Javier Júdez

El deber de no abandonar al paciente

a Medico de Familia. Coordinador del Grupo Comunicacion y Salud. SEMFyC. EAP Gavarra, ICS. Cornella de Llobregat. Barcelona. bMedico, Jefe de Proyectos de Bioetica y Educacion Medica. Fundacion de Ciencias de la Salud. Madrid. cJurista. Licenciado en Ciencias Morales. Profesor en el ISP de la Universidad Pontificia de Salamanca. dMedico de Familia. Coordinadora de la Unidad Docente de MFyC. Santander-Laredo. eEnfermera. Centro de Salud Actur Sur.

Indicadores de calidad en colonoscopia. Procedimiento de la colonoscopia

The aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Española de Patología Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification.espanolEl objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad utiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este segundo resultado se proponen procedimientos e indicadores de la colonoscopia. Primero, se ha disenado un diagrama de los pasos previos y consecutivos a la realizacion de la colonoscopia. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Espanola de Patologia Digestiva (SEPD), han realizado una revision cualitativa de la literatura haciendo referencia a la busqueda de indicadores de calidad en la colonoscopia. Posteriormente, por un procedimiento de analisis por pares se ha hecho la seleccion y analisis de la literatura seleccionada. Se han identificado un total de 13 indicadores especificos, independientemente de los ya descritos comunes, de los cuales diez son de proceso (uno de preprocedimiento, siete de procedimiento y dos de posprocedimiento) y tres, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificacion utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation). EnglishThe aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Espanola de Patologia Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification.

RECALAD. Patient care at National Health System Digestive Care Units - A pilot study, 2015

OBJECTIVES To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. MATERIAL AND METHODS A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). RESULTS Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities. CONCLUSIONS The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement.