Las unidades funcionales para la gestión de riesgos sanitarios (seguridad del paciente / Operational units for health risk management (patient safety)

En 1995, el INSALUD comenzó a desarrollar actuaciones de asesoría en gestión de riesgos que después de las transferencias culminaron en el desarrollo de estructuras funcionales en los centros sanitarios. Estas unidades están compuestas por un conjunto de profesionales, incluidos directivos, y tienen como objetivo identificar, evaluar, analizar y tratar los riesgos sanitarios para mejorar la seguridad de los pacientes. Su estructura organizativa puede variar en función de necesidades, recursos y filosofía de cada organización. En este artículo se presenta la experiencia de las unidades de gestión de riesgo desarrolladas en las comunidades autónomas de Madrid, País Vasco, INGESA (Ceuta y Melilla) y Galicia. Asimismo, se plantea una reflexión sobre la evaluación de su impacto y sus futuras funciones para mejorar la seguridad de los servicios sanitarios (AU)

In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services (AU)

[Operational units for health risk management (patient safety)]. / Las unidades funcionales para la gestión de riesgos sanitarios (seguridad del paciente).

In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services.

A prediction rule to identify allocation of inpatient care in community-acquired pneumonia.

The current authors developed a new prediction rule based on the five risk classes defined by the Pneumonia Severity Index to identify allocation of inpatient care in community-acquired pneumonia. The decision to hospitalise in low-risk classes (I-III) was unquestionable, if the presence of one or more of the following were evident: arterial oxygen tension <8.0 kPa (60 mmHg), shock, decompensated coexisting illnesses, pleural effusion, inability to maintain oral intake, social problem, and lack of response to previous adequate empirical antibiotic therapy. The results at 18 months after implementation of this new prediction rule are reported in a series of 616 patients. The mortality rate was 0.5% in 221 patients treated as outpatients versus 8.9% in 395 patients treated as inpatients. Specific additional criteria for hospitalisation included in the prediction rule were present in 106 of the 178 low-risk patients treated as inpatients, whereas in the remaining 72, the decision to hospitalise was apparently unjustified by the prediction rule. These 72 patients showed a better outcome (significantly shorter hospitalisation, days on intravenous antibiotics, mortality, and complicated course) than high-risk patients and low-risk patients who met the additional specific criteria for deciding hospital admission. Therefore, admission in these low-risk patients might have been avoided by strict adherence to the new prediction rule. Another relevant finding was that the Pneumonia Severity Index alone did not identify all patients who needed to be admitted to the hospital.