1
|
Vicente-Guijarro J, San Jose-Saras D, Aranaz-Andres JM. Inappropriate Hospitalization: Measurement approaches. Med Clin (Barc) 2024:S0025-7753(24)00144-1. [PMID: 38637219 DOI: 10.1016/j.medcli.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Jorge Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja (UNIR). La Rioja, Logroño, España
| | - Diego San Jose-Saras
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja (UNIR). La Rioja, Logroño, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
| | - Jesús María Aranaz-Andres
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja (UNIR). La Rioja, Logroño, España
| |
Collapse
|
2
|
San Jose-Saras D, Vicente-Guijarro J, Sousa P, Moreno-Nunez P, Aranaz-Andres JM. Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study. BMC Med 2023; 21:312. [PMID: 37592294 PMCID: PMC10433586 DOI: 10.1186/s12916-023-03024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. METHODS An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. RESULTS A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample. CONCLUSIONS Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.
Collapse
Affiliation(s)
- Diego San Jose-Saras
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Universidad de Alcalá, School of Medicine and Health Sciences, Department of Medicine and Medical Specialities, Alcalá de Henares, Spain
| | - Jorge Vicente-Guijarro
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain.
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain.
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paloma Moreno-Nunez
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
| | - Jesús María Aranaz-Andres
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
| |
Collapse
|
3
|
San Jose-Saras D, Vicente-Guijarro J, Sousa P, Moreno-Nunez P, Espejo-Mambié M, Aranaz-Andres JM. Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach. J Gen Intern Med 2023; 38:1655-1663. [PMID: 36717430 DOI: 10.1007/s11606-022-07998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. OBJECTIVES To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. DESIGN AND PARTICIPANTS This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients' intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. MAIN MEASURES AND KEY RESULTS A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). CONCLUSIONS The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact.
Collapse
Affiliation(s)
- D San Jose-Saras
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Biología de Sistemas, Alcalá de Henares, Spain.,Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain.
| | - P Sousa
- National School of Public Health, Public Health Research Center, Comprehensive Health ResearchCenter, CHRC, NOVA University Lisbon, Lisbon, Lisbon, Portugal
| | - P 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, La Rioja, Spain
| | - M Espejo-Mambié
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J M Aranaz-Andres
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Moreno-Nunez P, Bueno-Cavanillas A, San Jose-Saras D, Vicente-Guijarro J, Fernández Chávez AC, Aranaz-Andrés JM. How Does Vaccination against SARS-CoV-2 Affect Hospitalized Patients with COVID-19? J Clin Med 2022; 11:jcm11133905. [PMID: 35807189 PMCID: PMC9267443 DOI: 10.3390/jcm11133905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The development of effective COVID-19 vaccines has reduced the impact of COVID-19 on the general population. Our study aims to analyze how vaccination modifies the likelihood of death and length of stay in hospitalized patients with COVID-19; (2) Methods: A retrospective cohort study of 1927 hospitalized patients infected with COVID-19 was conducted. Information was gathered on vaccination status, hospitalization episode, and clinical profile of the patients. The effect of vaccination on mortality was analyzed using a multiple logistic regression model, and length of stay was analyzed using linear regression. The performance and fit of the models were evaluated; (3) Results: In hospitalized patients with COVID-19, the risk of dying during admission in vaccinated patients was half that of non-vaccinated (OR: 0.45; CI 95%: 0.25 to 0.84). In patients who were discharged due to improvement, the reduction in hospital stay in vaccinated patients was 3.17 days (CI 95%: 5.88 to 0.47); (4) Conclusions: Patients who, despite having been vaccinated, acquire the infection by SARS-CoV-2, have a significant reduction of the risk of death during admission and a reduction of hospital stay compared with unvaccinated patients.
Collapse
Affiliation(s)
- Paloma Moreno-Nunez
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (P.M.-N.); (J.V.-G.); (A.C.F.C.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
- School of Medicine, Universidad Internacional de La Rioja, 26006 Logroño, La Rioja, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, Granada University, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Diego San Jose-Saras
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (P.M.-N.); (J.V.-G.); (A.C.F.C.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
- Department of Medicine and Medical Specialities, School of Medicine, Alcalá University, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-91-336-83-72
| | - Jorge Vicente-Guijarro
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (P.M.-N.); (J.V.-G.); (A.C.F.C.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
- School of Medicine, Universidad Internacional de La Rioja, 26006 Logroño, La Rioja, Spain
| | - Abelardo Claudio Fernández Chávez
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (P.M.-N.); (J.V.-G.); (A.C.F.C.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
- School of Medicine, Universidad Internacional de La Rioja, 26006 Logroño, La Rioja, Spain
| | - Jesús María Aranaz-Andrés
- Department of Preventive Medicine and Public Health, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (P.M.-N.); (J.V.-G.); (A.C.F.C.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
- School of Medicine, Universidad Internacional de La Rioja, 26006 Logroño, La Rioja, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | |
Collapse
|
6
|
Vicente-Guijarro J, Valencia-Martín JL, Fernández-Herreruela C, Sousa P, Mira Solves JJ, Aranaz-Andrés JM. Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018. J Patient Saf 2022; 18:276-286. [PMID: 35503970 PMCID: PMC9162075 DOI: 10.1097/pts.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Compensation claims are a useful source of information on patient safety research. The purpose of this study was to determine the main causes of surgical compensation claims and their financial impact on the health system. METHODS A descriptive observational study with analytical components was carried out on compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. We analyzed the frequency, causes, consequences, locations and surgical settings of these claims, the time of judicial procedure, and compensation adjusted to the Consumer Price Index. RESULTS There were 1172 compensation claims. "orthopedic surgery and traumatology" (27.4%), "gynecology and obstetrics" (25.7%), and "general surgery" (17.2%) were the main surgical settings involved. The most frequent causes were surgical error (42.4%) and treatment error (30.9%). The main sequelae were musculoskeletal (20.0%), neurological (17.7%), and obstetric (17.7%). The average time from incident to resolution of claims was 6.3 years. A total of 20.1% of these claims were successful, particularly those involving retained surgical foreign bodies (71.4% successful claims; P < 0.001). The total compensation paid was €56,338,247 (an average of €17,207 per claim). Compensation was higher in cases with respiratory sequelae (median, 131,600; P = 0.033), death (75,916; P < 0.001), and neurological (60,000; P = 0.024). CONCLUSIONS Compensation claims associated with surgical procedures are made on a variety of grounds. They are drawn-out proceedings, and patients are only successful in 20% of cases.
Collapse
Affiliation(s)
- Jorge Vicente-Guijarro
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Acalá de Henares
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
| | - José Lorenzo Valencia-Martín
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla
| | - Carlos Fernández-Herreruela
- Dirección Asistencial Noroeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud
- Perito Médico de Seguros, Asesor en Gestión de Riesgos Sanitarios, Madrid, Spain
| | - Paulo Sousa
- NOVA National School of Public Health, Universidade NOVA de Lisboa
- Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - José Joaquín Mira Solves
- Health Psychology Department, Miguel Hernández University, Elche
- Alicante-Sant Joan Health District, Consellería Sanitat, Alicante
- REDISSEC, Health Services Network Oriented to Chronic Diseases
| | - Jesús María Aranaz-Andrés
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
7
|
Valencia-Martín JL, Martin-Delgado J, Pardo-Hernández A, Vicente-Guijarro J, Requena-Puche J, Aranaz Andrés JM. The Study on Safety in Hospitals in the Region of Madrid (ESHMAD) design: Screening and analysis of incidents and adverse events. J Healthc Qual Res 2021; 36:231-239. [PMID: 33967001 DOI: 10.1016/j.jhqr.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A Study related to Safety in Hospitals in the Region of Madrid (ESHMAD) was carried out in order to determine the prevalence, magnitude and characteristics of adverse events in public hospitals. This work aims to define a useful methodology for the multicenter study of adverse events in the Region of Madrid, to set out the preliminary results of the hospital enrollment and to establish a model of a strategy of training of trainers for its implementation. METHODS ESHMAD was a multicenter, double phase study for the estimation of adverse events and incidents prevalence across the Region of Madrid. First phase comprehended a 1-day cross-sectional prevalence study, in which it was collected, through a screening guide, information about admission, patient characteristics, intrinsic and extrinsic risk factors, and the possibility of an adverse event or incident had happened during the hospitalization. Second phase was a retrospective nested cohort study, in which it was used a Modular Review Form for reviewing the positive screenings of the first phase, identifying in each possible adverse event or incident the classification of the patient safety event, clinical onset, root, and associated causes and factors, impact, and preventability. A pilot study was performed in an Internal Medicine Unit of a tertiary hospital. RESULTS 34 public hospitals participated, belonging to 6 healthcare categories and with more than 10,000 hospitalisations aggregate capacity. 72 coordinators were enrolled in the strategy of training of trainers, which was performed through five on-site training workshops. In the pilot study, 45.2% patients were identified with at least one positive event of the screening. Of them, 48.1% (25 positive events) were identified as truly AE, with a result of 0.29 EA per analyzed patient. CONCLUSIONS The ESHMAD protocol allows to estimate the prevalence of adverse events, and the strategy of training of trainers facilitated the spread of the research methodology among the participants.
Collapse
Affiliation(s)
- J L Valencia-Martín
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - J Martin-Delgado
- Atenea Research Group, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 46035 Valencia, Spain; Health Services & Policy Research Group, University of Exeter, EX1 2LU Exeter, United Kingdom
| | - A Pardo-Hernández
- Subdirección General de Calidad Asistencial y Cooperación Sanitaria, Consejería de Sanidad de la Comunidad de Madrid, 28013 Madrid, Spain; Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, 28933, Madrid, Spain
| | - J Vicente-Guijarro
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain.
| | - J Requena-Puche
- Hospital General Universitario de Elda, 03600 Alicante, Spain; Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández de Elche, 03202 Elche, Alicante, Spain
| | - J M Aranaz Andrés
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | |
Collapse
|
8
|
Vicente-Guijarro J, Valencia-Martín JL, Moreno-Nunez P, Ruiz-López P, Mira-Solves JJ, Aranaz-Andrés JM. Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable? Int J Environ Res Public Health 2020; 17:ijerph17238783. [PMID: 33256032 PMCID: PMC7730586 DOI: 10.3390/ijerph17238783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. METHODS This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to "Choosing Wisely", "No Hacer" and "Essencial" initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. RESULTS A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the "No Hacer" recommendation and 73.3% according to "Choosing Wisely" and "Essencial" criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to "Choosing Wisely" and "Essencial"; 4.1% according to "No Hacer"). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to "No Hacer" and EUR 3895.29 (2276.1 Relative Value Units) according to "Choosing Wisely" or "Essencial" criteria. CONCLUSIONS There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.
Collapse
Affiliation(s)
- Jorge Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, 28801 Acalá de Henares, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Correspondence: ; Tel.: +34-913-368-372
| | - José Lorenzo Valencia-Martín
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Servicio de Medicina Preventiva y Salud Pública, Unidad de Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud, Hospital La Merced, Área de Gestión Sanitaria de Osuna, 41640 Osuna, Sevilla, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
| | - Paloma Moreno-Nunez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
| | - Pedro Ruiz-López
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
- Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - José Joaquín Mira-Solves
- Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain;
- Alicante-Sant Joan Health District, Ministry of Health, 03550 Alicante, Spain
- REDISSEC, Health Services Network Oriented to Chronic Diseases, Spain
| | - Jesús María Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (P.M.-N.); (J.M.A.-A.)
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, 28034 Madrid, Spain;
- Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja, 26006 Logroño, La Rioja, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), 28034 Madrid, Spain
| | | |
Collapse
|
9
|
Garcia-Haro M, Bischofberger Valdés C, Vicente-Guijarro J, Díaz-Agero Pérez C, Fabregate-Fuente M, Moreno-Nunez P, Aranaz-Andrés JM. Decontamination of filtering facepiece respirators using a low-temperature-steam-2%-formaldehyde sterilization process during a pandemic: a safe alternative for re-use. J Hosp Infect 2020; 108:113-119. [PMID: 33157170 PMCID: PMC7609237 DOI: 10.1016/j.jhin.2020.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
Background The coronavirus disease 2019 pandemic has caused problems with respirator supplies. Re-use may minimize the impact of the shortage, but requires the availability of an efficient and safe decontamination method. Aim To determine whether low-temperature-steam–2%-formaldehyde (LTSF) sterilization is effective, preserves the properties of filtering facepiece (FFP) respirators and allows safe re-use. Methods Fourteen unused FFP2, FFP3 and N95 respirator models were subjected to two cycles of decontamination cycles. After the second cycle, each model was inspected visually and accumulated residual formaldehyde levels were analysed according to EN 14180. After one and two decontamination cycles, the fit factor (FF) of each model was tested, and penetration tests with sodium chloride aerosols were performed on five models. Findings Decontamination physically altered three of the 14 models. All of the residual formaldehyde values were below the permissible threshold. Irregular decreases and increases in FF were observed after each decontamination cycle. In the sodium chloride aerosol penetration test, three models obtained equivalent or superior results to those of the FFP classification with which they were marketed, both at baseline and after one and two cycles of decontamination, and two models had lower filtering capacity. Conclusion One and two decontamination cycles using LTSF did not alter the structure of most (11/14) respirators tested, and did not degrade the fit or filtration capacity of any of the analysed respirators. The residual formaldehyde levels complied with EN 14180. This reprocessing method could be used in times of shortage of personal protective equipment.
Collapse
Affiliation(s)
- M Garcia-Haro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - C Bischofberger Valdés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - J Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | | | - M Fabregate-Fuente
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - P Moreno-Nunez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - J M Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; CIBER Epidemiología y Salud Pública, Spain
| | | |
Collapse
|
10
|
Aranaz Andrés JM, Gea Velázquez de Castro MT, Vicente-Guijarro J, Beltrán Peribáñez J, García Haro M, Valencia-Martín JL, Bischofberger Valdés C. [Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. J Healthc Qual Res 2020; 35:245-252. [PMID: 32680724 PMCID: PMC7316065 DOI: 10.1016/j.jhqr.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/21/2023]
Abstract
Antecedentes y objetivo Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes. Material y métodos Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España. Resultados Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana. Conclusión En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar.
Collapse
Affiliation(s)
- Jesús M Aranaz Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Jorge Vicente-Guijarro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, España.
| | | | - Mercedes García Haro
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, España
| | | | | | | | | |
Collapse
|