Calidad del registro escrito del médico anestesiólogo durante la transferencia de pacientes postoperados: influencia de la aplicación de una herramienta de comunicación estructurada / Quality of the anesthesiologist written record during the transfer of postoperative patients: Influence of implementing a structured communication tool

Objetivo. La falta de comunicación es una de las principales causas de errores asistenciales, especialmente durante la transferencia de pacientes entre profesionales y/o unidades asistenciales; la normalización de la comunicación es una práctica recomendada. En nuestro estudio hemos querido valorar si la aplicación de la herramienta estructurada de comunicación SBAR podría influir sobre la calidad de la información escrita en la hoja de evolución por el anestesiólogo implicado en la transferencia del paciente posquirúrgico. Material y métodos. Se trata de un estudio observacional, retrospectivo, aleatorizado, de revisión de la calidad del registro escrito realizado por el médico anestesiólogo durante la transferencia de pacientes desde el área quirúrgica a la unidad de reanimación postoperatoria, mediante la aplicación de un listado validado. Se evaluaron 3 periodos de observación: un periodo control de 2 meses del año 2011 (preSBAR) y un segundo periodo de 2 meses en 2012 (postSBAR), en este último con 2 grupos de pacientes transferidos con (postSBAR+) o sin SBAR (postSBAR−). Resultados. La fuerza de concordancia entre los evaluadores obtuvo un coeficiente de correlación interclase de 0,8459 (p < 0,001). Existían diferencias significativas en función del grupo estudiado, con mayor puntuación media en el grupo con SBAR (grupo postSBAR+: media ± DE 7,56 ± 1,20 frente a grupo postSBAR−: 5,41 ± 2,98; p < 0,001) y en función de que el anestesiólogo responsable de la intervención participara en el estudio (media ± DE: 7,00 ± 1,99; frente a 4,81 ± 3,24 en los no participantes; p < 0,001) (AU)

Objective. The lack of communication is a major cause of health care errors, especially during patient transfer between practitioners and/or healthcare units, when standardization of communication is a recommended practice. In our study we wanted to assess whether the application of the structured communication SBAR tool could influence the quality of the information written on the progress sheet by the anesthesiologist involved in the transfer of the patient after surgery. Material and methods. This is an observational, retrospective, randomized, quality review of the written record made by the anesthesiologist during the transfer of patients from the surgical area to the postoperative recovery unit, by applying a validated list. We evaluated three observation periods: a control period of two months in 2011 (preSBAR) and a second period of two months in 2012 (postSBAR); in the latter two groups of patients were transferred (postSBAR +) or without SBAR (postSBAR−). Results. The strength of agreement between raters obtained an intraclass correlation coefficient of 0.8459 (p <0.001). There were significant differences in the study group, with highest average score in the group with SBAR (postSBAR + group: mean ± SD 7.56 ± 1.20 versus postSBAR-group: 5.41 ± 2.98, p <0.001) and depending on the anesthesiologist responsible for the intervention participated in the study (mean ± SD: 7.00 ± 1.99, compared to 4.81 ± 3.24 in the non-participants, p <0.001). Conclusions. There was an improvement in the quality of written records made in 2012 during the implementation of the SBAR, without the actual application of this instrument appearing to influence it. The anesthesiologists that were involved in new forms of patient safety were also those who made written records of highest quality (AU)

[Quality of the anesthesiologist written record during the transfer of postoperative patients: Influence of implementing a structured communication tool]. / Calidad del registro escrito del médico anestesiólogo durante la transferencia de pacientes postoperados: influencia de la aplicación de una herramienta de comunicación estructurada.

OBJECTIVE: The lack of communication is a major cause of health care errors, especially during patient transfer between practitioners and/or healthcare units, when standardization of communication is a recommended practice. In our study we wanted to assess whether the application of the structured communication SBAR tool could influence the quality of the information written on the progress sheet by the anesthesiologist involved in the transfer of the patient after surgery. MATERIAL AND METHODS: This is an observational, retrospective, randomized, quality review of the written record made by the anesthesiologist during the transfer of patients from the surgical area to the postoperative recovery unit, by applying a validated list. We evaluated three observation periods: a control period of two months in 2011 (preSBAR) and a second period of two months in 2012 (postSBAR); in the latter two groups of patients were transferred (postSBAR +) or without SBAR (postSBAR-). RESULTS: The strength of agreement between raters obtained an intraclass correlation coefficient of 0.8459 (p <0.001). There were significant differences in the study group, with highest average score in the group with SBAR (postSBAR + group: mean ± SD 7.56 ± 1.20 versus postSBAR-group: 5.41 ± 2.98, p <0.001) and depending on the anesthesiologist responsible for the intervention participated in the study (mean ± SD: 7.00 ± 1.99, compared to 4.81 ± 3.24 in the non-participants, p <0.001). CONCLUSIONS: There was an improvement in the quality of written records made in 2012 during the implementation of the SBAR, without the actual application of this instrument appearing to influence it. The anesthesiologists that were involved in new forms of patient safety were also those who made written records of highest quality.

Valoración de la satisfacción materna con la analgesia epidural para el trabajo del parto / Assessment of maternal satisfaction with epidural analgesia during labour

Objetivos. Conocer el grado de satisfacción de las pacientes obstétricas a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuestas realizadas durante tres meses a las pacientes ingresadas en el Hospital Universitario Virgen de las Nieves (HUVN) a las que se les aplicó la técnica epidural para control del dolor para el parto. Resultados. Se recogieron 100 encuestas de un total de 105. La satisfacción media global de las pacientes (puntuación SERVQHOS) fue de 3,98 con una desviación estándar, DE±0,64 con mejor resultado en las cuestiones subjetivas: 4,10 con DE±0,68 y menor en las objetivas con 3,86 y DE±0,73. El 92% de las pacientes se mostraron satisfechas con la analgesia epidural, con un intervalo de confianza, IC al 95% entre 87-97%. El análisis de los factores demográficos no mostró asociación estadísticamente significativa entre la edad de las pacientes y un mayor grado de satisfacción; tampoco se encontraron diferencias estadísticamente significativas entre la nacionalidad y la valoración de la satisfacción con la técnica epidural. El grado de recomendación posterior fue de 98% en las pacientes satisfechas y 85,7% en las no satisfechas. Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales)(AU)

Objective. To measure the overall satisfaction of obstetrics patients with epidural analgesia during labour, and in particular, with the technique and other subjective factors. Material and methods. An anonymous questionnaire was administered over a three-month period to patients who received analgesia to control pain during labour and who had vaginal delivery, in order to obtain information of the satisfaction with technique and their care. Results. Of the 100 patients who responded to the questionnaire, 92% were satisfied with the technique. The mild satisfaction measured by SERVQHOS score was 3.98 (SD±0.64). The score for the subjective aspects was 4.10 (± 0.68), which was better than objective ones. The recommendation rate was 98% for satisfied patients and 85.7% for those who were not satisfied. There were no differences between Spanish and foreign patients in their evaluation of the satisfaction. Conclusions. The proportion of patients satisfied with the technique was very high, and was the top rated subjective aspect (treatment and public confidence)(AU)

[Assessment of maternal satisfaction with epidural analgesia during labour]. / Valoración de la satisfacción materna con la analgesia epidural para el trabajo del parto.

OBJECTIVE: To measure the overall satisfaction of obstetrics patients with epidural analgesia during labour, and in particular, with the technique and other subjective factors. MATERIAL AND METHODS: An anonymous questionnaire was administered over a three-month period to patients who received analgesia to control pain during labour and who had vaginal delivery, in order to obtain information of the satisfaction with technique and their care. RESULTS: Of the 100 patients who responded to the questionnaire, 92% were satisfied with the technique. The mild satisfaction measured by SERVQHOS score was 3.98 (SD ± 0.64). The score for the subjective aspects was 4.10 (± 0.68), which was better than objective ones. The recommendation rate was 98% for satisfied patients and 85.7% for those who were not satisfied. There were no differences between Spanish and foreign patients in their evaluation of the satisfaction. CONCLUSIONS: The proportion of patients satisfied with the technique was very high, and was the top rated subjective aspect (treatment and public confidence).

[High risk congenital diaphragmatic hernia. Factors predicting mortality]. / Hernia diafragmática congénita de alto riesgo. Factores predictores de mortalidad.

A retrospective study of patients with high-risk congenital diaphragmatic hernia operated on in our hospital the last 15 years is made in order to establish some predictors involved in the final evolution of the patients. The best prognostic correlation has been demonstrated by preoperatory roentgenogram, Apgar-test and gasometric values 24 hours after surgical repair. A delayed surgical operation is also correlated with a better prognosis in accordance with the suitability of respiratory stabilization of the patient before the stress of surgery or because of a lesser respiratory insufficiency in patients operated on later.