Walter Mendes

The assessment of adverse events in hospitals in Brazil

OBJECTIVE To evaluate the incidence of adverse events in Brazilian hospitals. DESIGN Retrospective cohort study based on patient record review. SETTING Three teaching hospitals in the State of Rio de Janeiro, Brazil. PARTICIPANTS Random sample (1103) of 27 350 adult patients admitted in 2003. Patients under 18 years old, psychiatric patients and patients whose length of stay was less than 24 hr were excluded, and obstetric cases were included. MAIN OUTCOME MEASURE(S) Incidence of patients with adverse events; proportion of preventable adverse events; number of adverse events per 100 patients and incidence density of adverse events per 100 patient-days. RESULTS The incidence of patients with adverse events was 7.6% (84 of 1103 patients). The overall proportion of preventable adverse events was 66.7% (56 of 84 patients). The incidence density was 0.8 adverse events per 100 patient-days (103 of 13,563 patient-days). The patients ward was the most frequent location of adverse events (48.5%). In regard to classification, surgical adverse events were the most frequent ones (35.2%). CONCLUSIONS The incidence of patients with adverse events at the three hospitals was similar to that in international studies. However, the proportion of preventable adverse events was much higher in the Brazilian hospitals.

Revisão dos estudos de avaliação da ocorrência de eventos adversos em hospitais

OBJETIVO: Rever os estudos sobre a ocorrencia de eventos adversos em hospitais, com objetivo de avaliar as metodologias empregadas e os seus resultados. METODOLOGIA: Revisao sistematica da literatura cientifica sobre avaliacao da ocorrencia de evento adverso em hospitais. Esta pesquisa incluiu apenas os estudos que empregaram na avaliacao o metodo de revisao retrospectiva de prontuario do paciente. A analise dos estudos abordou a definicao de evento adverso e de eventos adversos evitaveis, a incidencia, a forma de aplicacao do metodo de revisao retrospectiva; os criterios de avaliacao empregados e as categorias de analise: area clinica, especialidade, local de ocorrencia, momento da ocorrencia do evento adverso, gravidade da lesao. RESULTADOS: Foram identificados nove estudos publicados nos Estados Unidos da America, Australia, Nova Zelândia, Franca, Inglaterra, Dinamarca e Canada, que avaliaram, no total, 92063 prontuarios. A partir da mudanca do enfoque dos estudos, que evoluiu de um carater medico legal para estudos de melhoria de qualidade, o evento adverso passou a ser definido como lesao [injury] nao intencional que resultou em incapacidade [disability] temporaria ou permanente e/ou prolongamento do tempo de permanencia ou morte como consequencia do cuidado prestado. A incidencia de eventos adversos variou de 2,9 a 16,6 por 100 pacientes admitidos em hospitais nos estudos revisados. CONCLUSAO: Em que pesem as diferencas nos criterios de avaliacao e dos resultados nos nove estudos, eles permitem orientar o desenho da metodologia para mensurar um fenomeno cuja magnitude nao e conhecida no Brasil.

Características demográficas dos idosos vinculados ao sistema suplementar de saúde no Brasil

OBJETIVO: Analisar aspectos da cobertura da populacao idosa pelos planos de assistencia medica na saude suplementar e a caracterizacao sociodemografica desses beneficiarios. METODOS: Estudo descritivo da populacao idosa do Brasil e dos estados de Sao Paulo e Rio de Janeiro, no ano de 2006. Foram utilizados dados do Sistema de Informacoes sobre Beneficiarios da Agencia Nacional de Saude Suplementar e dados da Pesquisa Nacional por Amostra de Domicilios. A analise foi conduzida considerando-se as variaveis: sexo, idade, distribuicao por unidade federada, modalidade da operadora, tipo de contratacao e segmentacao do plano. RESULTADOS: As maiores coberturas na populacao geral foram observadas nas faixas etarias de 70 a 79 anos (26,7%) e 80 anos e mais (30,2%). Entre as mulheres na faixa de 80 anos e mais, 33% possuiam plano privado de assistencia medica, e entre os homens, esse percentual foi de 25,9%. Cerca de 80% dos beneficiarios de planos de saude encontravam-se nas regioes Sudeste e Sul, dos quais 55% no eixo Rio-Sao Paulo. As cooperativas medicas tiveram maior cobertura nas faixas mais jovens do que entre os idosos (39% e 34,5% respectivamente) e os planos de autogestao tiveram participacao mais significativa na cobertura de idosos no Pais (22,8% e 13,8%, respectivamente). CONCLUSOES: A cobertura da populacao idosa pelos planos de assistencia medica foi significativa e as faixas etarias iniciadas em 70 anos representaram o percentual de cobertura mais elevado entre a populacao brasileira, especialmente entre as mulheres.

Características de eventos adversos evitáveis em hospitais do Rio de Janeiro

OBJECTIVE To analyze the features of preventable adverse events (AEs) in hospitals inpatient in the State of Rio de Janeiro, in Brazil, in order to identify elements that serve as a substrate for priority actions aimed at improving patient safety. METHODS Analysis of data from a baseline retrospective cohort study to assess the incidence of AEs in a sample of records in three teaching hospitals in the State of Rio de Janeiro to describe the features of preventable AEs. RESULTS In a sample of 1,103 patients, were identified 65 preventable AEs of 56 patients who suffered preventable AEs. The healthcare associated infections (HAI) accounted for 24.6% of preventable AEs; surgical complications and/or anesthetic, 20.0%; damages arising from delay or failure in diagnosis and/or treatment, 18.4%, pressure ulcers, 18.4%; damage from complications of venipuncture, 7.7%; damage due to falls, 6.2%; damage as a result of the use of drugs, 4.6%. The preventable AEs were responsible for additional 373 days of hospital stay. CONCLUSION The HAI is the major preventable AEs, as observed in other developing countries. Despite the limitations of the study, the characterization of preventable AEs indicates that known and effective actions available to reduce HAI, such as hand hygiene, to prevent pressure ulcers, to encourage adherence to protocol and clinical guidelines and to create continuing education programs for health professionals, should compose the list of priorities of hospital managers and health professionals involved in the care of hospitalized patients.

Hospital deaths and adverse events in Brazil

BackgroundAdverse events are considered a major international problem related to the performance of health systems. Evaluating the occurrence of adverse events involves, as any other outcome measure, determining the extent to which the observed differences can be attributed to the patients risk factors or to variations in the treatment process, and this in turn highlights the importance of measuring differences in the severity of the cases. The current study aims to evaluate the association between deaths and adverse events, adjusted according to patient risk factors.MethodsThe study is based on a random sample of 1103 patient charts from hospitalizations in the year 2003 in 3 teaching hospitals in the state of Rio de Janeiro, Brazil. The methodology involved a retrospective review of patient charts in two stages - screening phase and evaluation phase. Logistic regression was used to evaluate the relationship between hospital deaths and adverse events.ResultsThe overall mortality rate was 8.5%, while the rate related to the occurrence of an adverse event was 2.9% (32/1103) and that related to preventable adverse events was 2.3% (25/1103). Among the 94 deaths analyzed, 34% were related to cases involving adverse events, and 26.6% of deaths occurred in cases whose adverse events were considered preventable. The models tested showed good discriminatory capacity. The unadjusted odds ratio (OR 11.43) and the odds ratio adjusted for patient risk factors (OR 8.23) between death and preventable adverse event were high.ConclusionsDespite discussions in the literature regarding the limitations of evaluating preventable adverse events based on peer review, the results presented here emphasize that adverse events are not only prevalent, but are associated with serious harm and even death. These results also highlight the importance of risk adjustment and multivariate models in the study of adverse events.

Avaliação de eventos adversos cirúrgicos em hospitais do Rio de Janeiro

A study on surgical adverse events (AE) is relevant because of the frequency of these events, because they are in part attributable to deficiencies in health care, because of their considerable impact on patient health and economic consequences on social and health expenditures, and because this study is an assessment tool for quality of care. We aimed to evaluate the incidence and the contributive factors of surgical AE in hospitals of Rio de Janeiro. This retrospective cohort study aimed to perform a descriptive analysis of secondary data obtained from the Adverse Events Computer Program, which was developed for collecting data for the assessment of AE in three teaching hospitals in the state of Rio de Janeiro. Incidence of patients with surgical AE was 3.5% (38 of 1,103 patients) (95% CI 2.4 - 4.4) and the proportion of patients submitted to surgery among patients with surgical AE was 5.9% (38 of 643) (95% CI 4.1 - 7.6). The proportion of avoidable surgical AE was 68.3% (28 of 41 events) and the proportion of patients with avoidable surgical AE was 65.8% (25 of 38 patients). One in five patients with surgical AE had a permanent disability or died. Over 60% of the cases were classified as not complex or of low complexity, and with low risk for care-related AE.

Efeitos adversos a medicamentos em hospital público: estudo piloto

The results from implementing a strategy for monitoring adverse effects from drugs in a public hospital in the municipality of Rio de Janeiro, Southeastern Brazil, in 2007, were analyzed. Based on retrospective analysis of 32 medical files, adverse effects were found in 16%. To identify these effects, 38 tracking criteria were needed. Among these, the main ones were the use of antiemetics, abrupt cessation of medication and over-sedation. Despite the difficulties, especially in relation to access to information and the record quality, application of these tracking criteria seems to be viable. To improve the implementation of the method, it is suggested that the data collection should be computerized and risk adjustment indicators should be sought.Fueron analizados los resultados de la implantacion de estrategia de monitoreo de efectos adversos a los medicamentos en hospital publico en Rio de Janeiro, Sureste de Brasil, en 2007. Con base en analisis retrospectivo de 32 prontuarios fueron encontrados efectos adversos en 16%. Para identificarlos, fueron necesarios 38 criterios rastreadores, de los cuales los principales fueron: uso de antiemeticos, interrupcion abrupta de medicamentos y sedacion excesiva. A pesar de las dificultades, sobre todo relacionadas con el acceso a las informaciones y a la calidad de los registros, la aplicacion de los criterios rastreadores parece ser viable. Para perfeccionar la implantacion del metodo, se sugiere informatizar la colecta de datos y buscar indicadores de ajuste del riesgo.

Distribuição das espécies do gênero Anopheles (Diptera, Culicidae) no Estado do Maranhão, Brasil

We studied the distribution and diversity of Anopheles species in 123 counties (municipalities) in the State of Maranhão, Brazil. The basic method consisted of capturing female specimens inside and around human dwellings between 6 PM and 6 AM from January 1992 to December 2001. A total of 84,467 specimens belonging to 24 species were captured, with a predominance of A. triannulatus sensu lato (20,788), A. darlingi (19,083), A. nuneztovari (16,884), A. albitarsis s.l. (14,352), A. aquasalis (8.202), and A. evansae (2,885). The other 18 species together accounted for only 2.7% of the total. The species found in the most counties were A. albitarsis s.l. (109 counties), A. triannulatus s.l. (106), A. nuneztovari (93), A. darlingi (87), and A. evansae (64). The richness and wide distribution of anopheline species in Maranhão agree with the States geographic position among Brazils macro-regions, resulting in a mixed fauna with representative elements from these regions.

Espécies de Triatominae (Hemiptera: Reduviidae) do Estado do Maranhão, Brasil

Cerca de 15 especies de Triatominae sao de conhecida ocorrencia no Estado do Maranhao. Na Ilha de Sao Luis, zona do litoral, dez especies ja foram encontradas associadas as areas silvestres: Eratyrus mucronatus, Psammolestes tertius, Panstrongylus diasi, e as habitacoes das areas urbanas e periurbanas: Panstrongylus geniculatus, Panstrongylus lignarius, Rhodnius nasutus, Rhodnius neglectus, Rhodnius pictipes, Rhodnius robustus e Triatoma rubrofasciata. Esta ultima tem sido encontrada exclusivamente na Ilha de Sao Luis, ao passo que as demais tambem ocorrem no interior do Estado. Na zona litorânea, nao foram encontradas: Panstrongylus megistus, Triatoma brasiliensis, Triatoma maculata, Triatoma pseudomaculata e Rhodnius brethesi, as quais sao encontradas nas areas mais secas das zonas que formam as chapadas e os chapadoes do Sudeste e Sul do Estado.

Estudo de incidência de eventos adversos hospitalares, Rio de Janeiro, Brasil: avaliação da qualidade do prontuário do paciente

Abstract Objective : To evaluate the quality of information obtained from medical records of three teaching hospitals in the State of Rio de Janeiro, Brazil, which participated in a previous study on the incidence of adverse events (AE) . Methods : Descriptive study based on the information collected from medical record review during the incidence study. An evaluation score of completeness, measuring the proportion of absent information was applied, based on the following items: excellent (less than 5%), good (5% - 10%), moderate (11% - 20%), bad (21% - 50%), and very bad (more than 50%). Proportions and 95%confidence intervals were calculated for each variable obtained from medical records. Analysis was developed for the whole group of patients, by hospital groups, and by patients with and without AE. For analyzing the group of variables, means were estimated and the t-student’s test was applied for comparisons. The Chi-squared test and Fisher’s statistics were applied for comparing patients with and without AE.