[Practical considerations for implementing health outcomes measurement projects within a healthcare organization: Delphi Expert Consensus Study]. / Consideraciones prácticas para la implementación de proyectos de medición de resultados en salud en una organización sanitaria: Estudio Delphi de consenso de expertos.

INTRODUCTION: Measuring health outcomes and costs per patient is an essential element of value-based healthcare (VBHC). The aim of the study was to generate expert consensus on the activities required to implement it. METHODS: A two-round modified Delphi study with healthcare professionals, quality and clinical management methodologists and managers with academic and/or practical experience in outcome measurement projects. A median equal to or greater than 4 and a relative interquartile range (RIQR) equal to or greater than 25% were established as consensus criteria. RESULTS: Consensus was obtained on 91% of the items (N=74/81). In terms of feasibility, the items that received the highest score and consensus were the existence of data protection guarantees (median=5; mean=4.8; RIQR=0%), the vision and motivation of healthcare professionals (median=5; mean=4.7; RIQR=20%), the existence and availability of ICT tools (or systems) for data recording (median=5; mean=4.5; RIQR=20%), and having sufficient funding to undertake the project (median=5; mean=4.2; RIQR=20%). The most highly rated factors adding complexity were the number of units or departments involved in the care process for the clinical condition (median=5; mean=4.4; RIQR=20%), having an accepted set of monitoring indicators for the condition (median=5; mean=4.4; RIQR=20%), and the involvement of several levels of care in the project (median=5; mean=4.3; RIQR=20%). CONCLUSIONS: We describe practical aspects for the application of systematic outcomes measurement in routine clinical practice. These results can serve as a tool for prioritising, sizing, resource planning, and estimating implementation costs.

Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19 / Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period

OBJETIVO: Diseñar un protocolo asistencial para reiniciar la actividad quirúrgica programada en un servicio de Urología de un hospital de tercer nivel de la Comunidad de Madrid, de manera segura para nuestros pacientes y profesionales en el contexto de la epidemia por coronavirus SARS-CoV-2. MATERIAL Y MÉTODOS: Constituimos un grupo multidisciplinar que se encargó de analizar las diferentes recomendaciones de la literatura, organizaciones sanitarias nacionales e internacionales y sociedades científicas, así como de su aplicación a nuestro medio. Una vez reiniciada la cirugía programada, se está llevando a cabo un seguimiento de los pacientes intervenidos en cuanto a complicaciones relacionadas con COVID-19. RESULTADOS: Desde el reinicio de la actividad quirúrgica se han programado 19 pacientes, de los cuales 2 han sido suspendidos por presentar COVID-19, diagnosticado uno por PCR positiva para SARS-CoV-2, y otro por alteraciones analíticas y radiológicas compatibles con esta infección. En el seguimiento realizado no se han detectado complicaciones relacionadas con COVID-19, con una mediana de seguimiento de 10 días (4-14 días). CONCLUSIONES: Resultados preliminares indican que el protocolo diseñado para asegurar la correcta aplicación de medidas de prevención de transmisión de la infección por coronavirus está siendo seguro y efectivo

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to covid-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective

[Detection of adverse events in thyroid and parathyroid surgery using trigger tool and Minimum Basic Data Set (MBDS)]. / Detección de eventos adversos en la cirugía tiroidea y paratiroidea utilizando la herramienta trigger y el Conjunto Mínimo de Datos Básicos (CMBD).

OBJECTIVES: To compare the ability of the trigger tool) and the Minimum Basic Data Set (MBDS) in detecting adverse events (AE) in hospitalized surgical patients with thyroid and parathyroid disease. METHODS: A descriptive, cross-sectional observational study, retrospective and cross-sectional study was conducted from May 2014 to April 2015 analysing retrospectively data on of patients submitted to thyroidectomy and parathyroidectomy in order to detect AE through the identification of triggers (an event often associated to an AE) and the MBDS. triggers and AE were located by systematic review of clinical documentation. The MBDS was got from the data base. Once an AE was detected, it was characterized. RESULTS: 203 AE were identified in 251 patients, being the 90.04% detected by trigger tool and 10.34% by MBDS. 126 patients had at least one AE (50.2%). Without the cases in which uncontrolled pain was the only AE, the percentage of patients that suffering AE was 38.65%. 187 AE were considered preventable and 16 AE were considered unpreventable. The trigger tool and the MBDS demonstrated a sensitivity of 91.27 and 13.49%, a specificity of 4.8 and 100%, a positive predictive value of 49,15 and 100%, and a negative predictive value of 35.29 and 53.42%, respectively. The triggers with more predictive power in AE detection were «antiemetic administration¼ and «calcium administration¼. CONCLUSIONS: Trigger tool shows higher sensitivity for detecting AE than the MBDS. All the detected AE were considered low severity and most of them were preventable.

Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period. / Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19.

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to COVID-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective.

Comparación de la herramienta Trigger con el conjunto mínimo básico de datos (CMBD) para la detección de eventos adversos en cirugía general / Comparison of the 'Trigger' tool with the minimum basic data set for detecting adverse events in general surgery

Introducción. La cirugía supone una de las tareas de alto riesgo para la aparición de eventos adversos. El objetivo principal de este estudio fue comparar la efectividad de la herramienta Trigger frente al registro de altas de hospitales del Sistema Nacional de Salud en la detección de eventos adversos (EA) en pacientes hospitalizados en cirugía general y sometidos a intervención quirúrgica. Material y métodos. Estudio retrospectivo observacional y descriptivo sobre pacientes ingresados en cirugía general de un hospital de tercer nivel, sometidos a intervención quirúrgica durante el año 2012. La identificación de eventos adversos se llevó a cabo mediante una revisión de historias clínicas empleando una adaptación de la metodología Global Trigger Tool y una revisión del registro del conjunto mínimo básico de datos (CMBD) de los mismos pacientes. Una vez identificados los EA se les asignó una categoría de daño y se determinó el grado en que estos podrían haber sido evitados. Para determinar el poder discriminatorio de las herramientas se usaron el área bajo la curva (ROC). Para comparar ambas herramientas se realizó la prueba estadística Hanley y McNei. Resultados. La herramienta Trigger detectó el 89,9% de todos los EA, mientras que el registro CMBD detectó el 28,4% de ellos. La herramienta Trigger obtuvo más información sobre la naturaleza y características de los EA. La prevalencia de EA fue de 36,8%. El área bajo la curva de la herramienta Trigger fue de 0,89, el de la herramienta basada en el registro de CMBD fue de 0,66. Las diferencias mostradas fueron estadísticamente significativas (p<0,001). Conclusiones. La herramienta Trigger detecta 3 veces más eventos adversos que el registro CMBD. La prevalencia de eventos adversos en cirugía general fue más alta de la estimada en otros estudios (AU)

Introduction. Surgery is a high risk for the occurrence of adverse events (AE). The main objective of this study is to compare the effectiveness of the Trigger tool with the Hospital National Health System registration of Discharges, the minimum basic data set (MBDS), in detecting adverse events in patients admitted to General Surgery and undergoing surgery. Material and methods. Observational and descriptive retrospective study of patients admitted to general surgery of a tertiary hospital, and undergoing surgery in 2012. The identification of adverse events was made by reviewing the medical records, using an adaptation of "Global Trigger Tool" ethodology, as well as the (MBDS) registered on the same patients. Once the AE were identified, they were classified according to damage and to the extent to which these could have been avoided. The area under the curve (ROC) were used to determine the discriminatory power of the tools. The Hanley and Mcneil test was used to compare both tools. Results. AE prevalence was 36.8%. The TT detected 89.9% of all AE, while the MBDS detected 28.48%. The TT provides more information on the nature and characteristics of the AE. The area under the curve was 0.89 for the TT and 0.66 for the MBDS. These differences were statistically significant (P<.001). Conclusions. The Trigger tool detects three times more adverse events than the MBDS registry. The prevalence of adverse events in General Surgery is higher than that estimated in other studies (AU)

[Comparison of the "Trigger" tool with the minimum basic data set for detecting adverse events in general surgery]. / Comparación de la herramienta Trigger con el conjunto mínimo básico de datos (CMBD) para la detección de eventos adversos en cirugía general.

INTRODUCTION: Surgery is a high risk for the occurrence of adverse events (AE). The main objective of this study is to compare the effectiveness of the Trigger tool with the Hospital National Health System registration of Discharges, the minimum basic data set (MBDS), in detecting adverse events in patients admitted to General Surgery and undergoing surgery. MATERIAL AND METHODS: Observational and descriptive retrospective study of patients admitted to general surgery of a tertiary hospital, and undergoing surgery in 2012. The identification of adverse events was made by reviewing the medical records, using an adaptation of "Global Trigger Tool" methodology, as well as the (MBDS) registered on the same patients. Once the AE were identified, they were classified according to damage and to the extent to which these could have been avoided. The area under the curve (ROC) were used to determine the discriminatory power of the tools. The Hanley and Mcneil test was used to compare both tools. RESULTS: AE prevalence was 36.8%. The TT detected 89.9% of all AE, while the MBDS detected 28.48%. The TT provides more information on the nature and characteristics of the AE. The area under the curve was 0.89 for the TT and 0.66 for the MBDS. These differences were statistically significant (P<.001). CONCLUSIONS: The Trigger tool detects three times more adverse events than the MBDS registry. The prevalence of adverse events in General Surgery is higher than that estimated in other studies.

Detección de eventos adversos en pacientes adultos hospitalizados mediante el método Global Trigger Tool / Detection of adverse events in hospitalized adult patients by using the Global Trigger Tool method

Objetivos. Identificar y caracterizar los eventos adversos (EA) en el servicio de Medicina Interna de un hospital comarcal mediante el uso de la herramienta Global Trigger Tool (GTT) ampliada, analizando su validez diagnóstica. Material y métodos. Estudio observacional, analítico, descriptivo y retrospectivo de altas de pacientes en 2013 en un servicio de Medicina Interna para la detección de EA mediante la identificación de triggers (evento relacionado frecuentemente con EA). Los triggers y los EA se localizaron mediante la revisión sistemática de la documentación clínica. Una vez detectado el EA, se procedió a su caracterización. Resultados. Se detectaron 149 EA en 291 altas durante el año 2013, de los cuales el 75,3% fueron puestos en evidencia directamente por la herramienta, mientras que el resto no tuvieron asociado un trigger. El porcentaje de altas que presentó al menos un EA fue del 35,4%. El EA más frecuentemente hallado fue la úlcera por presión (12%), seguido de delirium, estreñimiento, infección respiratoria nosocomial y alteración del nivel de conciencia por fármacos. El 47,6% de los EA estuvieron relacionados con el uso de fármacos. Se consideraron evitables el 32,2% de EA. La herramienta demostró tener una sensibilidad del 91,3% (IC 95%: 88,9-93,2) y una especificidad del 32,5% (IC 95%: 29,9-35,1). Presentaron un valor predictivo positivo del 42,5% (IC 95%: 40,1-45,1) y un valor predictivo negativo del 87,1% (IC 95%: 83,8-89,9). Conclusiones. La herramienta empleada en este trabajo es válida, útil y reproducible para la detección de EA. Asimismo, sirve para determinar tasas de daño y observar su evolución en el tiempo. En este estudio se ha hallado una frecuencia elevada tanto de EA como de eventos evitables (AU)

Objectives. To identify and characterize adverse events (AE) in an Internal Medicine Department of a district hospital using an extension of the Global Trigger Tool (GTT), analyzing the diagnostic validity of the tool. Methods. An observational, analytical, descriptive and retrospective study was conducted on 2013 clinical charts from an Internal Medicine Department in order to detect EA through the identification of ‘triggers’ (an event often related to an AE). The ‘triggers’ and AE were located by systematic review of clinical documentation. The AE were characterized after they were identified. Results. A total of149 AE were detected in 291 clinical charts during 2013, of which 75.3% were detected directly by the tool, while the rest were not associated with a trigger. The percentage of charts that had at least one AE was 35.4%. The most frequent AE found was pressure ulcer (12%), followed by delirium, constipation, nosocomial respiratory infection and altered level of consciousness by drugs. Almost half (47.6%) of the AE were related to drug use, and 32.2% of all AE were considered preventable. The tool demonstrated a sensitivity of 91.3% (95% CI: 88.9-93.2) and a specificity of 32.5% (95% CI: 29.9-35.1). It had a positive predictive value of 42.5% (95% CI: 40.1-45.1) and a negative predictive value of 87.1% (95% CI: 83.8-89.9). Conclusions. The tool used in this study is valid, useful and reproducible for the detection of AE. It also serves to determine rates of injury and to observe their progression over time. A high frequency of both AE and preventable events were observed in this study (AU)

[Detection of adverse events in hospitalized adult patients by using the Global Trigger Tool method]. / Detección de eventos adversos en pacientes adultos hospitalizados mediante el método Global TriggerTool.

OBJECTIVES: To identify and characterize adverse events (AE) in an Internal Medicine Department of a district hospital using an extension of the Global Trigger Tool (GTT), analyzing the diagnostic validity of the tool. METHODS: An observational, analytical, descriptive and retrospective study was conducted on 2013 clinical charts from an Internal Medicine Department in order to detect EA through the identification of 'triggers' (an event often related to an AE). The 'triggers' and AE were located by systematic review of clinical documentation. The AE were characterized after they were identified. RESULTS: A total of 149 AE were detected in 291 clinical charts during 2013, of which 75.3% were detected directly by the tool, while the rest were not associated with a trigger. The percentage of charts that had at least one AE was 35.4%. The most frequent AE found was pressure ulcer (12%), followed by delirium, constipation, nosocomial respiratory infection and altered level of consciousness by drugs. Almost half (47.6%) of the AE were related to drug use, and 32.2% of all AE were considered preventable. The tool demonstrated a sensitivity of 91.3% (95%CI: 88.9-93.2) and a specificity of 32.5% (95%CI: 29.9-35.1). It had a positive predictive value of 42.5% (95%CI: 40.1-45.1) and a negative predictive value of 87.1% (95%CI: 83.8-89.9). CONCLUSIONS: The tool used in this study is valid, useful and reproducible for the detection of AE. It also serves to determine rates of injury and to observe their progression over time. A high frequency of both AE and preventable events were observed in this study.

[Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain]. / Opinión sobre la organización asistencial en el ictus. Encuesta a directores médicos hospitalarios en España.

INTRODUCTION: Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself. AIM: To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004. RESULTS: Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists. CONCLUSIONS: The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients.

Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ).

INTRODUCTION: The main aim of this study was to make a Spanish adaption of the international Patient-Doctor Relationship Questionnaire (PDRQ) that assesses the quality of patient-doctor relationship in Spanish patients admitted to an Internal Medicine Service under conditions of regular clinical practice. METHOD: A total of 188 adult patients of 6 Internal Medicine physicians from a University Hospital in downtown Madrid were analyzed. Sociodemographic and clinical variables were collected and the PDRQ Spanish version questionnaire was administered. RESULTS: Results showed excellent psychometric data on reliability, factorial, and construct validity. Furthermore, based on scientific literature, criteria validity was determined, considering continuity of care as external criteria. Results ratify previous data related to positive relation between quality of doctor-patient relation and continuity of care. CONCLUSIONS: The Spanish 13 item version of the PDRQ (CREM-P in Spanish) proved to be a valid instrument for assessing the quality of patient-doctor relation in adult patients, with clinical and research value.

Opinión sobre la organización asistencial en el ictus. Encuesta a directores médicos hospitalarios en España / Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain

Introducción. La terapia del ictus ha cambiado dramáticamente. Hace 70 años no tenía tratamiento y, en la actualidad, es una urgencia médica. La conciencia de este cambio no ha llegado a muchos estamentos médicos o sanitarios ni a la sociedad. Objetivo. Evaluar las actitudes, mediante encuesta, de directores médicos y de especialistas médicos hospitalarios hacia la problemática asistencial hospitalaria del paciente con ictus. Materiales y métodos. Se desarrolló una encuesta por medio de un estudio piloto en hospitales de Madrid con subencuestas específicas para directores médicos, responsables de los servicios de neurología, neurocirugía y de las unidades de ictus. Se remitieron estas encuestas a 108 hospitales de enfermos agudos mayores de 250 camas en 2003-2004. Resultados. Sólo se analizan los resultados de la encuesta a los directores médicos. Se obtuvieron 52 encuestas de 108 hospitales. Se obtuvo información sobre varios aspectos de los pacientes con ictus: atención en la urgencia hospitalaria, ingreso en el hospital, tratamiento de rehabilitación y dotación de unidades ictus. La atención al paciente con ictus mereció una valoración por parte de los directores médicos significativamente más positiva (mejor atención al ictus) que por parte de los neurólogos hospitalarios. Conclusiones. La encuesta mostró gran carga asistencial de ictus en urgencias hospitalarias y de ingresos hospitalarios, déficit de guardias neurológicas y de capacidad para la realización de fibrinólisis y, sobre todo, de unidades de ictus. Los datos obtenidos indican que los directores médicos deberían mejorar sus actitudes sobre la asistencia al paciente con ictus (AU)

Introduction. Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself. Aim. To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004. Results. Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists. Conclusions. The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients (AU)

Validación psicométrica de la versión española del Cuestionario de Relaciones Médico-Paciente (CREM-P) / Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ)

Introducción. El principal objetivo del presente estudio fue la adaptación del instrumento internacional Patient-Doctor Relationship Questionnaire (PDRQ) que evalúa la calidad de la relación médico-paciente a una muestra española de pacientes de Medicina Interna en condiciones de práctica clínica habitual. Método. Fueron evaluados 188 pacientes de 6 médicos especialistas en Medicina Interna de un Hospital Universitario de Madrid capital. Se recogieron información clínica y sociodemográfica y fue administrada la traducción española del cuestionario PDRQ. Resultados. Los resultados indicaron niveles altos en fiabilidad, validez factorial y validez de contenido. Asimismo, a partir de los resultados obtenidos en la literatura científica se procedió al estudio de la validez criterial utilizando como criterio externo la continuidad del cuidado. Los resultados refrendan datos previos sobre la relación positiva entre calidad de la relación médico-paciente y continuidad del cuidado. Conclusiones. El cuestionario final obtenido (CREM-P )de 13 ítems se muestra como un instrumento fiable, válido y de fácil cumplimentación, diseñado para permitir la evaluación tanto en contextos clínicos como de investigación (AU)

Introduction. The main aim of this study was to make a Spanish adaption of the international Patient-Doctor Relationship Questionnaire (PDRQ) that assesses the quality of patient-doctor relationship in Spanish patients admitted to an Internal Medicine Service under conditions of regular clinical practice. Method. A total of 188 adult patients of 6 Internal Medicine physicians from a University Hospital in downtown Madrid were analyzed. Sociodemographic and clinical variables were collected and the PDRQ Spanish version questionnaire was administered. Results. Results showed excellent psychometric data on reliability, factorial, and construct validity. Furthermore, based on scientific literature, criteria validity was determined, considering continuity of care as external criteria. Results ratify previous data related to positive relation between quality of doctor-patient relation and continuity of care. Conclusions. The Spanish 13 item version of the PDRQ (CREM-P in Spanish) proved to be a valid instrument for assessing the quality of patient-doctor relation in adult patients, with clinical and research value (AU)

Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events.

OBJECTIVE: To determine the incidence and incidence density of adverse events (AEs) in Spanish hospitals (including the pre-hospitalisation period). METHOD: Retrospective cohort study. RESULTS: The incidence of patients with AEs relating directly to hospital care was 8.4% (95% CI 7.7% to 9.1%) and rose 9.3% (95% CI 8.6% to 10.1%), including those from the pre-hospitalisation period. The incidence density was 1.2 AEs per 100 patient-days (95% CI 1.1 to 1.3). The incidence of moderate and serious AEs was 5.6 AEs per 1000 patient-days (95% CI 4.9% to 6.3%). In 66.3% of AEs, additional procedures were required and in 69.9% additional treatments were required. In total 42.8% of AEs were considered as avoidable. Of the subjects with some intrinsic risk factors, 13.2% developed AEs compared with 5.2% of the subjects who had no risk factors (p<0.001), and 9.5% of the subjects who had some extrinsic risk factors developed AEs compared with 3.4% of the subjects who had not (p<0.001). Patients older than 65 years of age showed a higher frequency of AEs than those under this age (12.4% vs 5.4%, p<0.001, RR 2.5). The most frequent AEs were those associated with medication (37.4%), hospital infections of any type (25.3%) and those relating to technical problems during a procedure (25.0%). A total of 31.4% of the AEs involved an increase in the length of stay. The AEs associated with medical assistance caused 6.1 additional hospital stays by patient. CONCLUSIONS: The incidence of patients with AE related to medical assistance in Spanish hospitals was relevant and similar to those found in the studies from Canada and New Zealand that had been conducted with comparable methodology. Patient vulnerability has been identified therein as playing a major role in generating healthcare-related AEs. These and other recent results indicate the need for AEs to be considered a public health priority in Europe.

Sucesos adversos en cirugía general y de aparato digestivo en los hospitales españoles / Adverse events in general and digestive surgery departments in Spanish hospitals

Objetivo. Determinar la incidencia de pacientes con efectos adversos (EA) en los servicios de cirugía general, describir las causas inmediatas del EA, definir los evitables y conocer su impacto. Material y método. Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499 camas) y 5 de tamaño grande (500 camas o más). Pacientes ingresados, cuya hospitalización fuera superior a 24 h, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y los que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados. La incidencia de pacientes con EA fue del 10,5% (76/735), con un intervalo de confianza (IC) del 95%, 8,1%-12,5%. La presencia de factores de riesgo intrínsecos aumenta el riesgo de EA (el 14,8 frente al 7,2%; p = 0,001), y también lo hace la presencia de factores de riesgo extrínseco (el 16,2 frente al 7,0%; p < 0,001). La comorbilidad influyó en la aparición de EA (el 33,7 de EA frente al 2,2% sin comorbilidad; p < 0,001). La gravedad del EA se relacionó con el riesgo ASA (p = 0,036). El 41,7% de los EA se relacionó con la infección nosocomial; el 27,1%, con procedimientos, y el 24%, con la medicación. El 31,3% de los EA se consideraron leves; el 39,6%, moderados, y el 29,2%, graves. Un 36,5% se valoraron como evitables. El total de estancias adicionales provocadas por EA fueron de 527 (6,3 estancias adicionales por paciente), de las cuales 216 correspondieron a EA evitables. Conclusiones. Los pacientes de cirugía general y aparato digestivo tienen más riesgo de EA. Existen factores de vulnerabilidad, como son la edad, la comorbilidad y la aplicación de dispositivos externos. Una parte importante de los EA se relacionan con la infección nosocomial (especialmente infección de la herida quirúrgica) y también con el propio procedimiento. Finalmente, los EA tienen un impacto notable en el paciente y en una proporción considerable de casos pueden evitarse. El impacto sanitario, social y económico de los EA, hasta hace poco una epidemia silenciosa en nuestro país, convierte la necesidad de su estudio en una prioridad de salud pública (AU)

Objective. To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. Material and method. We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. Results. The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P<.001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P<.001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. Conclusions. Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority (AU)

[An analysis of complaints received in a Neurology Service]. / Análisis de reclamaciones en un servicio de neurología.

AIMS: To determine the number of complaints received by the Neurology Service in one year, to carry out a qualitative analysis, and to examine how they are dealt with in order to provide patients with a solution. MATERIALS AND METHODS: The work involved a retrospective study of the complaints from patients in the Neurology Service throughout the year 2004, using the information provided by the Patient Advice and Liaison Service. The following quality indicators were used to evaluate how these claims were managed: the percentage of complaints that were attended in less than 30 days after being received and the percentage of complaints that were resolved. RESULTS: Throughout the period under study a total of 183 complaints were received: 1/478 hospital admissions (0.21%), 71/43,841 medical visits (0.16%), 110/5,522 neurophysiological studies (2%) and 3 due to other reasons. It was found that 90.2% of all complaints had to do with waiting lists, 3.3% were related to dealings with staff and the rest were due to other causes. 86.3% of the complaints were resolved, 10.2% were dismissed and the others were passed on or shelved. 77.5% of the claims were attended within 30 days (quality parameter), the mean delay being 21.3 days (standard deviation: 11.3). CONCLUSIONS: Our rate of complaints is low, although improvements must be introduced both quantitatively and in their management. Practically no data has been published to date concerning these aspects of clinical management in neurology services.

Cuidados al final de la vida en la unidad de cuidados intensivos pediátrica. Revisión de la bibliografía / End-of-life care in the pediatric intensive care unit. A literature review

Introducción: En los últimos años destaca en la literatura especializada una preocupación reciente sobre las cuestiones referentes al cuidado del paciente en fase terminal dentro de la unidad de cuidados intensivos pediátrica (UCIP), prestando especial atención a la unidad familia/paciente, comunicación y muerte digna. Objetivo: Evaluar a través de la revisión bibliográfica, la experiencia y el desarrollo de los cuidados al final de la vida dentro de las UCIP, determinando qué tipo de estudios se han realizado, qué temas se han tratado y cuál ha sido la evolución en los últimos años. Material y métodos: Revisión de la literatura médica en Medline y la base de datos National Library of Medicine Gateway, utilizando las palabras claves extraídas del MeSH: "end of life", "pediatric intensive care", "critical care", "palliative care", "death", "compassionate care". El año límite inferior de la búsqueda fue 1990. Los idiomas seleccionados fueron inglés y castellano. Los criterios de inclusión fueron la relación con el tema objeto de estudio, excluyéndose aquellos artículos que no tenían abstract. Se obtuvieron trabajos adicionales a través de las referencias bibliográficas de los artículos seleccionados. Resultados: De la búsqueda inicial se obtuvieron un total de 81 artículos de los que se seleccionaron 43 por sus referencias al cuidado al final de la vida en UCI, de los cuáles 18 hacían especial referencia a la UCIP. Más de la mitad (62 %) fueron revisiones del tema y el resto, estudios de tipo descriptivo u observacional. El número de publicaciones es creciente a partir del año 1995. La mayoría de los trabajos (85 %) han sido realizados en Estados Unidos y Canadá, y se han encontrado tres referencias en España. Conclusiones: En los últimos años se han llevado a cabo varios estudios que muestran cada vez mayor sensibilización acerca de cuestiones sobre la limitación del esfuerzo terapéutico y la necesidad de mejorar los cuidados médicos y de bienestar al final de la vida en el entorno de la UCIP

Introduction: In the last few years, there has been growing concern in the literature about issues related to end-of-life care in pediatric intensive care units (PICUs), with special attention on the family/patient unit, communication, and a dignified death. Objective: To evaluate the experience and development of end-of-life care in PICUs through a literature review, by determining the type of studies that have been performed, their topics, the issues discussed, and their development in the last few years. Material and methods: Review of the medical literature in Medline and the database of the National Library of Medicine Gateway, using the key words from MeSH: "end of life", "pediatric intensive care", "critical care", "palliative care", "death", and "compassionate care". The earliest year of the search was 1990. The languages selected were English and Spanish. Inclusion criteria were the relationship with the topic to be studied, excluding articles with no abstract. Additional searches were made of references in selected articles. Results: Eighty-one articles were retrieved from the initial search. Of these, 43 were selected as the most relevant investigations in end-of-life care in ICUs and 18 placed special emphasis on the PICU. More than half of the articles (62 %) were reviews and the remaining articles were descriptive or observational studies. The number of publications increased after 1995. Most of the studies were performed in the USA or Canada and only three studies were performed in Spain. Conclusions: In the last few years, several studies have been performed that reveal increasing concern about limits to therapeutic intervention and the need to improve end-of-life care in the PICU setting

[End-of-life care in the pediatric intensive care unit. A literature review]. / Cuidados al final de la vida en la unidad de cuidados intensivos pediátrica. Revisión de la bibliografía.

INTRODUCTION: In the last few years, there has been growing concern in the literature about issues related to end-of-life care in pediatric intensive care units (PICUs), with special attention on the family/patient unit, communication, and a dignified death. OBJECTIVE: To evaluate the experience and development of end-of-life care in PICUs through a literature review, by determining the type of studies that have been performed, their topics, the issues discussed, and their development in the last few years. MATERIAL AND METHODS: Review of the medical literature in Medline and the database of the National Library of Medicine Gateway, using the key words from MeSH: "end of life", "pediatric intensive care", "critical care", "palliative care", "death", and "compassionate care". The earliest year of the search was 1990. The languages selected were English and Spanish. Inclusion criteria were the relationship with the topic to be studied, excluding articles with no abstract. Additional searches were made of references in selected articles. RESULTS: Eighty-one articles were retrieved from the initial search. Of these, 43 were selected as the most relevant investigations in end-of-life care in ICUs and 18 placed special emphasis on the PICU. More than half of the articles (62 %) were reviews and the remaining articles were descriptive or observational studies. The number of publications increased after 1995. Most of the studies were performed in the USA or Canada and only three studies were performed in Spain. CONCLUSIONS: In the last few years, several studies have been performed that reveal increasing concern about limits to therapeutic intervention and the need to improve end-of-life care in the PICU setting.

[Lasegue's test as prognostic factor for patients undergoing lumbar disc surgery]. / El test de Lásegue postoperatorio como factor pronóstico de los pacientes intervenidos de hernia discal lumbar.

INTRODUCTION: In patients operated for herniated lumbar disc it could be very useful to develop physical examination criteria that would allow early prediction of medium or long term clinical outcomes. The result of the Lasegue test after surgery depends on the occurrence of recurrent herniated disc and/or scar formation around the nerve root. Previous studies have shown the association between the result of Lasegue test, assessed 4 months after surgery, and the short term functional outcome. OBJECTIVE: To determine the prognostic value of postoperative Lasegue test in relation with medium term functional and clinical outcomes which were estimated by analyzing the functional grade, employment status, quality of life, reoperation for recurrent disc herniation, and the number of clinical revisions and imaging studies needed during the follow-up. PATIENTS AND METHODS: 243 patients who underwent hemilaminectomy for lumbar herniated disc between 1996 and 2002 were studied. The Lasegue sign was tested 3 months after surgery. A modification of Spangfort's criteria (to measure the functional grade) and the 12-item Short-form health survey (SF-12) method (to measure the quality of life) were used to quantify outcomes at 12, 24 and 36 months after initial surgery. RESULTS: This investigation has proved the prognostic value of Lasegue test assessed 3 months after initial surgery. A statistically significant correlation was found between a positive straight leg raising test and a poor functional status at 24 and 36 months, and the risk do not return to work because of persistent pain at 12, 24 and 36 months. A statistically significant correlation was also found between the result of the test and the frequency of reoperation for recurrent disc herniation and the number of clinical revisions and imaging control studies needed through the follow-up. Likewise, the prognostic value of Lasegue test on different aspects of quality of life (health perception, functional performances, poor social interaction and severe pain) analyzed at 24 and 36 months after surgery were also confirmed. CONCLUSION: This study provides additional information about the predictive value of the straight leg raising tested 3 months after surgery on the clinical (diagnostic resources consumption, successive outpatient revisions, etc) and functional (quality of life, functional grade and return to work) outcomes assessed 24 and 36 months after initial surgery.