Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto / Clinical safety audits for primary care centers. A pilot study

Objetivo: Detectar procesos organizativos, infracciones de normas o actuaciones profesionales que supongan niveles de inseguridad clínica. Diseño: Estudio descriptivo transversal mediante encuesta personalizada heteroadministrada de junio de 2008 hasta febrero de 2010. Emplazamiento: Trece de los 53 equipos de atención primaria (EAP) del ICS Costa de Ponent, Barcelona. Participantes: Trabajadores de 13 EAP agrupados en: director/a, adjunto/a, responsable del servicio de admisiones y médico/a centinela. Métodos: Selección no aleatoria, aparejando centros docentes/no docentes, urbanos/rurales, pequeños/grandes. Se evaluaron 33 indicadores: 15 de procedimientos, 9 de cultura y actitud, 3 de formación y 6 de comunicación. Criterios de exclusión: no colaboración. Resultados: Características de los 55 profesionales encuestados: 84,6% de centros urbanos, 46,2% docentes y 76,9% EAP grandes. Distribución por estamentos: 13 responsables de atención al usuario, 13 adjuntos de enfermería, 13 directores y 16 médicos centinelas. Nivel de inseguridad: < 50% respuestas afirmativas por indicador. Los EAP estudiados presentaron niveles de inseguridad en: recepción de nuevos profesionales médicos, administración de inyectables, sistema de recogida de domicilios por enfermería en fines de semana, interconsultas urgentes a especialistas, pacientes agresivos, presencia de incidentes críticos sobre las agendas de los médicos y barreras de comunicación en planes terapéuticos y con inmigrantes. Discusión y conclusiones: La seguridad clínica está en la agenda de los centros de salud. Las áreas detectadas de inseguridad son fácilmente abordables, y están consideradas en el futuro sistema de acreditación de la Generalitat de Catalunya. Los médicos centinelas son más críticos que los directores y los centros docentes, rurales y pequeños, refieren mejor percepción de seguridad (AU)

Objective: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. Design: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. Setting: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). Participants: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. Methods: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. Exclusion criteria: no collaboration. Results: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. Discussion and conclusions: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security (AU)

[Clinical safety audits for primary care centers. A pilot study]. / Auditorías en seguridad clínica para centros de atención primaria. Estudio piloto.

OBJECTIVE: To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. DESIGN: Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. SETTING: Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). PARTICIPANTS: Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. METHODS: Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. EXCLUSION CRITERIA: no collaboration. RESULTS: A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. DISCUSSION AND CONCLUSIONS: Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security.