global del 96,2%. Según el año de intervención quirúrgica los porcentajes de identificación han sido del 93,5% en 2003, del 88,7% en 2004, del 94,3% en 2005, del 95,7% en 2006, del 93,3% en 2007, del 98,8% en 2008, del 97,1% en 2009 y del 99,1% en 2010 y 2011. Existe una diferencia de proporciones entre el porcentaje de identificación antes y después de la incorporación de la gammacámara portátil del 4,6% que es estadísticamente significativa (IC 95% de la diferencia 2-7,2% con una p asociada de 0,0037). Conclusiones. El porcentaje de identificación global se halla por encima del nivel recomendado por las directrices actuales. Cronológicamente se constata elevación de este parámetro a lo largo del periodo estudiado. Los datos apuntan a que la incorporación de una gammacámara portátil ha tenido un papel en ello (AU)

Aim. To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. Material and methods. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. Results. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2–7.2%, P = 0.0037). Conclusions. The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role (AU)

[Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. / Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria.

AIM: To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS: A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS: The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS: The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.

[Quality of the information supplied to patients by outpatient clinical units through multilevel model analysis]. / Análisis de la calidad de la información proporcionada a los pacientes por parte de unidades clínicas especializadas ambulatorias mediante análisis po.

BACKGROUND: The influence of the information received by patients on their satisfaction is of great importance since, amongst other aspects, it can improve patients' adherence to treatment and contribute to improving their state of health. The study aimed to determine, on the basis of satisfaction questionnaires, the percentage of variability in patients' perception of the information received concerning way of life and medicines, attributed to the following levels: patient, clinical unit and specialisation. It also aimed to identify the variables that influence the results. METHODS: Telephone interviews were conducted with 6,922 patients treated in outpatient units in the Navarre Health Service in the year 2005 (rate of reply, 92.4%). An evaluation was made of whether the patients had received medical prescription and information on way of life and, where affirmative, their evaluation of the quality of this information. Ninety-four outpatient clinics and 34 medical specialisations were analysed. A hierarchical statistical analysis at three levels was made. RESULTS: In the items studied, the variability explained by clinical unit and medical specialisation oscillated between 0 and 12.6%, and explained by the patient between 87.4 and 99.3%. CONCLUSIONS: Variability was detected in the behaviour of the different clinical units in relation to medical prescription and information provided on way of life. However, the greater part of the variability was localised at the "patient" level.