A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge.

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge / Un cuestionario en espanol sobre seguridad del paciente para medir las actitudes y los conocimientos de los estudiantes de medicina y enfermería

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimatedfor each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

OBJETIVO: Diseñar y validar un cuestionario de evaluación de las actitudes y los conocimientos en materia de seguridad del paciente con una muestra de estudiantes de medicina y enfermería que reciben formación médica en Espana y en cuatro países de América Latina. MÉTODOS: En este estudio transversal se llevó a cabo una revisión bibliográfica y se encuestó a un total de 786 estudiantes de medicina y enfermería de ocho universidades de cinco países (Chile, Colombia, El Salvador, Espana y Guatemala) con objeto de elaborar y corregir un cuestionario en espanol sobre conocimientos y actitudes en materia de seguridad del paciente. El ámbito del cuestionario se basó en cinco dimensiones (factores) presentadas en estudios relacionados con la cultura de la seguridad del paciente encontrados en PubMed y Scopus. Con base en los cinco factores, se elaboraron 25 ítems reactivos. Se calcularon los índices de fiabilidad compuesta y alfa de Cronbach para cada factor, y se realizó un análisis factorial confirmatorio para evaluar la validez. Tras una prueba piloto se corrigió el cuestionario mediante modelos confirmatorios, el cálculo de la máxima probabilidad y la matriz de variancia-covariancia (como insumo). Se utilizaron modelos de regresión lineal múltiple para confirmar la validez externa, considerando las variables relacionadas con la cultura de seguridad del paciente como variables dependientes y los cinco factores como variables independientes. RESULTADOS: El instrumento final fue una encuesta autoadministrada mediante escala de Likert estructurada en cinco puntos ("Cuestionario de Seguridad del Paciente para Estudiantes Latinos"), que consta de 21 ítems agrupados en cinco factores. Los índices de fiabilidad compuesta (prueba estadística de alfa de Cronbach) calculados para los cinco factores fueron aproximadamente de 0,7 o superiores. Los resultados de los análisis de regresión lineal múltiple indicaron un buen ajuste del modelo (índice de bondad de ajuste: 0,9). Las correlaciones ítem-total fueron superiores a 0,3 en todos los casos. La validez convergente y discriminatoria fue adecuada. CONCLUSIONES: El cuestionario disenado y validado en este estudio evalúa las actitudes y los conocimientos de los estudiantes de enfermería y medicina en materia de seguridad del paciente. Este instrumento podría utilizarse para evaluar indirectamente si los estudiantes de disciplinas de la salud están adquiriendo, y por lo tanto, es probable que pongan en práctica, las habilidades profesionales consideradas actualmente como más apropiadas para la seguridad del paciente.

La cultura de seguridad del paciente: del pasado al futuro en cuatro tiempos / No disponible

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[Adverse events in ambulatory surgical procedures]. / Efectos adversos en cirugía mayor ambulatoria.

OBJECTIVE: To assess the incidence of adverse events and patients with adverse events in ambulatory surgical procedures and to compare it with that of other studies. MATERIAL AND METHOD: Historical cohort study. The scope of the study was the ambulatory surgical procedures unit of a university hospital. All general surgery department patients seen in this unit during the year 2005 were included. RESULTS: The incidence of patients with adverse events directly related to hospital care was of 3% (95% CI, 0.9-5). Of the adverse events identified 5 were considered slight, 3 moderate and none were considered serious. All the moderate ones were considered unavoidable and of slight, only the one was avoidable. Six of the adverse events were associated to a procedure, one due to hospital infections and one with other causes. There was an increase in hospital stay due to 75% of the adverse events, and 25% of them affected admission. CONCLUSIONS: The incidence of adverse events related to medical care in the Spanish hospitals is similar to those found in the studies carried out in American and European countries using the same methodology. The surgical area is considered a high risk unit. However, ambulatory surgical procedures reduce these risks, in such a way that the incidence is far below that of surgery department. Therefore, besides improving the technical efficiency of the clinical services, it is safer for the patients.

Efectos adversos en cirugía mayor ambulatoria / Adverse events in ambulatory surgical procedures

Objetivo. Determinar la incidencia de efectos adversos y de pacientes con efectos adversos en cirugía mayor ambulatoria y compararla con la incidencia encontrada en los servicios de cirugía general incluidos en el estudio ENEAS. Material y método. Estudio de cohortes históricas. El ámbito del estudio fue la unidad de cirugía mayor ambulatoria de un hospital universitario. Se incluyó a todos los pacientes atendidos en el servicio de cirugía general durante el año 2005. Resultados. La incidencia de pacientes con efectos adversos relacionados directamente con la asistencia sanitaria fue del 3% (intervalo de confianza del95%, 0,9-5). De los 8 efectos adversos detectados, 5se consideraron leves, 3 moderados y ninguno grave. Todos los moderados se consideraron inevitables y de los leves tan sólo uno era evitable. Entre los efectos adversos, 6 tuvieron relación con un procedimiento, uno con infección nosocomial y otro con otras causas. Tres cuartas partes de los efectos adversos tuvieron como consecuencia un incremento de la estancia y en una cuarta parte el efecto adverso condicionó el ingreso. Conclusiones. La incidencia de efectos adversos relacionados con la asistencia sanitaria en los hospitales españoles es similar a la de los estudios realizados en países americanos y europeos con similar metodología. Se considera que el área quirúrgica es de alto riesgo para desencadenarlos; sin embargo, la cirugía mayor ambulatoria reduce su incidencia. Por lo tanto, además de mejorar la eficiencia técnica de los servicios clínicos, es más segura para los pacientes (AU)

Objective. To assess the incidence of adverse events and patients with adverse events in ambulatory surgical procedures and to compare it with that of other studies. Material and method. Historical cohort study. The scope of the study was the ambulatory surgical procedures unit of a university hospital. All general surgery department patients seen in this unit during the year 2005 were included. Results. The incidence of patients with adverse events directly related to hospital care was of 3% (95% CI, 0.9-5). Of the adverse events identified 5 were considered slight, 3 moderate and none were considered serious. All the moderate ones were considered unavoidable and of slight, only the one was avoidable. Six of the adverse events were associated to a procedure, one due to hospital infections an done with other causes. There was an increase in hospital stay due to 75% of the adverse events, and 25%of them affected admission. Conclusions. The incidence of adverse events related to medical care in the Spanish hospitals is similar to those found in the studies carried out in American and European countries using the same methodology. The surgical area is considered a high risk unit. However, ambulatory surgical procedures reduce these risks, in such a way that the incidence is far below that of surgery department. Therefore, besides improving the technical efficiency of the clinical services, itis safer for the patients (AU)

Safety Data for Safer Care: The Importance of International Consensus and Action

El interés en la medida y en la evaluación de la calidad ha crecido considerablemente a través de las últimas 2 décadas debido a diversos factores, como el reconocimiento de la gran variabilidadexistente en la práctica clínica, la mayor disponibilidad de evidencia de eficacia probada y la creciente preocupación sobre el costo y la calidad del cuidado de la salud. En particular, el interés ha crecido en asegurar que el cuidado de la salud sea seguro, sobre todo desde que en 2001 el Institute of Medicine (IOM) incluyera la seguridad como una más de las dimensiones de la calidad. Este interés en la seguridad no está relacionado con barreras internacionales o con las particularidades de “mayor desarrollo” o “menor desarrollo” de un país.Iniciativas internacionales del más alto nivel gubernamental, como las de la Organización para la Cooperación Económica y del Desarrollo(OCDE), el Proyecto de Indicadores de Calidad en Salud(HQIP) y su grupo de trabajo en Seguridad del Paciente o la de la Alianza mundial por la Seguridad del Paciente de la OMS, resaltan la necesidad de un convenio internacional para lograr un mayor aprendizaje sobre la seguridad del paciente. Sin embargo, poco se ha estado haciendo para mejorar la disponibilidady la comparabilidad de los datos/indicadores acerca de la seguridad del paciente dentro y entre los países.Material y método: En este artículo, describimos el trabajo realizado por cuerpos nacionales como la Agencia para la Investigación y la Calidad de la Asistencia Sanitaria (AHRQ) de Estados Unidos y pororganizaciones internacionales como la OCDE y la Alianza Mundial (OMS) para mejorar los datos de seguridad en la búsqueda de proveer un cuidado más seguro, a la vez que contrastamos con la información existente en España sobre esta misma cuestión. Resultados: La propuesta de la OCDE pretende identificar las medidasapropiadas para favorecer comparaciones en el ámbito internacional, aunque una serie de dificultades (disponibilidad de datos,aspectos éticos, organización de los sistemas) hace que el número de indicadores sugeridos se haya visto reducido. Los indicadores que propone la AHRQ, basándose en varias fuentes de información sólidas, ofrecen una visión más rica respecto a la seguridad del pacienteen el ámbito nacional. En España, existen iniciativas para comparación internacional mediante los indicadores propuestos por la OCDE e, internamente, usando los propuestos por la AHRQ, basándose en el CMBD. Conclusiones: El desarrollo de los sistemas de datos sobre seguridad del paciente, tanto en el ámbito nacional como en el internacional, tiene aún un largo camino por recorrer. Un aspecto importante a considerar es la necesidad de involucrar a los pacientes y sus asociaciones en la recogida y registro de datos sobre seguridad del paciente

Objective: Interest in comparative quality measurement and evaluation has grown considerably over the past two decades due to several factors, such as recognition of widespread variation in clinical practice,the increased availability of evidence on medical effectiveness, and increasing concern about the cost and quality of healthcare. Interest in ensuring that healthcare is safe has grown, particularlysince 2001 when the Institute of Medicine (IOM) included patient safety as another quality dimension.This interest in safety is not limited by international borders or by classifications of “more developed” or “less developed” countries.International initiatives at the highest levels of government such as the Organization for Economic Cooperation and Development’s (OECD)Health Care Quality Indicators Project and its Patient Safety Working Group, as well as the World Alliance for Patient Safety, highlight the need for international agreement to increase learning on patient safety.However, little is being done to improve the availability and comparability of data/indicators on patient safety within and between countries. Material and method: In this paper, we describe the work beingdone by national bodies such as the US Agency for Healthcare Research and Quality (AHRQ), and international organizations such asthe OECD and the World Alliance (WHO) to improve safety data with a view to providing safer care. At the same time, we compare this with information existing in Spain on this same question. Results: The proposal by the OECD attempts to identify suitablemeasurements to enable comparisons at international level, although several difficulties (availability of data, ethical aspects, organizationof the systems) mean that the number of indicators hasbeen reduced. The indicators proposed by the AHRQ, based on several solid information sources, offer a much clearer vision as regards patient safety at national level. In Spain, there are initiatives for international comparisons using the indicators proposed by the OECD and, at national level, using the proposalsby AHRQ, based on the MBDS (minimum basic data set).Conclusions: The development of patient safety data systems, both at national and international level, still has a long way to go. One important aspect to consider, is the need to involve patients and their associationsin the collection and recording of data on patient safety

Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays.

OBJECTIVE: To evaluate the effectiveness of a combined intervention to reduce inappropriate hospital stays. DESIGN: Quasi-experimental pre-test/post-test with a non-equivalent control group. SETTING: Three teaching hospitals in the National Health System in Alicante, Spain. STUDY PARTICIPANTS: Intervention group (2 Surgical Units with 1451 hospital stays) and control group (1 Surgical Unit with 1268 hospital stays). INTERVENTION: Structured oral presentation followed by direct feedback to surgeons about their own percentages of inappropriate stays and daily evaluation of appropriateness by the surgeons during their rounds. MAIN OUTCOME MEASURES: Reduction in the percentage of inappropriate stays identified by the Appropriateness Evaluation Protocol during the intervention period compared to the basal period. RESULTS: The intervention group reduced its percentage of inappropriate stays from 14.3% to 7.9% (absolute reduction: -6.40; 95% CI -10.7 to -2.14; relative reduction: 44.8%), while no changes occurred in the control group. The reduction was in the number of inappropriate stays attributable to the patients' medical management that went from 12.7% to 5.8% (absolute reduction: -6.92; 95% CI -10.90 to -2.92), while no significant changes occurred in inappropriate stays due to other causes. CONCLUSIONS: A combined intervention of feedback and physician participation in appropriateness evaluations is effective in reducing the percentage of inappropriate hospital stays, particularly those attributable to conservative medical patterns at discharge.

[Health assistance as a risk factor: side effects related to clinical practice]. / La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica.

The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed.

La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica / Health assistance as a risk factor: side effects related to clinical practice

Los sistemas sanitarios cada vez más complejos, junto con pacientes más vulnerables y a la vez más informados y demandantes, conforman un entorno clínico en el que aparecen los efectos adversos (EA) ligados a la asistencia sanitaria. La incidencia de EA en pacientes hospitalizados se ha estimado entre el 4 y el 17%. Una cuarta parte fueron graves y el 50% se consideró evitables. El 70% de los EA se deben a fallos técnicos, defectos en la toma de decisiones, no actuación de la manera más apropiada en función de la información disponible, problemas en la anamnesis, y ausencia o prestación inadecuada de cuidados necesarios. El modelo explicativo de la cadena causal de un efecto adverso mantiene que son más importantes los fallos de sistema que los fallos de las personas. Para facilitar el necesario cambio de la cultura punitiva a la cultura proactiva es necesario el enfoque multidisciplinario del problema teniendo en cuenta el punto de vista de los profesionales, los pacientes, los líderes sociales y la magistratura (AU)

The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed (AU)

Soluciones en busca de problema y problemas en busca de solución / Solutions in search of a problem and problems in search of a solution

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Uso inadecuado de la hospitalización en cirugía general. Magnitud, factores asociados y causas / Inappropriate hospitalization use in general surgery wards. Magnitude, associated factors and causes

Objetivo. Identificar la proporción de estancias inadecuadas en los servicios de cirugía general de 3 hospitales universitarios, los factores asociados a la inadecuación y sus causas. Material y método. Revisión concurrente de 596 estancias, durante una semana en el año 2000, utilizando el Appropriateness Evaluation Protocol. Se analizó la asociación entre la inadecuación de la estancia y diversas variables independientes, mediante análisis bivariable y multivariable. Tambien se describen las causas de inadecuación. Resultados. El 17,6% de las estancias fueron evaluadas como inadecuadas, sin diferencias significativas entre hospitales (el 21,5, el 12,5 y el 17,5%). La inadecuación se asoció a los fines de semana (odds ratio = 2,1), ingreso programado (odds ratio = 2,9), ingresos de más de una semana de duración (odds ratio = 2,3), último tercio de la estancia (odds ratio = 3,7) y a la inadecuación del día de ingreso (odds ratio = 2,1). Las principales causas de estancias inadecuadas fueron los problemas organizativos del hospital y del manejo clínico del alta hospitalaria. Conclusiones. Las estancias inadecuadas suponen un importante componente de la duración de la estancia, y se deben fundamentalmente a problemas de programación quirúrgica y, sobre todo, de la gestión médica de las altas, aspectos que dependen de la propia organización de los servicios quirúrgicos y los servicios hospitalarios relacionados (AU)

Objective. To determine the proportion of inappropriate days of hospitalization in the general surgery wards of three university hospitals, its causes, and associated factors. Material and method. We concurrently reviewed 596 days of hospitalisation during a 1-week period in 2000, using the Appropriateness Evaluation Protocol (AEP). The association among inappropriate days of hospital stay and independent variables was evaluated using bivariable and multivariable methods. Finally, the causes for inappropriate hospitalization use were analyzed. Results. The percentage of inappropriate days was 17.6%, with no significant differences among the hospitals (21.5%, 12.5% and 17.5%). Inappropriate days were associated with the weekend (odds ratio [OR] = 2.1, scheduled admissions (OR = 2.9), hospital stay of more than 1 week (OR:2.3), the last third of the hospital stay (OR: 3.7), and inappropriate admission (OR: 2.1). The main causes of inappropriate hospital stays were organizational problems in the hospital or in the clinical management of discharge. Conclusions. Inappropriate days of hospitalization represent a considerable percentage of hospitalization in surgery wards. The main reasons for inappropriate days are problems with surgical and discharge planning and factors that depend on the organization of the surgery departments and other related departments in the hospital (AU)

Siguiendo la pista de los efectos adversos: cómo detectarlos / Monitoring adverse events: how to detect them

Objetivos: Comparar la efectividad, la validez y la aceptabilidad al estimar tasas de efectos adversos y su carácter evitable al utilizar 3 métodos diferentes: transversal, prospectivo y retrospectivo. Diseño: Valoración independiente de los métodos sobre una misma muestra. Participantes: Un total de 778 pacientes en 37 unidades clínicas en Francia. Medidas principales: Efectividad: proporción de casos identificados por cada método comparados con una lista de la referencia de casos confirmados por el personal del servicio y proporción de casos evitables. Otras medidas secundarias: fiabilidad en el cribado e identificación interobservador, carga de trabajo percibida y validez percibida de los resultados. Resultados: Los métodos prospectivo y retrospectivo identificaron un número similar de casos médicos y quirúrgicos (el 70 y el 66% del total, respectivamente), pero el prospectivo identificó más casos evitables (el 64 y el 40%, respectivamente). El método transversal mostró muchos falsos positivos y no identificó ninguno de los efectos adversos más graves. Ninguno de los métodos resultó apropiado para las unidades obstétricas. La carga de trabajo fue percibida como similar para los métodos prospectivo y transversal, y menor para el retrospectivo. Conclusión: En este estudio se han encontrado diferencias en la efectividad de identificación de estos métodos por tipo de servicio pero, globalmente, el método retrospectivo es igual de eficaz que el prospectivo para la identificación de efectos adversos. El papel que han de desempeñar los métodos epidemiológicos en el estudio de los efectos adversos podría resumirse en que el método transversal tiene un interesante coste de oportunidad en nuestro medio, el estudio de cohortes retrospectivo sigue siendo el método de referencia para evaluar la aparición de los efectos adversos; el prospectivo ha destacado por sus virtudes pedagógicas y comunicativas, y su buena apreciación de las cadenas de efectos y sus consecuencias y el estudio de casos y controles se podría utilizar para la evaluación del impacto de los efectos adversos

Objectives: To compare the effectiveness, reliability, and acceptability of estimating rates of adverse events and rates of preventable adverse events using three methods: cross sectional, prospective, and retrospective. Design: Independent assessment of three methods applied to the same sample. Participants: A total of 778 patients in 37 wards in France. Main outcome measures: Effectiveness: the proportion of cases identified by each method compared with a reference list of cases confirmed by ward staff and the proportion of preventable cases. Secondary outcome measures were inter-rater reliability in screening and identification, perceived workload, and the perceived validity of the results. Results: The prospective and retrospective methods identified similar numbers of medical and surgical cases (70% and 66% of the total, respectively), but the prospective method identified a greater number of preventable events (64% and 40%, respectively). The cross sectional method showed a large number of false positives and identified none of the most serious adverse events. None of the methods was appropriate for obstetrics. The workload for the prospective and cross sectional methods was perceived as similar and that for the retrospective method was perceived as lower. Conclusion: In this study, differences in the effectiveness of the three methods were found according to ward type; however, the overall effectiveness of the retrospective and prospective methods in identifying adverse events was similar. The role of epidemiological methods in the study of adverse events can be summarized as follows: the cross sectional method can be useful in certain circumstances; the retrospective cohort study continues to be the reference method to evaluate the incidence of adverse events; the prospective method has notable pedagogic and communicative properties and is effective in appraising chains of events and consequences, and the case-control study could be used to evaluate the impact of adverse events

[Inappropriate hospitalization use in general surgery wards. Magnitude, associated factors and causes]. / Uso inadecuado de la hospitalización en cirugía general. Magnitud, factores asociados y causas.

OBJECTIVE: To determine the proportion of inappropriate days of hospitalization in the general surgery wards of three university hospitals, its causes, and associated factors. MATERIAL AND METHOD: We concurrently reviewed 596 days of hospitalisation during a 1-week period in 2000, using the Appropriateness Evaluation Protocol (AEP). The association among inappropriate days of hospital stay and independent variables was evaluated using bivariable and multivariable methods. Finally, the causes for inappropriate hospitalization use were analyzed. RESULTS: The percentage of inappropriate days was 17.6%, with no significant differences among the hospitals (21.5%, 12.5% and 17.5%). Inappropriate days were associated with the weekend (odds ratio [OR] = 2.1, scheduled admissions (OR = 2.9), hospital stay of more than 1 week (OR:2.3), the last third of the hospital stay (OR: 3.7), and inappropriate admission (OR: 2.1). The main causes of inappropriate hospital stays were organizational problems in the hospital or in the clinical management of discharge. CONCLUSIONS: Inappropriate days of hospitalization represent a considerable percentage of hospitalization in surgery wards. The main reasons for inappropriate days are problems with surgical and discharge planning and factors that depend on the organization of the surgery departments and other related departments in the hospital.

Proyecto IDEA: Identificación de efectos adversos / No disponible

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