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San Jose-Saras D, Valencia-Martín JL, Vicente-Guijarro J, Moreno-Nunez P, Pardo-Hernández A, Aranaz-Andres JM. Adverse events: an expensive and avoidable hospital problem. Ann Med 2022; 54:3157-3168. [PMID: 36369717 PMCID: PMC9665082 DOI: 10.1080/07853890.2022.2140450] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. METHODS This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. RESULTS A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. CONCLUSIONS The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messagesAdverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.
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Affiliation(s)
- Diego San Jose-Saras
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Biología de Sistemas, Alcalá de Henares, Spain
| | - José L Valencia-Martín
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain
| | - Jorge Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain
| | - Paloma Moreno-Nunez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain
| | - Alberto Pardo-Hernández
- Subdirección General de Calidad Asistencial, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain.,Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jesús M Aranaz-Andres
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de de Salud Carlos III, Madrid, Spain
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Bonilla-García JL, Cortiñas-Sáenz M, Pozo-Gavilán ED. Opioids and immunosupression in oncological postoperative patients. ACTA ACUST UNITED AC 2017; 63:753-763. [PMID: 29239457 DOI: 10.1590/1806-9282.63.09.753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/26/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU)-acquired infection after a schedule of sedoanalgesia of at least 6 days. METHOD All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Bivariate analysis was performed to determine risk factors for infection acquired in the unit. A comparative study between periods of 6 days before and after the cessation of remifentanil was performed. Paired samples test and McNemar test was used for quantitative and categorical variables, respectively. RESULTS There were 1,789 patients admitted to the PACU during the study and the population eligible was constituted for 102 patients. The incidence rate of PACU-acquired infection was 38 per 1,000 PACU days. Ventilator-associated pneumonia was the most frequently diagnosed PACU-acquired infection. Pseudomona aeruginosa was the most frequently isolated microorganism. Hospital mortality was 36.27%. No statistically significant differences were seen in the incidence of HAI in cancer patients in relation to discontinuation of remifentanil (p=0.068). CONCLUSION The baseline state of immunosuppression of cancer patients does not imply a higher incidence of HAI in relation to the interruption of remifentanil. It would be of interest to carry out a multicenter PACU study that included immunological patterns.
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Affiliation(s)
| | | | - Esperanza Del Pozo-Gavilán
- Departamento de Farmacología e Instituto de Neurociencias, Facultad de Medicina, Universidad de Granada, Granada, Spain
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Hernández-García I, Sáenz-González M, Meléndez D. Evaluación de un programa formativo para la prevención de las infecciones relacionadas con la asistencia sanitaria. ACTA ACUST UNITED AC 2013; 28:96-108. [DOI: 10.1016/j.cali.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 09/01/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
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