Colombian Journal of Anesthesiology (Revista Colombiana de Anestesiología)最新文献

{"title":"Reportable hospital events: incidence and contributing factors in the surgery service of a high complexity hospital in Bogotá, Colombia, 2017","authors":"K. Estrada-Orozco, H. Gaitán-Duarte, S. Moreno, Jaime Moreno-Chaparro","doi":"10.1097/CJ9.0000000000000091","DOIUrl":"https://doi.org/10.1097/CJ9.0000000000000091","url":null,"abstract":"Introduction: Patient safety includes monitoring, analysis, and proposed actions for the prevention of reportable events with unwanted effects (REUE). Objective: To estimate the incidence, preventability, severity, and contributing factors of REUEs in patients admitted to the surgery service. Materials and methods: Prospective cohort study in patients with at least 12 hours of hospitalization in the surgical services of a university hospital in Bogotá, Colombia. Random sampling was used and the sample size was 200 subjects. Sociodemographic and baseline clinical variables were evaluated. We estimated the presence of REUE detection events, their preventability and severity. The analysis of the contributing factors was done using the London protocol. Results: A total of 106 women (52.47%) and 96 men (47.53%) were included; the median age was 51.93 years (range 18–93); 60% had at least 1 comorbidity measured by the Charlson index and 25.74% had 3 or more. Of the participants, 28.21% presented at least 1 detection event, the incidence of REUEs was 11.8%, and 75% of them were classified as preventable while 75% were serious events. The main contributing factors were: patient-related 58.33%, related to scheduled tasks and clinical context 50.00%, and work team-related factors 37.50%. Conclusion: The incidence, preventability, and severity of REUE are similar to those reported in the literature. The analysis of the contributing factors shows areas that are susceptible to intervention and can be considered as opportunities for improvement. Introducción: La seguridad del paciente incluye la vigilancia, análisis y la propuesta de acciones para la prevención de eventos reportables con efectos no deseados (EREND). Objetivo: Estimar la incidencia, preventibilidad, severidad y factores contribuyentes de los EREND en pacientes hospitalizados en el servicio de cirugía. Materiales y métodos: Estudio de cohorte prospectiva en pacientes con al menos 12 horas de hospitalización en los servicios quirúrgicos de un hospital universitario en Bogotá, Colombia. Muestreo aleatorio. Tamaño muestral: 200 sujetos. Se evaluaron las variables sociodemográficas y clínicas basales. Se estimó la presencia de eventos de detección, de EREND, si eran prevenibles y su severidad. El análisis de los factores contribuyentes se hizo mediante el protocolo de Londres. Resultados: Se incluyeron 106 mujeres (52.47%) y 96 hombres (47.53%); la edad mediana fue 51.93 años (rango 18–93). El 60% tuvo al menos una comorbilidad medida por el índice de Charlson y el 25.74% tuvo 3 o más. El 28.21% de los participantes presentaron al menos un evento de detección, la incidencia de EREND fue 11.8% y el 75% de estos fueron calificados como prevenibles y 75% fueron eventos serios. Los principales factores contribuyentes fueron: del paciente 58.33%, relacionados con tareas programadas y contexto clínico 50.00% y factores del equipo de trabajo 37.50%. Conclusiones: La incidencia, evitabilidad y severidad de ","PeriodicalId":399659,"journal":{"name":"Colombian Journal of Anesthesiology (Revista Colombiana de Anestesiología)","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128431001","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}

{"title":"What happens to quality of life after the intensive care unit? Cross-sectional observational study","authors":"Daniela Arango-Isaza, M. Velásquez-Duran, C. Franco-Mesa, Esteban Calle-Correa, M. Jaramillo‐Hurtado, Victoria Ángel-Mejía, Natalia Uribe-Corrales","doi":"10.1097/CJ9.0000000000000085","DOIUrl":"https://doi.org/10.1097/CJ9.0000000000000085","url":null,"abstract":"Introduction: Quality of life (QOL) of patients discharged from the intensive care unit (ICU) is affected by the procedures performed, and the sequelae and comorbidities associated with their etiology at the time of admission. Objective: To determine health-related QOL after discharge from an ICU between 2014 and 2016. Methods: Cross-sectional observational study that included patients over 50 years of age with a length of stay of more than 48 hours in an ICU. Demographic data were obtained from the clinical records, and an EQ-5D-3L survey was conducted by telephone. Data were analyzed using the SPSS version 21 software package. Results: Total mortality was 33.6%, and of these cases, 61.7% occurred within the first 6 months after discharge. Average total EQ-5D-3L results, where 0 is the worst result and 1 is the best in terms of QOL, was 0.65 and the most affected dimension was pain/discomfort. On the analog quality-of-life scale, the total average was 69.05%. Conclusion: QOL is impacted negatively following discharge from the ICU, especially in patients over 80 years of age. The most affected dimensions are pain/discomfort and anxiety/depression. Moreover, more than 1/3 of patients die within the first 6 months after discharge. Introducción: Para los pacientes que egresan de una unidad de cuidados intensivos, los procedimientos realizados, las secuelas y las comorbilidades asociadas a su etiología de ingreso afectan su calidad de vida. Objetivo: Determinar la calidad de vida relacionada a la salud posterior al egreso de una unidad de cuidados intensivos entre 2014 – 2016. Métodos: El siguiente es un estudio observacional de corte transversal, donde se incluyeron pacientes mayores de 50 años con una estancia en una unidad de cuidados intensivos superior a 48 horas. Se obtuvieron datos demográficos de las historias clínicas y se realizó el cuestionario EQ-5D-3L vía telefónica. El análisis de la información se llevó a cabo utilizando SPSS ® versión 21. Resultados: Se obtuvo una mortalidad total del 33.6%, de la cual el 61.7% sucedió en los primeros 6 meses posterior al alta médica. El promedio en el total del resultado del EQ-5D-3L fue de 0.65 y la dimensión más afectada fue dolor/malestar. Siendo 0 el peor resultado de la escala y 1 el mejor en cuanto a calidad de vida. En cuanto a la escala análoga de calidad de vida, el promedio total fue de 69.05%. Conclusión: La calidad de vida tiene un impacto negativo después del egreso de la unidad de cuidados intensivos, especialmente en aquellos pacientes mayores de 80 años. Las dimensiones más afectadas son dolor/malestar y ansiedad/depresión. Además, la mortalidad es superior a un tercio en los primeros seis meses después del alta.","PeriodicalId":399659,"journal":{"name":"Colombian Journal of Anesthesiology (Revista Colombiana de Anestesiología)","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121521596","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}

{"title":"Association between reportable preventable adverse events and unfavorable decisions in medical malpractice claims involving obstetricians covered by FEPASDE Colombia 1999 to 2014. Case–control study","authors":"H. Gaitán-Duarte, J. Eslava-Schmalbach, L. Montoya, Gloria Jiménez, Jorge Medina-Parra, Carmen Doris Garzón-Olivares, M. Vasco, Liliana Arango-Rodríguez, I. Cediel-Carrillo","doi":"10.1097/CJ9.0000000000000081","DOIUrl":"https://doi.org/10.1097/CJ9.0000000000000081","url":null,"abstract":"Introduction: Reportable, preventable events are potential causes for medical liability litigation. It is important to determine whether the occurrence of such events increases the risk of unfavorable legal or ethical decisions. Objective: To assess the association between the occurrence of a reportable preventable event and unfavorable legal and ethical decisions in medical liability processes against obstetricians. Materials and methods: Case–control study. Population: obstetricians affiliated to FEPASDE, with legal or ethical claims closed between 1999 and 2014 in Colombia. Cases: obstetricians with unfavorable judicial decision in malpractice claims. Controls: obstetricians with a favorable judicial decision. Sample: 322 subjects (64 cases, 258 controls). Analysis: variables concerning the obstetrician, the institution, the process, and the patient were measured. Bi-varied and multivaried analyses with a logistic regression model were conducted, using a propensity score or index. Results: An association was identified between the occurrence of the reportable preventable event and an unfavorable ruling (OR = 4,4; CI 95%: 2,23 – 8,76). Other associated factors included: private institution (OR = 2.3 95% CI: 1.14–4.51), type of civil claim (OR = 14.1 95% CI: 5.51–36.04), product diagnosis—demise (OR = 3.1 95% CI: 1.64–5.94), history of other unfavorable proceedings (OR = 2.3 95% CI: 1.27–4.06). Inadequacies in the prevention and medication therapy were associated with an unfavorable ruling (P < 0.05). Conclusion: The presence of reportable preventable events is associated with an unfavorable legal or ethical decision in malpractice claims involving obstetricians. Inadequate patient management and poor functioning of the hospital care system provide opportunities for intervention to reduce the risk of an unfavorable legal or ethical decisions in malpractice claims. Introducción: Los eventos reportables prevenibles son potenciales causas de procesos de responsabilidad médica, es importante identificar si su ocurrencia incrementa el riesgo de decisiones judiciales o éticas desfavorables. Objetivo: Evaluar la asociación entre la ocurrencia de un evento reportable prevenible y las decisiones judiciales y éticas desfavorables en procesos de responsabilidad médica contra obstetras. Materiales y métodos: Estudio de casos y controles. Población: Obstetras vinculados a FEPASDE con procesos judiciales o éticos cerrados entre 1999 -2014 en Colombia. Casos: obstetras con decisión judicial desfavorable en procesos de responsabilidad médica. Controles: obstetras con una decisión judicial favorable. Muestra: 322 sujetos (64 casos, 258 controles). Análisis: se midieron variables del obstetra, la institución, del proceso, de la paciente. Análisis bi y multivariado con un modelo de regresión logística y la utilización del puntaje o índice de propensión. Resultados: Se encontró asociación entre la presencia de evento reportable prevenible y una decisión judicial de","PeriodicalId":399659,"journal":{"name":"Colombian Journal of Anesthesiology (Revista Colombiana de Anestesiología)","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115219865","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}