INTRODUCTION AND OBJECTIVES:Intravenous therapy is widely used in hospital settings, however, nurse practice compliance remains suboptimal in many contexts. Although standardized initiatives have been introduced to address this issue, gaps in regulatory guidance and empirical evidence persist in Vietnam. This study aimed to evaluate nurses' compliance with newly implemented program and to identify factors associated with non-compliance in inpatient care settings. MATERIALS AND METHODS:A cross-sectional descriptive study was conducted at the tertiary military hospital in Southern Vietnam. Data were collected from 255 nurses using a peripheral IV drug preparation and administration processes assessment form based on JCI standards. RESULTS:Compliance with standard IV medication preparation and injection procedures was 33.7% and 38%, respectively, with the mandatory step of "checking for drug interactions" achieved in only 38.8% of cases. Nurses with more than 10 years of experience demonstrated lower compliance with medication preparation procedures (AOR=0.44, 95% CI: 0.20-0.96; p=0.041). Significant differences in drug administration compliance were observed between emergency rooms and general wards (AOR=0.31, 95% CI: 0.15-0.63; p=0.001), weekdays and weekends (AOR=0.42, 95% CI: 0.21-0.83; p=0.001), and day and night shifts (AOR=0.30, 95% CI: 0.14-0.62; p=0.023), whereas gender, age, and professional level were not significantly associated. CONCLUSIONS:Nurse compliance with both IV medication preparation and administration procedures were low. Continuous international training programs for all nurses is essential to ensure medication safety.
BACKGROUND:Surgical site infection are among the most common healthcare-associated infections in Spain, contributing to increased morbidity, longer hospital stays, and higher associated costs. The objective of this study was to estimate the incidence of surgical site infection and identify risk factors in patients undergoing nephrectomy, with a focus on patient safety and quality improvement in surgical care. METHODS:A prospective cohort study was conducted from 2009 to 2023 at the University Hospital Alcorcón Foundation, including patients undergoing nephrectomy with a 30-day postoperative follow-up. Variables studied included demographic, clinical, surgical and prophylactic factors. Data were analyzed using descriptive statistics, bivariate tests, and a multivariate logistic regression model was built to identify independent risk factors for infection. RESULTS:A total of 468 patients (482 procedures) were included. The difference represents 14 patients undergoing subsequent contralateral or completion nephrectomies, each treated as an independent event. Most surgeries were elective (95.5%), clean-contaminated (92.1%), and laparoscopic (59.5%). The overall surgical site infection incidence was 4.8% (n=23). In the bivariate analysis, laparoscopic surgery was associated with a significantly lower risk of infection compared to open surgery (OR 0.29; 95% CI: 0.12-0.73; p=0.008). In multivariate model, partial nephrectomy (OR 0.22, 95% CI: 0.07-0.69; p=0.009) was identified as a protective factor, whereas incorrect antibiotic prophylaxis (OR 7.29, 95% CI: 1.03-51.83; p=0.047) and a National Healthcare Safety Network risk index of 3 (OR 94.53, 95% CI: 4.45-2006.17; p=0.004) were significantly associated with increased risk. The most frequently isolated microorganisms were Escherichia coli and Enterococcus faecium. Patients with surgical site infection had longer hospital stays (median 16 vs. 5 days). CONCLUSIONS:Surgical site infection risk after nephrectomy showed a low incidence (4.8%). Partial nephrectomy has a lower risk than radical procedures. Appropriate antibiotic prophylaxis and risk stratification using the NHSN index are associated with a reduced risk of infection, and may improve patient safety and quality of care.
BACKGROUND:Informal caregivers are key to home-based care safety. OBJECTIVE:To evaluate whether the effectiveness of immersive training aimed at reducing home-based care errors differs according to caregiver sex. METHODS:A randomized comparative study with pre-post assessment involving 141 informal caregivers compared virtual reality (VR; n=70) and 360° video training (360VT; n=71). Data were collected at baseline and three months after the intervention. The primary outcome was the number of self-reported home-based care errors. Data were analysed using a mixed-effects Poisson regression model. RESULTS:The mean number of self-reported errors decreased from 0.91 to 0.46 per caregiver after training. Exploratory subgroup analyses suggested that pre-post changes may have differed according to training modality and caregiver sex, with larger estimated reductions among women in the VR group (IRR=0.29, 95%CI: 0.14-0.59; p=0.0005) and among men in the 360VT group (IRR=0.19, 95%CI: 0.06-0.60; p=0.0048). The phase×modality×sex interaction was statistically significant (IRR=13.88, 95%CI: 1.95-98.75; p=0.0087). Satisfaction was high overall, although women in the VR group reported lower ease of participation (adjusted p=0.0373). CONCLUSIONS:Immersive training may contribute to improving home-based care safety among informal caregivers. These findings also highlight the importance of appropriate onboarding, usability adaptations, and further evaluation in larger and more diverse caregiver populations.
BACKGROUND AND OBJECTIVE:Inappropriate use of antimicrobial agents accelerates the emergence and spread of resistance. Antimicrobial treatment guidelines (ATG) stand between evidence and clinical practice as they are designed to guide policy decision framework for all stakeholders promoting the prudent use of antimicrobials in bedside care. The trustworthiness of these decision-making instruments relies on their methodological quality and reporting. The aim of this systematic review is to critically appraise the methodological quality and reporting of antimicrobial treatment guidelines using the AGREE II, AGREE-REX tools and the RIGHT checklist respectively. MATERIALS AND METHODS:A systematic review was conducted. ATGs from public institutions and hospitals with over 500 beds were identified through a systematic search using the Google search engine and by consulting members of the AFinf workgroup (https://gruposdetrabajo.sefh.es/afinf/en/). Screening and data extraction were performed in duplicate. Quality and reporting were assessed using the validated checklists AGREE II, AGREE REX and RIGHT. Central tendency, dispersion, and correlations were calculated and compared using Student's t-test. Results are de-identified. Prospective protocol: https://osf.io/cey2v RESULTS: N=22. The mean scores for AGREE II, AGREE-REX, and RIGHT were generally low: 31.0% (95% CI: 23.7%-38.3%), 20.4% (95% CI: 15.6%-25.1%), and 28.7% (95% CI: 23.4%-34.0%) respectively. Low rates were observed for development rigour (10.2%); reference existing reviews (4.6%); quality assurance (4.6%); conflict of interests disclosure (4.6%); values and preferences (1.9%) while clarity (94.8%) and implementability (37.7%) rated the highest. Strong correlations among AGREE II and AGREE-REX (corr=0.9092) and RIGHT (corr=0.9203). CONCLUSION:There is room for improvement in the quality and reporting of current ATGs in Spain, especially at hospital level, where they have greater potential to optimize antibiotic prescribing practices.
BACKGROUND AND OBJECTIVE:Assessing patient satisfaction is essential for the continuous improvement of healthcare quality. The objective of this study was to determine whether specific factors (age, payer, period of care, etc.) influence patient satisfaction, whether they act in the same way in two hospital settings (Emergency Department and Major Outpatient Surgery), and to identify areas of the care process with the greatest potential for improvement in these settings. METHOD:The data considered correspond to 12176 internal surveys conducted by the Hospital de Manises (Valencia) on patient satisfaction between April 2022 and March 2024. The analysis methodology combined descriptive and inferential techniques, using SPSS® (version 28) and Statgraphics® (version 18), and establishing statistical significance at p < 0,05. RESULTS:On average, a higher degree of satisfaction was detected in patients undergoing Major Outpatient Surgery compared to those in the Emergency Department (mean ratings of 8.67 and 7.83, respectively). The factors considered were influential in the Emergency Department (p < 0,009 in all cases), but not in Major Outpatient Surgery (the lowest p, 0,254, corresponded to the age factor). Waiting times and the information and care received were identified as key areas for improvement, for both the most satisfied and least satisfied patients. CONCLUSIONS:The factors considered did not act in the same way in Emergency Department and Major Outpatient Surgery, being significant in the former but not in the latter, with different diachronic behaviours. The most and least satisfied patients identified the same areas for improvement.
OBJECTIVE:To describe the redesign and implementation of an electronic alert management system aimed at supporting the identification and management of patients requiring transmission-based precautions in a high-complexity hospital. MATERIALS AND METHODS:An organizational and technological intervention was carried out focusing on the revision of the alert workflow for patients at risk of transmitting microorganisms within the electronic health record system (HCIS). Standardized icons were designed for each type of precaution and integrated into bed maps and patient locator tools. A digital workflow was established allowing provisional alert activation by clinical or admission staff and subsequent validation by the Preventive Medicine Department. Alerts were automatically linked to a non-pharmacological prescription specifying the required precautionary measures, and a real-time locator system was developed. The evaluation was conducted through a descriptive before-after analysis across two six-month periods (2023-2024 and 2024-2025). RESULTS:A total of 1205 alerts were generated during both periods. Changes were described in the validation rates of provisional alerts and in the mean validation times, particularly for contact alerts. CONCLUSIONS:The intervention allowed the reorganization and standardization of electronic alert management for transmission-based precautions, providing an organizational and technological framework that may be useful for other hospitals.
Objectives To evaluate the impact of implementing a Computerized Physician Order Entry (CPOE) system designed and managed by Clinical Laboratory professionals, on laboratory test demand in Primary Care (PC). The study assessed its effect on laboratory costs, intra- and inter-physician variability, and the use of high-demand tests. Material and methods A prospective longitudinal study was conducted at Hospital Clínico Universitario in Valencia, Spain, involving 154 Primary Care Physicians (PCPs) across 28 centers. A before-and-after analysis compared laboratory test requests during a six-month period before (PRE) and after (POST) CPOE implementation. Cost indicators, variability metrics, and request patterns for selected high-demand tests were analyzed using parametric and non-parametric statistical tests according to data distribution. Results A significant reduction in laboratory costs was observed following the implementation of the CPOE system. The median cost per request decreased by €5.69 (14%), with 89% of PCPs reducing their test-related expenditures. The number of tests per request also dropped significantly (median reduction: 2.2 tests), with a notable decrease in the use of redundant or low-value tests. Despite stable total request volumes, overall costs and test variability per request were significantly reduced. Individual test analysis showed improved appropriateness, with marked declines in unnecessary use of tests such as PSA, Vitamin B12, Folate, and serum iron. Conversely, appropriate increases were noted in the use of tests like urinary albumin. Conclusions CPOE systems managed by Clinical Laboratory professionals are effective tools for optimizing test demand in PC. Their implementation can improve cost-efficiency, reduce clinical variability, and promote appropriate test utilization.
Introduction Describe a methodological proposal and value-based ratio calculations based in real-world hospital-care episodes in Spain, serving as cost per outcomes benchmarking references. Methodology Patient Reported Experience/Outcome Measures (PREMs/PROMs) as well as professional opinions were collected. A first data collection took place (January/June-2023), six months after knee (KP) and hip prostheses (HP) surgeries, as well as after heart failure admissions (HF). A second (February/April-2024) six months after an oncological prostatectomy (OPr) surgeries. Total: 42 hospitals. Costs data was calculated considering patients’ episode profiles with Machine-Learning and the Spanish Net of Hospital Costs database, based on a large database of hospital per-episode costs and partial-cost vectors. Crude PROMs scorings were compared across centers. Costs were divided by questionnaire values for reference benchmark ratios. Results Full-questionnaire ratios were based on 804 patients (KP), 729 (HP), 717 (set-HF) and 388 (OPr). Cost-per-Value-Based-Units were: 101€/VbU big public-84 medium public-89 private (KP), 110€/VbU-97-86 (HP), 102€/VU-46-59 (set-HF) and 68€/VU-56-62 (OPr). The higher variability (HF) was not associated to outcomes but differential costs. Better results were seen in private centers; big public centers treated higher complexity. Conclusion The current methodological proposal applied for calculating value-based results calculated in a large number of centers in Spain is feasible to calculate and therefore be used to evaluate for the improvement of variability in results according to health expenditure in different pathologies and types of centers.
BACKGROUND:Research on clinical decision-making in Intensive Care Units (ICUs) during the COVID-19 pandemic is limited. The objectives of this study are to quantify variation in ICU physicians' decisions in Spain and evaluate its association with contextual factors. METHODS:This was a mixed-methods, within-subjects, qualitative-quantitative experimental study using vignettes with manipulation of contextual factors (time of decision, age and pre-existing morbidity, incongruity of diagnostic results, pandemic wave) using an online questionnaire. A total of 146 physicians who worked in the ICU during the pandemic participated. Paired responses in each model were compared using the McNemar test (mid-P), and effect size was estimated using odds-ratios. RESULTS:Wide practice variation in clinical decision-making was identified, associated with the analysed contextual factors. In model 1, 73% of physicians opted not to intervene at 3:00 AM, but only 14.5% at 10:00 AM. In model 2, most physicians opted to admit the youngest patient with multimorbidity to the ICU during the first wave, but not the older patient with a better pre-existing condition (OR=8.13), an effect that decreased in the last wave (OR=2.42). In model 3, managing patients with COVID-19 despite a negative PCR test was much more frequent in the first wave than in the last (78.8% vs. 56.7%). CONCLUSIONS:High variation in ICU decisions during the pandemic was observed, sensitive to contextual factors such as time of day, age, and the influence of time. This suggests the use of heuristics by physicians and the need to incorporate the contextual component into their training.
BACKGROUND:Patient safety is a global priority, yet evidence on serious reportable events (SRE) in public hospitals in low- and middle-income countries is limited. This study aims to describe the characteristics of patients, the reported events, and the financial and length-of-stay impact associated with serious reportable event notifications in a federal hospital complex in southern Brazil. METHODS:This cross-sectional study used data from an institutional incident reporting system, supplemented by medical records and national administrative databases. RESULTS:Of 73,977 reports, 101(0.14%) were SRE (0.02 per 1000 patient-days). Most involved male patients over 50 years requiring intensive care. The most frequent SRE were late-stage pressure injuries (63.9%) and retained surgical items (19.6%). SRE-related admissions had 232% higher costs and 270% longer stays than institutional averages. CONCLUSION:SRE are rare but impose significant resource and outcome burdens. These findings support the use of SRE surveillance to inform patient safety strategies and guide decision-making in resource-constrained public health systems.
INTRODUCTION AND OBJECTIVES:Assessing quality of care from the patient's perspective is key to improving health services. In university podiatry, this perspective has been little explored, despite its relevance for guiding person-centred teaching and clinical practice. The aim of this study was to describe patients' care experience in a university podiatry clinic and to identify the factors associated with their perceived satisfaction. PATIENTS AND METHODS:Qualitative exploratory-descriptive study conducted at the University Podiatry Clinic of the University of A Coruña (Spain). Thirty-one adult patients participated, selected through purposive theoretical sampling. Individual semi-structured interviews were carried out and complemented with field notes. Data were analysed using Colaizzi's method within a phenomenological framework, until theoretical saturation was reached. RESULTS:The care experience was structured around six thematic axes: clinical aspects, interpersonal care, infrastructures, accessibility, characteristics of the centre and clinical experience. Patients reported high perceived satisfaction, highlighting the warmth of the interpersonal care, the clarity of communication and the confidence derived from clinical supervision. The free-of-charge nature of the service and its university setting were valued as added-value elements. The main areas for improvement were the waiting time for the first appointment in the orthopodiatry service and continuity of care between academic terms. CONCLUSIONS:University podiatry care is perceived as approachable, effective and technically adequate. The educational model, combined with high-quality interpersonal care, shapes a highly valued care experience and provides useful insights for defining quality standards in university clinical settings.
INTRODUCTION:Patient safety is an essential and transversal element in health care, encompassing multiple and varied elements, including the use of simulation as a training tool for professionals. OBJECTIVE:The main objective was to evaluate the feasibility, impact, and satisfaction with an in situ simulation program in a pediatric intensive care unit. METHODS:Prospective, longitudinal, observational study in a level III PICU was carried out during 5 months. Standardized simulations were realized during the working day in the own unit. Demographic participants data, unit́s workload, assessment of non-technical skills (TEAM scale), latent system errors identified and staff satisfaction were recorded. RESULTS:A total 45 healthcare professionals participated in 13 simulation cases, performing between 1 and 4 simulations per person. The average duration of the simulations was 50minutes (SD 10.5). The average of the TEAM scale was 7,8 (1) and the overall satisfaction of the staff was 4,4 (0.5) points on a Likert scale of 1 to 5. A total of 14 latent system errors were identified: organizational deficiencies (3, 21.4%), problems with material or consumables (3, 21.4%) and training gaps (8, 57.2%). CONCLUSIONS:It́s possible to carry out a in situ simulation program during working hours with good acceptance by the staff. This tool allows identifying latent errors in the system and non-technical skills training.
INTRODUCTION:The provision of information at the time of discharge from the Emergency Department (ED) represents a critical juncture in the patient care process. The objective of this study was to describe caregivers' discharge information needs and expectations, in order to update Caregivers' Information Sheets of the Spanish Society of Pediatric Emergency Medicine (SEUP), incorporating the needs and feedback of family members/caregivers. MATERIALS AND METHODS:This descriptive, observational, prospective, and multicenter study included family members/caregivers of children who attended the ED and subsequently discharged home. The project was carried out in three phases: a quantitative phase involving telephone surveys to assess the level of comprehension and perception of the SEUP information sheet, a qualitative phase involving focus groups, and finally a redesign phase to update the information sheets. RESULTS:In phase 1, 176 caregivers participated. 90.3% understood the diagnosis, 70.9% comprehended the recommendations, and 62.9% were aware of the reasons for potential return visits to the ED. The information was understandable (97.7%) and useful (89%), although 18.6% reported having some doubts. The paper format was considered suitable (80.1%). In phase 2, 10 family members participated in focus groups, resulting in 44 key statements. These were categorized into 19 central themes and 4 main dimensions: format(6), content(7), clarity(3), and concerns/empowerment(4). CONCLUSIONS:The majority of family members understood the information sheets and found them to be useful. Some participants considered the information to be incomplete. The analysis of family members' needs regarding discharge information has highlighted key aspects that have been incorporated into the redesigned SEUP information sheets.
INTRODUCTION AND OBJECTIVES:Pediatric oncology patients are at high risk for infectious complications, with febrile neutropenia being the most frequent oncological emergency. Early administration of antibiotics, ideally within the first hour of arrival at the emergency department, is associated with improved clinical outcomes. A digital alert tool was implemented to immediately identify these patients through an icon visible to all healthcare and administrative staff. The main objective of the study was to evaluate the impact of this intervention on medical care and antibiotic administration times. METHODS:A retrospective quasi-experimental study with a before-after design was conducted in the pediatric emergency department of a tertiary hospital between January 2020 and December 2024. Clinical care timelines in patients with febrile neutropenia were compared before (2020-2022) and after (2023-2024) the implementation of the alert tool. Clinical variables, time to medical evaluation, and time to antibiotic administration were collected. RESULTS:A total of 159 episodes in 104 patients were analyzed. Following the implementation of the alert, the percentage of patients classified as level 2 at triage significantly increased (p=0.001). Time to medical evaluation decreased (median from 25 to 13minutes; p <0.001), as did the time to antibiotic administration (median from 166 to 53minutes; p <0.001). The percentage of patients receiving antibiotics within the first hour increased from 8.3% to 58.7% (p <0.001). No deaths were recorded. CONCLUSION:The implementation of a digital alert tool improved triage prioritization and significantly reduced the time to medical evaluation and antibiotic administration, enhancing the quality of care for pediatric patients with febrile neutropenia.
Introduction Chronic multimorbidity, aging and care fragmentation challenge health systems. In Spain, strengthening coordination between primary and hospital care may support more effective chronic disease management. Objective The CARABELA PC-HC initiative proposes an integrated, patient-centered approach to strengthen chronic care continuity across levels. Methods This cross-sectional analysis included five CARABELA initiatives (from May 2019 to October 2024) supported by ten Spanish scientific societies and AstraZeneca. Centers were selected for territorial representativeness, structural diversity, and population size. The CARABELA methodology included: design of the ideal care process based on clinical guidelines and real-world practice; identification of improvement areas (IAs) and solutions; validation of proposals and quality indicators (QIs) through a national Delphi consensus; and development of a Whitebook incorporating patient input and dissemination via the CARABELA Playbook platform. Results Chronic care delivery was mapped across 124 Spanish health areas, covering 1337 centers and 10,696 professionals. Globally, 82 IAs, 282 solutions, and 121 QIs were identified. Prioritized IAs included poor care continuity, lack of shared protocols, limited patient education, and uneven digital integration. Professionals emphasized coordination, training, and clinical protocols; patients prioritized autonomy, information, and emotional support. A core set of 54 cross-cutting solutions (including shared electronic health records and multidisciplinary pathways) and 46 transversal indicators was defined to guide implementation and evaluation. Conclusions CARABELA PC-HC provides a scalable framework to optimize chronic care integration. By aligning processes and patient-centered professional collaboration, it supports coordinated care models that enhance clinical outcomes, efficiency and equity, with potential applicability to other health systems.
Background and aims Achieving compliance with hand hygiene (HH) to ensure safe healthcare remains a constant challenge. Observations in inpatient units revealed suboptimal adherence and the need for a quality improvement (QI) intervention. The study aim was to increase HH adherence from 50% to 85% by September 2024 in selected units. Methods From May to September 2024, the intervention was implemented in five inpatient units of a community hospital in Qatar. It included multimodal monitoring (entry/exit method, alcohol-based hand rub [ABHR] consumption), staff education through various formats (in-person sessions, printed materials, online training, practical workshops), and targeted feedback to staff and leaders. Results A total of 8638 HH opportunities were recorded: 4625 before entering and 4013 after leaving patient rooms. Adherence before entry reached the target (≥85%) during the final two weeks; after exit, from week 5 onwards, except week 11 (81.7%). Nursing staff showed higher compliance than physicians and aides. ABHR consumption increased by 52.4% compared to baseline. Conclusions The intervention improved HH compliance both before entry and after exit, with better performance among nursing staff. Key measures and surgical hand hygiene were identified as areas for future intervention.
