Carlos Aibar

La asistencia sanitaria como factor de riesgo: los efectos adversos ligados a la práctica clínica

The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals,

Prevalence of Parkinson's disease in lower Aragon, Spain.

We attempted to measure the prevalence of Parkinsons disease (PD) and to improve PD diagnosis in Lower Aragon (LA), a rural area located in northeast Spain with an elderly population numbering 60,724.

A study of the prevalence of adverse events in primary healthcare in Spain

BACKGROUND Healthcare practices involve risks for patients, but there has been little research to date on the occurrence of adverse events (AE) in primary care (PC). The frequency of AE in PC in Spain, the factors that contribute to their occurrence, their severity and their preventability, were analysed. METHODS Observational cross-sectional study was carried out in 48 PC centres in 16 regions of Spain. PC professionals were asked to assess whether the AE was caused by the healthcare or if it was an expectable consequence of the patients underlying condition. A total of 452 healthcare professionals who attended 96 047 consultations were involved. RESULTS A total of 773 AE were identified, so that the point prevalence of AE was 0.8% [95% confidence interval (CI) 0.76-0.85]. A majority of AE (64.3%) were considered preventable and only 5.9% were severe, usually related to medication [odds ratio (OR) = 4.6; 95% CI 2.1-10.3]. The most frequent causal factor of the AE was associated with medication (adverse drug reactions and medication errors), but problems in communication and management were at the root of many of the AE. Nurses reported more preventable AE (OR = 1.9; 95% CI 1.2-2.8). CONCLUSION In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.

Revisión sistemática de los estudios de satisfacción realizados en España en el período 1986-2001

Resumen Objetivos Analizar la finalidad, la metodologia y la aplicabilidad de los estudios sobre satisfaccion de pacientes en el Sistema Nacional de Salud (SNS) espanol. Material y metodos Revision sistematica de los estudios relacionados con la satisfaccion de los pacientes en el SNS entre los anos 1986 y 2001, incluidos en el Indice Medico Espanol y en Medline. Resultados Se revisaron 124 articulos sobre la satisfaccion de los pacientes que se centraban casi a partes iguales entre la atencion primaria y la especializada. El objeto de estudio mas frecuente fue un proceso asistencial concreto (33,9%), un recurso sanitario (27,4%) o un modelo organizativo (21%). Los trabajos de metodologia cuantitativa (90%) eran los predominantes. En el 71% de los trabajos se utilizan instrumentos de elaboracion propia para medir la satisfaccion, pero solo en el 46,8% de las ocasiones se han sometido a algun proceso de validacion. El diseno de los estudios tenia problemas importantes de validez metodologica en el 42% de las ocasiones. Solo en el 24% de ellos se expresaba alguna propuesta de cambio que pudiera hacerse extensible a otros lugares. Conclusiones Existen pocas evidencias publicadas de que el SNS este cambiando en funcion de los estudios sobre la satisfaccion de los pacientes. Tampoco pueden proponerse cambios significativos en la organizacion de la asistencia y en la practica clinica de acuerdo con las investigaciones hechas hasta el momento en nuestro entorno.

El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España

BACKGROUND In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <<process>> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study. RESULTS Consult request took place 10.6 days (on average) after the patients admission (<<lagtime 1>>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<<lagtime 2>>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <<complex>>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <<process>>. CONCLUSIONS The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <<quality assurance>> is also emphasized.

Incidencia e impacto de los efectos adversos en dos hospitales

Objectives: To present the preliminary results of the IDEA project relating to the effect and impact of adverse events in two of the hospitals included in the study.

Ebola’s media outbreak: lessons for the future

On 8 August 2014, the World Health Organization (WHO’s) Emergency Committee declared the Ebola virus disease (EVD or ‘Ebola’) outbreak a Public Health Emergency of International Concern. On 6 October 2014, the first case of EVD contracted in Europe was diagnosed.1 A healthcare worker was infected, after providing treatment to an Ebola patient in Spain. This secondary case, like those that occurred in Dallas, tested both the responsiveness of the healthcare system, and the attitudes and skills of the population, the health professionals and the media. Virulence and infectivity are epidemiological characteristics that define the magnitude and significance of an infectious disease. EVD virulence is evident as shown by its lethality. The number of cases this time exceeded past outbreaks suggesting people that infectivity was greater.2 These factors coalesced to generate social alarm. Unlike EVD, transmitted by direct contact with an infected patient or contaminated material, virus fear can spread in …

Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide

PurposeDetermining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care.MethodsThis retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics.ResultsThe MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide.ConclusionsThe MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.

Evaluación de la calidad de las guías y protocolos de lavado de manos existentes en España

The aim of this study was to evaluate, through a retrospective and external study, the quality of Spanish hand hygiene guidelines and protocols. None of the guidelines achieved a score of 100% in all areas. The mean score was only 43.9%, ranging from 23.8% for rigorous design to 69.4% for clarity and presentation. None of the protocols achieved a score of 100% in all areas; 100% clearly named the health problem dealt with in the protocol, which was reflected in its contents, and complied with length specifications and absence of formal defects; 80% had a paginated index and 66.7% a definition of compliance, while only 6.7% contained information on organization and functioning, the necessary resources, procedures and evaluation period. In general, the average compliance was less than 50%, except in one guideline, which met 87.5% of the requirements Problems with references were found in 77.7%. In view of the problems detected, a new guide for the drafting of hand hygiene guidelines and protocols is proposed.The aim of this study was to evaluate, through a retrospective and external study, the quality of Spanish hand hygiene guidelines and protocols. None of the guidelines achieved a score of 100% in all areas. The mean score was only 43.9%, ranging from 23.8% for rigorous design to 69.4% for clarity and presentation. None of the protocols achieved a score of 100% in all areas; 100% clearly named the health problem dealt with in the protocol, which was reflected in its contents, and complied with length specifications and absence of formal defects; 80% had a paginated index and 66.7% a definition of compliance, while only 6.7% contained information on organization and functioning, the necessary resources, procedures and evaluation period. In general, the average compliance was less than 50%, except in one guideline, which met 87.5% of the requirements Problems with references were found in 77.7%. In view of the problems detected, a new guide for the drafting of hand hygiene guidelines and protocols is proposed.