Gestión de incidencias interniveles. La experiencia de un distrito de atención primaria

Aim

Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC).

Design

Multicenter cross-sectional descriptive study.

Site

Primary care.

Participants

Professionals from a Health District and its reference hospitals.

Interventions

ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician.

Main measurements

ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ.

Results

We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%).

Conclusions

3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.