Innovando en procesos asistenciales y seguridad del paciente mediante simulación clínica / Innovation in healthcare processes and patient safety using clinical simulation

Objetivo. En las organizaciones sanitarias muchas ideas excelentes no siempre se han llevado a la práctica o adoptado de modo generalizado. Dos elementos han condicionado este resultado: pensar que el cambio se consigue fundamentalmente acumulando conocimiento y creer que la difusión del mismo es el pilar de la transformación. Se describe y evalúa el programa de gestión del cambio del Servicio Cántabro de Salud basado en entrenamiento de equipos interprofesionales mediante simulación clínica. Material y métodos. El Comité de Coordinación y Desarrollo de Formación Continuada analizó las necesidades de aprendizaje propuestas por las unidades clínicas y las gerencias. Se seleccionaron aquellas competencias susceptibles de ser entrenadas mediante simulación. En las actividades se incluyó al equipo clínico completo de cada unidad. Para el diseño docente se utilizaron técnicas de aprendizaje experiencial basadas en simulación y debriefing. Los resultados se evaluaron siguiendo el modelo de Kirkpatrick. Resultados. Los objetivos de cambio incluyeron mejorar el rendimiento de los equipos clínicos en enfermedades con elevada prevalencia e índice de complicaciones; promover la reorganización de procesos asistenciales para hacerlos más eficientes manteniendo la seguridad, y facilitar la implementación de nuevas técnicas complejas con alto riesgo de complicaciones. Treinta unidades asistenciales realizaron 39programas de entrenamiento en los 3 hospitales de la red y atención primaria durante 2013-14. Participaron 1.559profesionales sanitarios incluyendo auxiliares, enfermeras y médicos. Conclusiones. La simulación clínica es un método para el entrenamiento de profesionales sanitarios que promueve y facilita el cambio en los equipos, y la reorganización asistencial (AU)

Objective. Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. Material and methods. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Results. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Conclusion. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering (AU)

[Innovation in healthcare processes and patient safety using clinical simulation]. / Innovando en procesos asistenciales y seguridad del paciente mediante simulación clínica.

OBJECTIVE: Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. MATERIAL AND METHODS: The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. RESULTS: Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. CONCLUSION: Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering.

Risk factors for bacteremia in patients with limb cellulitis.

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.

[Incidence of invasive pneumococcal disease in Cantabria, Spain, [1995-2001] and implications for the childhood inmunization schedule]. / Incidencia de enfermedad neumocócica invasiva en Cantabria (1995-2001) e implicaciones para el calendario vacunal.

OBJECTIVE: To describe the incidence of invasive pneumococcal disease in Cantabria (Spain) between 1995 and 2001. METHOD: We reviewed the records of the Minimum Data Set (MDS) of public hospitals in Cantabria, discharges from private hospitals and the registry of diseases of mandatory reporting, as well as the microbiologic diagnoses and medical records of children discharged from the Pediatric Service of the Cantabria Hospital (the tertiary care hospital in our autonomous community). RESULTS: We obtained a meningitis incidence of 5.55, 5.03 and 0.76/100,000 in children < 2 years, > or = 2 and < 5 years, and > or = 5 years respectively, and an incidence of invasive disease of 11.11, 11.32 and 1.49/100,000 in the same age groups. CONCLUSIONS: The incidence of meningitis and invasive pneumococcal disease in Cantabria is low. We discuss factors that should be taken into account when introducing the pneumococcal conjugate vaccine in the childhood immunization schedule of Cantabria.

Incidencia de enfermedad neumocócica invasiva en Cantabria (1995-2001) e implicaciones para el calendario vacunal / Incidence of invasive pneumococcal disease in Cantabria, Spain, [1995-2001] and implications for the childhood inmunization schedule

El objetivo de este trabajo es presentar la evolución de la política y los servicios de salud pública relativos a los animales de compañía en la ciudad de Barcelona de 1983 a 2001. Partiendo de una actividad centrada en la custodia y la eutanasia de los animales sin dueño de Barcelona, y ofertando también servicios al resto de la provincia, se formula un Plan de Animales de Compañía para la ciudad y se reorienta la actividad, centrándola en los límites estrictos del municipio y el estímulo de la adopción. Se busca la participación de profesionales y entidades proteccionistas, se remodelan las instalaciones, se fomenta la tenencia responsable de animales, se crean colonias urbanas controladas de gatos y se estimulan las adopciones, redefiniendo la actividad con una mayor orientación al cliente. La evolución de la actividad desde 1998 refleja una notable disminución en el volumen de animales custodiados, así como en la proporción de los sacrificados. Esta disminución puede reflejar una mejora en el problema de los animales abandonados. Estos cambios se han traducido en una modificación positiva de las relaciones con los medios de comunicación y las entidades proteccionistas (AU)