viernes, 13 de enero de 2017

Seguridad del paciente / Patient safety

Enero 9, 2017. No. 2564

Seguridad de los pacientes ambulatorios
Patient Safety in Ambulatory Settings
Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Oct. Report No.: 16(17)-EHC033-EF.
BACKGROUND: Even though most medical care occurs in ambulatory settings, the patient safety movement originated in, and has been mainly focused on, adverse events in hospitalized patients. However, it is increasingly clear that the ambulatory setting is critically important. Ambulatory care differs substantially from inpatient care in ways that affect patient safety hazards and interventions. To better understand the scope of ambulatory care safety issues and the types of evaluations that have been reported for ambulatory patient safety practice (PSP), we have been tasked by AHRQ to provide an overview of key issues relating to the interventions. PURPOSE: This Technical Brief had the following guiding questions: What are the evidence-based hospital patient safety practices that may be applicable to the ambulatory care setting? What are the ambulatory care patient safety practices that have been studied in the literature? Which ones have not been broadly implemented or studied beyond a single ambulatory care center? What tools, settings, and other factors (such as implementation of Patient-Centered Medical Home and team-based care) may influence the implementation and spread of ambulatory care patient safety practices? METHODS: We integrated insights from discussions with eight Key Informants (KIs) with a literature scan of 28 safety topics/strategies. FINDINGS: KIs identified medication safety, diagnosis, transitions, referrals, and testing as important ambulatory care safety topics, and strategies that addressed communications, health IT, teams, patient engagement, organizational approaches, and safety culture as the most important strategies. The literature search found a moderate number of published intervention evaluations for e-prescribing, medication errors and adverse events, pharmacist-based interventions, and transitions from hospital to ambulatory care. There were few published evaluations of interventions for other targets/strategies. These results will assist AHRQ in developing a research agenda in ambulatory patient safety. SUMMARY AND IMPLICATIONS: Both key informant interviews and the literature scan reveal important differences between inpatient and ambulatory safety. There are significant gaps in ambulatory safety research, including a notable lack of studies on patient engagement and timely and accurate diagnosis. Key informants recommend prospective, large-scale studies in diverse ambulatory settings to develop and test ambulatory safety interventions.

Sistemas de informe de incidentes: estudio comparativo de dos hospitales
Incident reporting systems: a comparative study of two hospital divisions.
Arch Public Health. 2016 Aug 15;74:34. doi: 10.1186/s13690-016-0146-8. eCollection 2016.
BACKGROUND: Previous studies of incident reporting in health care organizations have largely focused on single cases, and have usually attended to earlier stages of reporting. This is a comparative case study of two hospital divisions' use of an incident reporting system, and considers the different stages in the process and the factors that help shape the process. METHOD: The data was comprised of 85 semi-structured interviews of health care practitioners in general internal medicine, obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. This work is part of a larger qualitative study found elsewhere in the literature. RESULTS: The findings showed that there were major differences between the two divisions in terms of: a) what comprised a typical report (outcome based vs communication and near-miss based); b) how the reports were investigated (individual manager vs interdisciplinary team); c) learning from reporting (interventions having ambiguous linkages to the reporting system vs interventions having clear linkages to reported incidents); and d) feedback (limited feedback vs multiple feedback). CONCLUSIONS: The differences between the two divisions can be explained in terms of: a) the influence of litigation on practice, b) the availability or lack of interprofessional training, and c) the introduction of the reporting system (top-down vs bottom-up approach). A model based on the findings portraying the influences on incident reporting and learning is provided. Implications for practice are addressed.
KEYWORDS: Internal medicine; Medical errors; Neonatology; Obstetrics; Patient safety; Qualitative research

Mejorando los informes sobre eventos de seguridad entre residentes y profesores
Improving Patient Safety Event Reporting Among Residents and Teaching Faculty.
Ochsner J. 2016 Spring;16(1):73-80Abstract
A June 2012 site visit report from the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review revealed that residents and physicians at TriHealth, Inc., a large, nonprofit independent academic medical center serving the Greater Cincinnati area in Ohio, had an opportunity to improve their awareness and understanding of the hospital's system for reporting patient safety concerns in 3 areas: (1) what constitutes a reportable patient safety event, (2) who is responsible for reporting, and (3) how to use the hospital's current reporting system. METHODS: To improve the culture of patient safety, we designed a quality improvement project with the goal to increase patient safety event reporting among residents and teaching faculty. An anonymous questionnaire assessed physicians' and residents' attitudes and experience regarding patient safety event reporting. An educational intervention was provided in each graduate medical education program to improve knowledge and skills related to patient safety event reporting, and the anonymous questionnaire was distributed after the intervention. We compared the responses to the preintervention and postintervention questionnaires and tracked monthly patient safety event reports for 1 year postintervention. RESULTS: The number of patient safety event reports increased following the educational intervention; however, we saw wide variability in reporting per month. On the postintervention questionnaire, participants demonstrated improved knowledge and attitudes toward patient safety event reporting. CONCLUSION: The goal of this unique project was to increase patient safety event reporting by both residents and teaching faculty in 6 residency programs through education. We achieved this goal through an educational intervention tailored to the institution's new event reporting system delivered to each residency program. We clearly understand that improvements in quality and patient safety require ongoing effort. The keys to ongoing sustainability include (1) developing patient safety faculty and resident experts in each training program to teach patient safety and to be role models, (2) working toward decreasing the barriers to reporting, and (3) providing timely feedback and system changes.
KEYWORDS: Education-graduate-medical; hospital incident reporting; medical errors; patient safety; quality improvement; risk management

5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT
Mayo 4-6, 2017, Mexicali, México
Informes Dr. Hugo Martínez Espinoza 
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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