Incidentes ligados a la asistencia en urgencias pediátricas

Abstract

Introduction: Paediatric emergency departments are potentially high-risk departments for the occurrence of safety incidents linked to care, due to the different organisational models, as well as the vulnerability of children to iatrogenic harm. Having a good patient safety culture is key to prevent the occurrence of adverse events, to encourage reporting and learning from errors and to implement strategies to avoid their recurrence. In addition, a better understanding of the extent and burden of paediatric harm is essential to design and implement safety actions aimed at reducing preventable diseases and channelling resources towards necessary system improvements. Hypotheses and objectives: The hypothesis of this study is that the Paediatric Emergency Department of the Hospital Clínico Universitario Virgen de la Arrixaca is a service with a high potential risk of occurrence of safety incidents linked to care. Objectives: To ascertain the state of the safety culture among PED professionals at the Hospital Clínico Universitario Virgen de la Arrixaca. To adapt an incident assessment tool for paediatric emergency services. To characterise safety incidents in the paediatric emergency department of the Hospital Clínico Universitario Virgen de la Arrixaca: frequency, sources, causal factors and consequences. Method: The study was divided into 3 phases. In the first phase, we analysed the perception of safety culture held by healthcare professionals in the Paediatric Emergency Department during October 2018, using the Spanish version of the Hospital Survey on Patient Safety Culture adapted from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture. In the second phase, the incident evaluation form used in the ERIDA study was adapted to the paediatric population, using Delphi methodology, with a group of national patient safety experts. Items with an average score below 7 points on a scale of 1 to 9 (1=totally disagree; 9=totally agree) were eliminated. In addition, new effects or causal factors were added. In the third phase, safety incidents were measured through an observational, descriptive, cross-sectional study based on a regional study of incidents arising from adult emergency care (ERIDA). The sample was selected by randomisation by chance. The study variables were grouped into 2 blocks: general variables and specific variables, if an incident occurred in care or in the 7-day telephone follow-up. Data were collected between December 2018 and January 2019. Each incident was subsequently reviewed by an external evaluator. Descriptive analysis of variables and between-group comparisons were performed. Results: First phase: 67 responses were obtained (N=78), with a response rate of 85%. Percentages of positive and negative responses were established for the 12 dimensions. Among the respondents 30% were paediatricians, 31% residents and 39% nurses. The highest rated dimension was teamwork with a 86.94% positive response rate, reflecting a strength, 3 dimensions had neutral responses and the rest provided opportunities for improvement, with staffing (69.32%) and hospital management support in CSP (53.54%) having the highest percentages of negative responses. On a scale of 0 to 10 (with 0 being no safety and 10 being maximum safety) the overall mean score for patient safety was 6.8. Second phase: 9 items were removed from the baseline form and none of the incidents detected occurred. In turn, extravasation and behavioural disturbance were added to the effects section. Third phase: 204 cases were included. In 25 cases at least one incident was detected, 3 cases had 2, for a total rate of 12.3%. 12 incidents were detected at the point of care, the rest on call. 10% did not affect the patient, 7.1% affected but without harm and 82.1% affected with harm. In 13 incidents (46.4%) care was not affected, 8 (28.6%) required further consultation or referral, 6 (21.4%) required further observation and 1 (3.6%) required medical or surgical treatment. The most frequent causal factors were care-related 11 (39.3%) and medication-related 10 (35.7%). Procedure- and medication-related effects were the most common. Of the incidents, 78.6% were considered avoidable, with 50% identified as a clear failure to act. Conclusions: The level of patient safety culture among the professionals of the Paediatric Emergency Department of the Hospital Clínico Universitario Virgen de la Arrixaca is low. The dimension "teamwork in the service" was the best rated. Among the worst rated were "staffing" and "hospital management support for patient safety". The adaptation of an incident evaluation form to the paediatric setting, by means of a Delphi group, made it possible to obtain data in a standardised, fast and efficient manner. 12.3% of the children attended in the Paediatric Emergency Department suffered a safety incident, with an avoidability rate of 78.6%. Following the study, the following were established as priority actions for improvement: improving communication, electronic prescribing, double check training