Quality indicators in the rational management of severe asthma: A Spanish multidisciplinary consensus.

AIM: Severe asthma is a complex, heterogeneous condition that can be difficult to control despite currently available treatments. Multidisciplinary severe asthma units (SAU) improve control in these patients and are cost-effective in our setting; however, their implementation and development can represent an organizational challenge. The aim of this study was to validate a set of quality care indicators in severe asthma for SAU in Spain. METHODS: The Carabela initiative, sponsored by SEPAR, SEAIC, SECA and SEDISA and implemented by leading specialists, analyzed the care processes followed in 6 pilot centers in Spain to describe the ideal care pathway for severe asthma. This analysis, together with clinical guidelines and SEPAR and SEAIC accreditation criteria for asthma units, were used to draw up a set of 11 quality of care indicators, which were validated by a panel of 60 experts (pulmonologists, allergologists, and health-policy decision-makers) using a modified Delphi method. RESULTS: All 11 indicators achieved a high level of consensus after just one Delphi round. CONCLUSIONS: Experts in severe asthma agree on a series of minimum requirements for the future optimization, standardization, and excellence of current SAUs in Spain. This proposal is well grounded on evidence and professional experience, but the validity of these consensus indicators must be evaluated in clinical practice.

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

Asistencia a extranjeros en urgencias. Hospital Virgen de la Arrixaca / Health care for foreigners in the emergency service. Hospital Virgen de la Arrixaca

En España se han superado los 40 millones de habitantes y como en el resto de Europa el crecimiento de la población se hubiera enlentecido a no ser por la incorporación de emigrantes. Según el INE la población española puede crecer hasta el año 2025, teniendo en cuenta la entrada de emigrantes en nuestro país. El 74 por ciento de los emigrantes que llegan a nuestra Región proceden de América del Sur y de manera especial de Ecuador. A gran distancia están los que proceden del continente africano (16 por ciento) con una alta representación de Marruecos. El incremento de población extranjera en la Región de Murcia provoca un cambio social y demográfico, con un fiel reflejo en la utilización de los servicios sanitarios. Los pacientes extranjeros atendidos han sido seleccionados teniendo en cuenta la cumplimentación, cuando ha existido, del campo país de nacimiento. Se han analizado 335.348 urgencias asistidas durante los años 2000 y 2001, extraídas de registros del Sistema de Información del Hospital Virgen de la Arrixaca de Murcia. De ellas, 11.602 han cumplido los requisitos para el estudio de urgencias, de las cuales el 19 por ciento ingresan. La evolución es ascendente y ha supuesto pasar de 4.674 pacientes en 2000 a 6.928 en 2001. En el desglose por meses de esta atención destaca la periodicidad casi simétrica en cada uno de los meses estudiados. En cuanto a días de la semana destaca el aumento de pacientes en urgencias los sábados, domingos y lunes. Al analizar el perfil del ciudadano inmigrante que acude a urgencias se detecta un gran impacto de las mujeres en edad fértil, que explicaría, posiblemente, el incremento de natalidad en la Región de Murcia (AU)