Impacto de los análisis aleatorios de seguridad en tiempo real en indicadores de estructura, proceso y resultado en medicina intensiva

Identificador:  TDX:2781

Handle: https://hdl.handle.net/20.500.11797/TDX2781

Autors:  Oliva Zelaya, Iban

Resum:
The risk of medical errors is high in intensive care medicine. Errors in healthcare may occur due to an unintended act or by omission. Errors of omission are more insidious and more difficult to identify. Our group previously developed and validated a new tool: the real time random safety audits (iAnálisis Aleatorios de Seguridad en Tiempo Real, AASTRE). It was effective in detecting and remedying errors of omission in real time. The purpose of this study was to investigate the AASTRE impact in structure, process and outcome indicators through a multicenter study. A prospective study was conducted over a period of 12 months in two adult patient ICUs. Safety rounds were conducted three days a week ascertaining the 37 safety measures (grouped into 10 blocks). In each round, 50% of the patients and 50% of the measures were randomized. The impact of this safety tool was analysed in indicators of structure (culture of safety, healthcare protocols), process (improvement proportion related to tool application, IPR-AASTRE) and outcome (mortality, average stay, rate of catheter-related bacteremias and rate of ventilator-associated pneumonia, VAP). 1214 patients-day were analyzed. Structure indicators: AASTRE was associated with an increased climate of security and creation / modification of protocols (sedation/analgesia and weaning). Process indicators: 12 of the 37 measures had an IPR-AASTRE> 10%. Seven mesures had an IPR-AASTRE > 10% in the three quarters analyzed. Six mesures showed a progressive decrease of the IPR over the study period. Nursing workloads and patient severity on the day of analysis were independently associated with a higher IPR-AASTRE in half of the blocks of variables. Outcome indicators: AASTRE was associated with a significant decrease in the rate of NAV. As conclusions, AASTRE was associated with improvement in structure, process and outcome indicators. This tool also improved the care process and adherence to the clinical practice guidelines.