Información del artículo
Resumen
Los sistemas sanitarios cada vez más complejos, junto con pacientes más vulnerables y a la vez más informados y demandantes, conforman un entorno clínico en el que aparecen los efectos adversos (EA) ligados a la asistencia sanitaria. La incidencia de EA en pacientes hospitalizados se ha estimado entre el 4 y el 17%. Una cuarta parte fueron graves y el 50% se consideró evitables. El 70% de los EA se deben a fallos técnicos, defectos en la toma de decisiones, no actuación de la manera más apropiada en función de la información disponible, problemas en la anamnesis, y ausencia o prestación inadecuada de cuidados necesarios. El modelo explicativo de la cadena causal de un efecto adverso mantiene que son más importantes los fallos de sistema que los fallos de las personas. Para facilitar el necesario cambio de la cultura punitiva a la cultura proactiva es necesario el enfoque multidisciplinario del problema teniendo en cuenta el punto de vista de los profesionales, los pacientes, los líderes sociales y la magistratura.
Palabras clave:
Seguridad de pacientes
Efectos adversos
Errores médicos
Calidad asistencial
Abstract
The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed.
Key words:
Safety patient
Adverse events
Medical errors
Quality healthcare
El Texto completo está disponible en PDF
Bibliografía
[1.]
Organización Mundial de la Salud Alianza mundial para la seguridad del paciente. Desarrollo del porgrama 2005. [Accedido 1 Ago 2005]. Disponible en: http://wwwwho.int/patientsafety/en/indez.html
[2.]
Aranaz JM por el Grupo de Estudio del Proyecto IDEA. Proyecto IDEA: Identificación de efectos adversos. Rev Calidad Asistencial. 204;19:14-18
[3.]
C. Chantler.
De role and education of doctors in the delivery of health care.
Lancet, 353 (1999), pp. 1178-1181
[4.]
D. Barr.
Hazards of modern diagnosis and therapy -the price we pay.
JAMA, 159 (1955), pp. 1452
[5.]
R. Moser.
Diseases of medical progress.
N Engl J Med, 255 (1956), pp. 606
[6.]
E.M. Schimmel.
The hazards of hospitalization.
Ann Inter Med, 60 (1964), pp. 100-110
[7.]
J. Holbrook.
The criminalisation of fatal medical mistakes.
BMJ, 327 (2003), pp. 1118-1119
[8.]
R.J. Blendon, C.M. DesRoches, M. Brodie, J.M. Benson, A.B. Rosen, E. Schneider, et al.
Views of practicing physicians and the public on medical errors.
N Engl J Med, 347 (2002), pp. 1933-1940
[9.]
L.t. Kohn, J. Corrigan, M.S. Donaldson.
To err is human: building a safer health system.
J Clin Pharmacol, 40 (2000), pp. 1075-1078
[10.]
T.A. Brennan, L.L. Leape, N.M. Laird, L. Hebert, A.R. Localio, A.G. Lawthers, et al.
Incidence of adverse events anda negligence in hospitalized patients. Results of the Harvard Medical Practice Study I.
N Engl J Med, 324 (1991), pp. 370-376
[11.]
L.L. Leape, T.A. Brennan, N. Laird, A.G. Lawthers, A.R. Localio, B.A. Barnes, et al.
The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II.
N Engl J Med, 324 (1991), pp. 377-384
[12.]
E.J. Thomas, D.M. Studdert, H.R. Burstin, E.J. Orav, T. Zeena, E.J. Williams, et al.
Incidence and types of adverse events and negligent care in Utah and Colorado.
Med Care, 38 (2000), pp. 261-271
[13.]
R.M. Wilson, W.B. Runciman, R.W. Gibberd, B.T. Harrisson, L. Newby, J.D. Hamilton.
The quality in Australian Health-Care Study.
Med J Aust, 163 (1995), pp. 458-471
[14.]
C. Vincent, G. Neale, M. Woloshynowych.
Adverse events in British hospitals: preliminary retrospective record review.
BMJ, 322 (2001), pp. 517-519
[15.]
T. Schioler, H. Lipczak, B.L. Pedersen, T.S. Mogensen, K.B. Bech, A. Stockmarr, et al.
[Incidence of adverse events in hospitals.A retrospective study of medical records].
Ugeskr Laeger, 163 (2001), pp. 5370-5378
[16.]
P. Davis, R. Lay-Yee, S. Schug, R. Briant, A. Scott, S. Johnson, et al.
Adverse events regional feasibility study: indicative findings.
N Z Med J, 114 (2001), pp. 203-205
[17.]
P. Davis, R. Lay-Yee, R. Brian, W. Ali, A. Scott, S. Schug.
Adverse events in New Zealand public hospital I: occurrence and Impact.
N Z Med J, 115 (2002), pp. 271
[18.]
P. Davis, R. Lay-Yee, R. Brian, W. Ali, A. Scott, S. Schug.
Adverse events in New Zealand public hospital II: preventability and clinical context.
N Z Med J, 116 (2003), pp. U624
[19.]
R.G. Baker, P.G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox, et al.
The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.
JAMA, 170 (2004), pp. 1678-1686
[20.]
A.J. Forster, T.R. Asmis, H.D. Clark, G.A. Saied, C.C. Code, S.C. Caughey, et al.
Ottawa Hospital Patient Safety Study: Incidence and timing of adverse events in patients admitted to a Canadian teaching hospital.
Can Med Assoc, 170 (2004), pp. 1235-1240
[21.]
J.M. Aranaz, C. Aibar, M.T. Gea, M.T. León.
Los efectos adversos en la asistencia hospitalaria. Una revisión crítica.
Med Clin (Barc), 123 (2004), pp. 21-25
[22.]
G. Rubin, A. George, D.J. Chinn, C. Richardson.
Errors in general practice: development of an error classification and pilot study of a method for detecting errors.
Qual Saf Health Care, 12 (2003), pp. 443-447
[23.]
M.J. Otero, C. Codina, M.J. Tamés, M. Pérez.
Errores de medicación: estandarización de la Terminología y clasificación.
Farm Hosp, 27 (2003), pp. 137-149
[24.]
P. Alonso, M.J. Otero, J.A. Maderuelo.
Ingresos hospitalarios causados por medicamentos: incidencia, características y coste.
Farm Hosp, 26 (2002), pp. 77-89
[25.]
M.I. Baena, M.J. Faus, R. Martín, A. Zarzuelo, J. Jiménez, J. Martínez.
Problemas de salud relacionados con los medicamentos en un servicio de urgencias hospitalarias.
Med Clin (Barc), 124 (2005), pp. 250-255
[26.]
J.L. Bailit, M.H. Blanchard.
The effect of house staff working hours on the quality of obstetric and gynecologic care.
Obstet Gynecol, 103 (2004), pp. 613-616
[27.]
Proyecto IDEA: Identificación de efectos adversos 2005. [Accedido 26 Mayo 2005]. Disponible en: http://www.dsp.umh.es/proyectos/idea/index.html
[28.]
M. Woloshynowych, G. Neale, C. Vincent.
Case record review of adverse events: a new approach.
Qual Saf Health Care, 12 (2003), pp. 411-415
[29.]
Grayson D, Boxerman St, Potter P, Dunagan Cl, Sorock G, Evanoff Br. Do Transient Working Conditions Trigger Medicals Errors? Advances in Patient Safety: From Research to Implementation. [Accedido 5 Julio 2005]. Agency for Healthcare Research and Quality, Rockville, MD and the Department of Defense (DoD)-Health Affairs,. 2005: 53-64. Disponible en: http://www.ahrq.gov/qual/advances/
[30.]
C.J. Eagle, J.M. Davies, J. Reason.
Accident analysis of largescale technological disasters applied to an anaesthetic complication.
Can J Anaesth, 39 (1992), pp. 118-122
[31.]
S. Ternov, R. Akselsson.
System weaknesses as contributing causes of accidents in health care.
Int J Qual Health Care, 17 (2005), pp. 5-13
[32.]
C.P. Landrigan, J.M. Rothschild, J.W. Cronin, R. Kaushal, E. Burdick, J.T. Katz, et al.
Effect of reducing interns’ work hours on serious medical errors in intensive care units.
N Engl J Med, 351 (2004), pp. 1838-1848
[33.]
J.L. Bailit, M.H. Blanchard.
The effect of house staff working hours on the quality of obstetric and gynecologic care.
Obstet Gynecol, 103 (2004), pp. 613-616
[34.]
S.B. Ransom, D.M. Studdert, M.P. Dombrowski, M.M. Mello, T.A. Brennan.
Reduced medicolegal risk by compliance with obstetric clinical pathways: a case-control study.
Obstet Gynecol, 101 (2003), pp. 751-755
[35.]
J.C. Javitt, G. Steinberg, T. Locke, J.B. Couch, J. Jacques, I. Juster, et al.
Using a claims data-based sentinel system to improve compliance with clinical guidelines: results of a randomized prospective study.
Am J Manag Care, 11 (2005), pp. 93-102
[36.]
Aibar C, Aranaz JM. ¿Pueden evitarse los sucesos adversos relacionados con la atención hospitalaria? [Accedido 5 Julio 2005]. An Sist Sanit Navar. 2003;26:195-209. Disponible en: http://www.cfnavarra.es/salud/anales/textos/vol26/n2/colaba.html
[37.]
R.A. Hayward, T.P. Hofer.
Estimating hospital deaths due to medical errors. Preventability is in the eye of the reviewer.
JAMA, 286 (2001), pp. 415-420
[38.]
J.J. Mira, V. Pérez-Jover, S. Lorenzo.
Navegando en Internet en busca de información sanitaria: no es oro todo lo que reluce.
Aten Primaria, 33 (2004), pp. 391-399
[39.]
H.R. Krause, A. Bremerich, J. Rustemeyer.
Reasons for patients’discontent and litigation.
J Craniomaxillofac Surg, 29 (2001), pp. 181-183
[40.]
J.W. Saxton.
How to increase economic returns and reduce liability exposure: Part 1-Patient satisfaction as an economic tool.
J Med Pract Manage, 17 (2001), pp. 142-144
[41.]
J. Irigoyen.
La crisis del sistema sanitario en España: una interpretación sociológica.
Universidad de Granada, (1997),
[42.]
M. Gorney.
Claims prevention for the aesthetic surgeon: preparing for the less-than-perfect outcome.
Facial Plast Surg, 18 (2002), pp. 135-142
[43.]
T.E. Burroughs, A.D. Waterman, T.H. Gallagher, B. Waterman, D. Adams, D.B. Jeffe, et al.
Patient concerns about medical errors in emergency departments.
Acad Emerg Med, 12 (2005), pp. 57-64
[44.]
M.A. Abreu.
Denuncias por mala praxis: causas, consecuencias y prevención.
Med Clin (Barc), 103 (1994), pp. 543-546
[45.]
Hegde S. Society should stop this trend before it is too late![Accedido 2 Julio 2005]. BMJ. 2003; Disponible en: http://www.cfnavarra.es/salud/anales/textos/vol26/n2/colaba.html
[46.]
M. Esteva, C. Larraz, J. Soler, H. Yaman.
Desgaste professional en los médicos de familia españoles.
Aten Primaria, 35 (2005), pp. 108-109
[47.]
P. Cathebras, A. Begon, S. Laporte, C. Bois, D. Truchot.
Burn out among French general practitioners.
Presse Med, 33 (2004), pp. 1569-1574
[48.]
D.M. Studdert, M.M. Mello, W.M. Sage, C.M. DesRoches, J. Peugh, K. Zapert, et al.
Defensive medicine. Among High-risk specialist physicians in a volatile malpractice environment.
JAMA, 293 (2005), pp. 2609-2617
[49.]
J. Reason.
L’erreur humaine.
Presses Universitaires de France, (1993),
[50.]
J. Reason.
Managing the risk of organizational accidents. Aldershot.
Ashgate, (1997),
Copyright © 2006. Sociedad Española de Salud Pública y Administración Sanitaria
