Significant improvements in safety culture.. The findings of the instrument were used to establish the following improvements: Healthcare comprises a chain of processes with the global objective of improving patient health; however, each process can be associated to variation, failure or even error, with an important impact for the individual, society and the institutions. It is a professional and ethical imperative to recognize these situations and reduce their incidence and importance. This is particularly relevant in Emergency and Critical Care Medicine, where the similarities with high risk sectors nuclear energy, aeronautics, petrochemical industry are greater, 22,23 the risk of error is higher, and its impact can be more serious.
The present study describes a risk management tool referred to emergency care and the treatment of serious trauma patients. Similar experiences have been described in other settings. The epidemiological data of our population coincide with those contained in other trauma registries in our setting, involving young and predominantly male populations with closed traumatisms. The results of the TRISS methodology warrant the quality of the care provided, with improvement of the expected mortality data.. The percentage of registries with the described instrument is high, taking into account that during the study period there were several holiday periods, with an important presence of temporary personnel.
Although we cannot establish comparisons, the activity of the Unit has been intense, as reflected by the occupation ratio and activities outside the ICU transfer to the operating room, risk of falls, administration of drugs associated with risks, etc. The instrument application time was short, thereby minimizing distraction, and could be performed at the patient bedside, with an important presence of those professionals directly implicated in patient care—thereby ensuring its incorporation to the routine of the organization.
In our Department of Intensive Care Medicine we have incorporated this and other similar tools to routine practice list of healthcare objectives, organizational goals, etc. The number of incidents detected with the instrument was high, probably as a result of the intense interaction with the system required in the care of critically ill and particularly seriously traumatized patients.
The types of incidents detected were similar to those published in other studies i. The present study has a number of limitations, such as the partial coverage of the instrument in registering incidents, the coexistence of this initiative with others referred to risk management and which can complicate interpretation of the impact of the results in relation to safety culture, the validation of the questionnaires in this setting, the quasi-experimental design of the study, and the Hawthorne effect.
Likewise, during implementation of the instrument we experienced difficulties such as the maintenance of objective language during the meetings, and reduction of the anonymous communication of incidents. Despite these limitations, however, we consider that the tool is useful for obtaining a description of the existing safety problems of an organization, for their analysis using other types of methods such as cause-root analysis and modal analysis of failures and effects MAFE referred to certain techniques that may pose safety problems e.
Briefing has been shown to exert a positive influence by reinforcing the safety culture in the Unit in those aspects where it could be expected to exert a greater influence communication of errors, loss of individual punitive character, etc. The study shows the feasibility of using validated tools for improving safety in certain high risk sectors such as Emergency and Critical Care Medicine. Briefing is an instrument for registering incidents that is simple, easy to use, useful for implementing improvements, and capable of exerting a positive influence upon patient safety culture..
The authors obtained informed consent from the personnel implicated in this study. The consent document is filed by the corresponding author.. The authors declare that they have no conflicts of interest.. Thanks are due to Dr. Manuel Quintana-Diaz for guidance in the development of this Doctoral Thesis..
Please cite this article as: Experiencia en una unidad de cuidados intensivos de trauma y emergencias. The results of this study have been presented as a Doctoral Thesis in the Department of Surgery of Madrid Autonomous University, receiving the qualification Apt Cum laude. Previous article Next article. October Pages Experience in a trauma and emergency intensive care unit. This item has received. Show more Show less. Objective To validate a safety tool used in high-risk sectors safety briefing in intensive care medicine. Design A prospective, observational and analytical study was carried out.
Setting Trauma and emergency intensive care unit in a tertiary hospital. Intervention Documentation of incidents related to patient safety PS. Variables Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool SP and safety culture impact. Results We included patients The tool significantly influenced different aspects of the safety culture of the unit communication frequency, number of events, punitive loss and active work in PS.
Conclusions Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture.
Objetivo Validar una herramienta de seguridad utilizada en sectores de alto riesgo briefing de seguridad en la medicina intensiva. Introduction The complex combination of processes, technologies and human interactions conforming modern healthcare can result in important benefits, but also implies the risk of adverse events. Patients and methods A prospective, observational and analytical study was made, comprising the registry of incidents related to PS, categorized according to types, severity and avoidability, and using a quality instrument briefing in the context of risk management in an ICU specialized in the care of serious traumatisms.
Photograph of the meeting and protocol. Principles of the briefing tool. It is a working instrument, not an aim in itself.
There must be an immediate objective, which is the introduction of improvements. The results should not be used to compare one Department with another. The instrument is to be incorporated to the working routine. It requires commitment on the part of the Unit supervisors. The instrument should be constructive and not of a punitive nature. A comfortable environment is recommendable.
The findings should be presented openly to the implicated personnel. The duration is between 5 and 10 min, in order to minimize time away from the patient bedside. The information generated during the sessions is confidential. A moderator or facilitator should be selected at the start. As the tool is put into practice, the number of facilitators should be varied. The language used should be objective and anonymous. The contents should vary according to the needs of the Unit.
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Percentage presence of the professionals in the meetings by shifts. Duration of the meetings with and without incidents. Type, number, severity and avoidability of the incidents. Significant improvements in safety culture. Manuel Quintana-Diaz for guidance in the development of this Doctoral Thesis. BMJ, , pp. To err is human. Building a safer health system. Committee on Health Care in America. National Academy Press, Improving safety in intensive care.
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What does it mean?. European Society of Intensive Care. Patient safety in intensive care medicine: Intensive Care Med, 21 , pp. Med Intensiva, 35 , pp. A teamwork model to promote patient safety in critical care. Crit Care Nurs North Am, 14 , pp. Qual Saf Health Care, 13 , pp.
Patient safety and quality of care in intensive care medicine, 1st ed. Walkrounds y Briefings en la mejora de la seguridad de los pacientes. Rev Calid Asist, 12 , pp.
Measurable otucomes of quality improvement in the Trauma Intensive Care Unit: J Trauma, 64 , pp. Evaluation of a preoperative checklist and team briefing among surgeons, nurses and anesthesiologists to reduce failures in communication. Arch Surg, , pp. Towards safer interprofesional communication: J Interprof Care, 20 , pp. World J Surg, 7 , pp. Incidentes y eventos adversos en medicina intensiva.
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