Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.10.004
F.J. Luque Mellado, F.J. Martos Molines, Y. Lebrero Villa
Objective
To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation.
Material and method
Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months.
Results
During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety.
Conclusions
The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality.
{"title":"Sistema integral de gestión de incidencias en atención primaria: más allá de la seguridad del paciente","authors":"F.J. Luque Mellado, F.J. Martos Molines, Y. Lebrero Villa","doi":"10.1016/j.cali.2017.10.004","DOIUrl":"https://doi.org/10.1016/j.cali.2017.10.004","url":null,"abstract":"<div><h3>Objective</h3><p>To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation.</p></div><div><h3>Material and method</h3><p>Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months.</p></div><div><h3>Results</h3><p>During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety.</p></div><div><h3>Conclusions</h3><p>The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 335-341"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.07.002
R. Ladenheim, D. Macchiavello, M. Milberg
Introduction
One of the factors identified to reduce medical errors has been the organisational culture. Education is proposed as a tool for its modification, but this does not have a unique way of being achieved. This paper sought to describe a patient safety elective for medical students and to determine their perceptions on the subject.
Materials and methods
A descriptive study was performed in the Center of Medical Education and Clinical Investigations, in Argentina. Every student who participated in the elective was included, and there were no exclusion criteria. An online survey was conducted on all participants, and individual interviews were conducted on a convenience sample.
Results
The subject was chosen by 54 students out of a total of 274 students between 2011 and 2014. All (100%) of the students completed the course and passed the exam, and stated that they would recommend the elective. Most of the students (n = 26) agreed that patient safety content should be mandatory, that its content was novel, and that the subject's structure seemed appropriate, with 21 saying that it was the first time they had been talked about these issues. From the individual interviews, students emphasised the novelty of the subject, and that their perception on patient safety issues had increased.
Discussion
The proposed elective had a good reception among students. The methodology planned for its teaching seemed appropriate. Inter-professional education in patient safety should be implemented to improve student competencies in the subject.
{"title":"Inclusión de la seguridad del paciente en la carrera de Medicina: descripción de la experiencia y percepción de los estudiantes","authors":"R. Ladenheim, D. Macchiavello, M. Milberg","doi":"10.1016/j.cali.2017.07.002","DOIUrl":"10.1016/j.cali.2017.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>One of the factors identified to reduce medical errors has been the organisational culture. Education is proposed as a tool for its modification, but this does not have a unique way of being achieved. This paper sought to describe a patient safety elective for medical students and to determine their perceptions on the subject.</p></div><div><h3>Materials and methods</h3><p>A descriptive study was performed in the Center of Medical Education and Clinical Investigations, in Argentina. Every student who participated in the elective was included, and there were no exclusion criteria. An online survey was conducted on all participants, and individual interviews were conducted on a convenience sample.</p></div><div><h3>Results</h3><p>The subject was chosen by 54 students out of a total of 274 students between 2011 and 2014. All (100%) of the students completed the course and passed the exam, and stated that they would recommend the elective. Most of the students (n<!--> <!-->=<!--> <!-->26) agreed that patient safety content should be mandatory, that its content was novel, and that the subject's structure seemed appropriate, with 21 saying that it was the first time they had been talked about these issues. From the individual interviews, students emphasised the novelty of the subject, and that their perception on patient safety issues had increased.</p></div><div><h3>Discussion</h3><p>The proposed elective had a good reception among students. The methodology planned for its teaching seemed appropriate. Inter-professional education in patient safety should be implemented to improve student competencies in the subject.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 316-321"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35611331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.07.003
Á. Giménez-Marín , F. Rivas-Ruiz , Grupo de la Comisión de Gestión del Laboratorio Clínico de la Sociedad Española de Bioquímica Clínica y Patología Molecular (SEQC), España
Aim
To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety.
Method
A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology.
Results
The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4 of the 6 areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals.
Conclusions
The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems.
{"title":"Gobierno clínico y cultura en seguridad de los laboratorios clínicos en el Sistema Nacional de Salud español","authors":"Á. Giménez-Marín , F. Rivas-Ruiz , Grupo de la Comisión de Gestión del Laboratorio Clínico de la Sociedad Española de Bioquímica Clínica y Patología Molecular (SEQC), España","doi":"10.1016/j.cali.2017.07.003","DOIUrl":"https://doi.org/10.1016/j.cali.2017.07.003","url":null,"abstract":"<div><h3>Aim</h3><p>To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety.</p></div><div><h3>Method</h3><p>A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology.</p></div><div><h3>Results</h3><p>The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4<!--> <!-->of the 6<!--> <!-->areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals.</p></div><div><h3>Conclusions</h3><p>The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 303-315"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.07.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90028024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.10.003
I. Araya Farías , N. Febré
Objective
To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU).
Material and methods
A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact.
Results
Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program.
Conclusions
The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%.
{"title":"Impacto de un programa de gestión de riesgo en la tasa de úlceras por presión","authors":"I. Araya Farías , N. Febré","doi":"10.1016/j.cali.2017.10.003","DOIUrl":"10.1016/j.cali.2017.10.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU).</p></div><div><h3>Material and methods</h3><p>A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: <em>1)</em> PU incidence study; <em>2)</em> Intervention by implementing a risk management program, and <em>3)</em> Assessment of the impact.</p></div><div><h3>Results</h3><p>Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (<em>P</em><.05) after the risk management program.</p></div><div><h3>Conclusions</h3><p>The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 322-327"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35284396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.09.003
N.D. Bravo Vallejos
Background
The concept of Social Capital (SC), originally described by Durkheim (1893), is composed of dimensions related to cohesion and trust between members of a social group, and considered by the Word Health Organization (WHO) as part of the social determinants of public health for the decrease of inequities and inequalities in health provision.
Objective
To contribute to the dissemination of the concept of SC related to the social determinants of Public Health, in order to offer the reader in-depth content to observe the potential applications and practices in this field.
Methodology
Literature search (Google Academics™, PubMed, Science direct™, Ebsco Host™).
Results
A total of 294 full-text publications were obtained, and those selected were the most influential sources on the evolution and application of the concept of Social Capital, socioeconomic development and health in the last decade.
Conclusion
Although the current evidence shows that Social Capital is a determinant related to health, standards are still needed for its measurement. This could allow the concept to be measured, and facilitate its integration into the form of actions that exert positive influence and contribute to the implementation of institutional interventions planned for development and public health.
{"title":"El capital social como determinante de salud pública","authors":"N.D. Bravo Vallejos","doi":"10.1016/j.cali.2017.09.003","DOIUrl":"10.1016/j.cali.2017.09.003","url":null,"abstract":"<div><h3>Background</h3><p>The concept of Social Capital (SC), originally described by Durkheim (1893), is composed of dimensions related to cohesion and trust between members of a social group, and considered by the Word Health Organization (WHO) as part of the social determinants of public health for the decrease of inequities and inequalities in health provision.</p></div><div><h3>Objective</h3><p>To contribute to the dissemination of the concept of SC related to the social determinants of Public Health, in order to offer the reader in-depth content to observe the potential applications and practices in this field.</p></div><div><h3>Methodology</h3><p>Literature search (Google Academics™, PubMed, Science direct™, Ebsco Host™).</p></div><div><h3>Results</h3><p>A total of 294 full-text publications were obtained, and those selected were the most influential sources on the evolution and application of the concept of Social Capital, socioeconomic development and health in the last decade.</p></div><div><h3>Conclusion</h3><p>Although the current evidence shows that Social Capital is a determinant related to health, standards are still needed for its measurement. This could allow the concept to be measured, and facilitate its integration into the form of actions that exert positive influence and contribute to the implementation of institutional interventions planned for development and public health.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 342-346"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.09.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35580635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.09.001
Á. Estella
{"title":"Del papel a las nuevas tecnologías en la comunicación con nuestros pacientes","authors":"Á. Estella","doi":"10.1016/j.cali.2017.09.001","DOIUrl":"10.1016/j.cali.2017.09.001","url":null,"abstract":"","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 349-350"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35250838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.10.002
R.J. Ellis , C.Y. Ko
{"title":"Improving the quality of surgical care: The American College of Surgeons National Surgical Quality Improvement Program","authors":"R.J. Ellis , C.Y. Ko","doi":"10.1016/j.cali.2017.10.002","DOIUrl":"10.1016/j.cali.2017.10.002","url":null,"abstract":"","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 301-302"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35611333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.09.002
J. Galvez-Olortegui , R. Olortegui-Mariño , D. Paredes-Ayrac , M. Villafan-Broncano
{"title":"Rol de los pacientes y su diversidad cultural en las guías de práctica clínica","authors":"J. Galvez-Olortegui , R. Olortegui-Mariño , D. Paredes-Ayrac , M. Villafan-Broncano","doi":"10.1016/j.cali.2017.09.002","DOIUrl":"10.1016/j.cali.2017.09.002","url":null,"abstract":"","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 347-349"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35632403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1016/j.cali.2017.09.004
A. Conesa González, X. Pastor Duran, R. Lozano-Rubí
Objective
The objective of this study was to evaluate a sample of electronic medical records (EMR) that was sufficiently representative of the different areas of care in a university hospital, as well as to verify the effectiveness of an initial intervention through a second evaluation.
Methods
Medical records audits were performed in 2012 and 2013 by a blind peer review of random samples of care episodes, proportional to the activity of each clinical department, and with the same evaluation method being applied to all of them.
Results
More than 1,000 episodes of care were reviewed in the 2 audits. A significant improvement was found in hospital admissions (P=.000) in all the sections of the EMR analysed (P=.002), and was especially significant for the reason for consultation, for which its completion increased by 8.5% (p<.05), and also in the sections of the current process record (7.1%), physical examination (4.7%), allergies (3.9%), and clinical course (3.6%). The assessment of the discharge report, as a whole, showed an improvement (P=.001). In outpatient follow-up visits, a significant positive improvement was observed in the 4 sections evaluated (P<.05), and also overall (P=.000).
Conclusions
According to study conditions, the dissemination of the results was effective in improving the quality of the EMR. The results have made it possible to implement actions to review the work processes in certain departments, and also the partial redesign of the interface on being a reproducible methodology accepted by the organisation.
{"title":"Efectividad de la evaluación de historias clínicas informatizadas en un hospital universitario","authors":"A. Conesa González, X. Pastor Duran, R. Lozano-Rubí","doi":"10.1016/j.cali.2017.09.004","DOIUrl":"10.1016/j.cali.2017.09.004","url":null,"abstract":"<div><h3>Objective</h3><p>The objective of this study was to evaluate a sample of electronic medical records (EMR) that was sufficiently representative of the different areas of care in a university hospital, as well as to verify the effectiveness of an initial intervention through a second evaluation.</p></div><div><h3>Methods</h3><p>Medical records audits were performed in 2012 and 2013 by a blind peer review of random samples of care episodes, proportional to the activity of each clinical department, and with the same evaluation method being applied to all of them.</p></div><div><h3>Results</h3><p>More than 1,000 episodes of care were reviewed in the 2<!--> <!-->audits. A significant improvement was found in hospital admissions (<em>P=</em>.000) in all the sections of the EMR analysed (<em>P=</em>.002), and was especially significant for the reason for consultation, for which its completion increased by 8.5% (p<.05), and also in the sections of the current process record (7.1%), physical examination (4.7%), allergies (3.9%), and clinical course (3.6%). The assessment of the discharge report, as a whole, showed an improvement (<em>P=</em>.001). In outpatient follow-up visits, a significant positive improvement was observed in the 4<!--> <!-->sections evaluated (<em>P</em><.05), and also overall (<em>P=</em>.000).</p></div><div><h3>Conclusions</h3><p>According to study conditions, the dissemination of the results was effective in improving the quality of the EMR. The results have made it possible to implement actions to review the work processes in certain departments, and also the partial redesign of the interface on being a reproducible methodology accepted by the organisation.</p></div>","PeriodicalId":101101,"journal":{"name":"Revista de Calidad Asistencial","volume":"32 6","pages":"Pages 328-334"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cali.2017.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35580664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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