Transferencia segura de pacientes y mejora de la comunicación en distintos entornos asistenciales / Safe handoff practices and improvement of communication in different paediatric settings

El manejo deficiente de información, en especial durante la transferencia o el traspaso de cuidados, contribuye en gran parte de los eventos adversos relacionados con la asistencia sanitaria. El Comité de Calidad Asistencial y Seguridad en el Paciente de la Asociación Española de Pediatría ha confeccionado este documento para ofrecer una aproximación a los procesos de transferencia en distintos ámbitos asistenciales pediátricos: urgencias-emergencias, hospitalización, cuidados intensivos, neonatología y atención primaria. Se describen recursos para lograr una comunicación segura y efectiva en todos estos ámbitos, empleando, entre otros métodos, herramientas estandarizadas de transferencia. Se proponen también recomendaciones para la prevención de errores de medicación durante los procesos de transferencia, la mejora de seguridad durante los traslados y derivaciones entre ámbitos, y también para un mejor traspaso de información asistencial en los niños y adolescentes con enfermedades crónicas y complejidad asistencial. (AU)

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardized handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimize communication and continuity of care in chronically ill and medically complex children. (AU)

Safe handoff practices and improvement of communication in different paediatric settings.

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardised handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimise communication and continuity of care in chronically ill and medically complex children.

Recomendaciones de no hacer en distintos ámbitos de la atención pediátrica / Do not do recommendations in different paediatric care settings

Introducción: Muchas son las iniciativas encaminadas a eliminar intervenciones clínicas de poco valor en la asistencia sanitaria. Desde el Comité de Calidad Asistencial y Seguridad del Paciente de la Asociación Española de Pediatría, se ha propuesto la elaboración de recomendaciones de «no hacer» (RNH) con el objetivo de señalar una serie de prácticas evitables en la atención del paciente pediátrico en atención primaria, urgencias, hospitalización y domicilio. Material y métodos: Este trabajo se desarrolló en 2fases: una primera en la que se propusieron posibles RNH y una segunda en la que se consensuaron las recomendaciones finales mediante el método Delphi. Tanto las propuestas como las evaluaciones partieron de miembros de los grupos y sociedades pediátricas a los que se les realizó la propuesta, coordinados por miembros del Comité de Calidad Asistencial y Seguridad del Paciente. Resultados: Fueron propuestas un total de 164 RNH por la Sociedad Española de Neonatología, la Asociación Española de Pediatría de Atención Primaria, la Sociedad Española de Urgencias de Pediatría, la Sociedad Española de Pediatría Interna Hospitalaria y el Comité de Medicamentos de la Asociación Española de Pediatría con el Grupo Español de Farmacia Pediátrica de la Sociedad Española de Farmacia Hospitalaria. Se logró reducir el conjunto inicial a 42 RNH y en sucesivas fases se llegó a la selección final de 25 RNH, 5 RNH por cada grupo o sociedad. Conclusiones: Este proyecto ha permitido seleccionar y consensuar una serie de recomendaciones para evitar prácticas inseguras, ineficientes o de escaso valor en distintos ámbitos de la atención pediátrica, lo que podría resultar útil para mejorar la seguridad y la calidad de nuestra actividad asistencial. (AU)

Introduction: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics has proposed the development of «do not do» recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. Material and methods: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. Results: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the Spanish Association of Pediatrics and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. Conclusions: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice. (AU)

Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

Impacto de la patología crónica en un servicio de urgencias pediátrico / Impact of chronic diseases on a pediatric emergency department

Objetivo. Describir las características clínicas de pacientes con patología crónica en un servicio de urgencias pediátrico. Método. Estudio de casos y controles realizado en un hospital pediátrico de tercer nivel. Incluye las visitas realizadas en urgencias un día a la semana durante 3 meses consecutivos. Se define como caso toda visita de pacientes con patología crónica, y como control, la visita inmediatamente posterior al caso. Resultados. De las 2.826 visitas realizadas, 278 son pacientes con patología crónica (prevalencia 9,8%; IC 95% 8,8-10,9%), que corresponden a 265 niños (12 reconsultan). Las patologías más frecuentes son respiratorias (35,2%) y neurológicas (24,9%). El 28,8% de las visitas están relacionadas con su patología crónica. La mediana de edad es mayor en casos que en controles (4 años vs 2,5; p<0,001), sin diferencias significativas en la distribución por sexos (60,8% masculino vs 52,7%, p=0,059). En los casos se realizan más análisis de sangre (16,5% vs 9%, p=0,008) y tomografías craneales (3,2% vs 0,7%, p=0,033). No encontramos diferencias en los análisis de orina (11,2% vs 9%, p=0,398), ni en las radiografías torácicas (19,1% vs 13,3%, p=0,065), ni en otras pruebas. En los casos se realizan más interconsultas a especialistas (7,6% vs 2,9%, p=0,013) y más ingresos (19,1% vs 7,6%, p<0,001). Conclusiones. Los niños con patología crónica constituyen un grupo importante de las visitas realizadas en urgencias, requieren mayor utilización de recursos hospitalarios y manejo multidisciplinario. El pediatra de urgencias debe conocer las pautas de manejo y tratamiento de estos pacientes e identificar cualquier descompensación de las enfermedades de base que sufren (AU)

Background. Childhood chronic diseases are an increasing problem for the healthcare systems. Advances made in their management have led to a marked increase in the survival of these children and thus there is a need to analyze their impact on the emergency services. Objective. To describe the clinical characteristics of patients with chronic diseases seen in a pediatric emergency department. Method. Case-control study performed in a tertiary pediatric hospital, including emergency room visits one day per week for three consecutive months. Cases were defined as any visit of patients with chronic diseases, and controls were defined as the visits immediately following the case. Results. Of the 2,826 visits, 278 were from patients with chronic diseases (prevalence 9.8%, CI 95% 8.8-10.9), corresponding to 265 children (12 revisits). The most frequent diseases were respiratory (35.2%) and neurological (24.9%) disorders; 28.8% of the visits were related to their chronic condition. The median age was higher in cases than controls (4 years vs. 2.5 years respectively, p<0.001). There were no significant differences in gender distribution (60.8% male vs. 52.7% female, p=0.059). More blood tests and CT scans were performed in cases compared to controls (16.5% vs. 9%, p=0.008, and 3.2% vs. 0.7%, p=0.033, respectively). There was no difference between cases and controls in the number of urinalysis (11.2% vs. 9% respectively, p=0.398), chest X-ray (19.1% vs. 13.3% respectively, p=0.065), or other tests performed. Compared to controls, visits of patients with chronic diseases included more consultations to specialists (7.6% vs. 2.9% respectively, p=0.013) and resulted in more admissions (19.1% vs. 7.6% respectively, p<0.001). Conclusions. Children with chronic diseases represent a large proportion of emergency room visits and require a greater utilization of hospital resources and multidisciplinary management. Pediatricians should be aware of the emergency management and treatment guidelines of these conditions and identify promptly any signs of deterioration in these children (AU)