INTRODUCTION:Patient handoff is an interactive process including data communication and responsible transfer in order to safely maintain the continuity of care. Failure in this process may result in inadequate care and favor the occurrence of errors.OBJECTIVE:To implement a standardized instrument for patient handoff from the intensive care unit (ICU) to the intermediate-medium care unit (IMCU), and compare communication between health care providers before and after the intervention.POPULATION AND METHODS:Before-and-after study conducted at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan." The intervention consisted in a written handoff form. The pre-intervention sample included patients transferred from ICUs to IMCUs between October 1st and October 31st, 2015. The post-intervention sample included patients transferred between March 1st and March 31st, 2016. A total of 4 IMCUs and 3 ICUs participated in the study. The main study variable was the written part of the handoff; in particular, whether it was timely and complete.RESULTS:A total of 50 handoffs were analyzed for each stage. With the written handoff, there was an increase in the communication of clinical data in 88 % of variables (oral communication between physicians, treating physician, therapeutic adequacy, diagnosis, course, etc.); the difference was statistically significant.CONCLUSION:After implementing the tool, there was an improvement in the transfer of patient clinical data relevant to the safe continuity of care.

Patient safety is one of the dimensions of care. Medical advances have made assistance processes more and more complex, and there is usually a combination of circumstances that converge for errors to occur. Adverse events constitute a serious public health problem, causing damages of varying degrees to the patient and his family, which also leads to an increase in the cost of the care process and hospital stay. Most of the adverse events occur in hospitals because their complexity is subject to a greater risk associated with care. That is why we present this consensus with the aim of offering tools whose implementation can contribute to provide a safer healthcare.

BACKGROUND:Patient safety is a priority for healthcare organizations. For the PRONAP´s 2013 final exam, the Quality & Patient Safety Subcommittee and the PRONAP managers designed a survey to be answered by pediatrician students nationwide. It was destined to evaluate attitudes, practices and safety conditions in which they worked.AIM:To assess the current state of practices in patient safety.MATERIAL AND METHODS:Setting and sample: PRONAP students (7,438 pediatrician nationwide) who answered 2013 final exam. Instrument: Patient Safety Survey about pediatric inpatient (9 domains) and outpatient (5 domains) practices, and population data.RESULTS:Patient Safety Survey: 6424 answered (86%). Population: age: 42% 30-40 years. Women: 80%. Residence in Pediatrics: 83%. Patient safety training: 30%. geographical origin: all provinces and CABA. Inpatient practices: 15% answered their institution had Patient Safety Committee. 74% of institutions did not have event reporting systems, 70% didn´t have a patient´s identification system. 32% answered that drug prescription should be done upon vademecum at their institution, and 27% had infection´s control programs, 28% performed surgical checklist in operating room and 55% had a standardized patient hand-off. Outpatient practices: 62% said they had washbasins, 56% had soap available, and 63% alcohol gel. 70% answered children with a supposed infectious rash did not wait his turn separately.CONCLUSION:This study shows that most pediatricians in Argentine work without prioritizing patient safety, both in ambulatory and inpatient practice.

Patient safety is a priority for healthcare organizations. For the PRONAP´s 2013 final exam, the Quality & Patient Safety Subcommittee and the PRONAP managers designed a survey to be answered by pediatrician students nationwide. It was destined to evaluate attitudes, practices and safety conditions in which they worked.To assess the current state of practices in patient safety.Setting and sample: PRONAP students (7,438 pediatrician nationwide) who answered 2013 final exam. Instrument: Patient Safety Survey about pediatric inpatient (9 domains) and outpatient (5 domains) practices, and population data.Patient Safety Survey: 6424 answered (86%). Population: age: 42% 30-40 years. Women: 80%. Residence in Pediatrics: 83%. Patient safety training: 30%. geographical origin: all provinces and CABA. Inpatient practices: 15% answered their institution had Patient Safety Committee. 74% of institutions did not have event reporting systems, 70% didn´t have a patient´s identification system. 32% answered that drug prescription should be done upon vademecum at their institution, and 27% had infection´s control programs, 28% performed surgical checklist in operating room and 55% had a standardized patient hand-off. Outpatient practices: 62% said they had washbasins, 56% had soap available, and 63% alcohol gel. 70% answered children with a supposed infectious rash did not wait his turn separately.This study shows that most pediatricians in Argentine work without prioritizing patient safety, both in ambulatory and inpatient practice.Introducción. La seguridad de los pacientes es un objetivo prioritario de las organizaciones de salud. Objetivo. Conocer las actitudes, prácticas y condiciones de seguridad del paciente pediátrico en Argentina. Material y métodos. La Subcomisión de Calidad y Seguridad del Paciente de la Sociedad Argentina de Pediatría y Programa Nacional de Actualización Pediátrica elaboraron una encuesta sobre seguridad del paciente y prevención de errores (datos poblacionales, 9 dimensiones para internación, 5 para atención ambulatoria). El instrumento fue enviado a los alumnos de Programa Nacional de Actualización Pediátrica 2013, distribuidos en todo el país. Resultados. Encuesta administrada a 7438 alumnos; respondida por 6424 (86%). Población: edad: 42% de 30 a 40 años. Mujeres: 80%. Residencia/concurrencia en Pediatría: 83%. Formación en seguridad del paciente: 30%. Internación: 15% respondió que la institución donde trabajaba tenía Comité de Seguridad. El 74% carecía de sistemas de reporte de eventos; 70% no tenía identificación de pacientes; 32% debía prescribir según vademécum; 27% tenía programas de control de infecciones; 28% aplicaba la lista de verificación quirúrgica. Ambulatorio: 62% respondió que había lavatorios; 56%, que había jabón; y 63%, gel alcohólico disponible. El 70% contestó que los niños con enfermedades exantemáticas esperaban en lugares comunes. Conclusión. Este trabajo muestra que gran parte de los pediatras argentinos encuestados trabaja en condiciones en las que no se prioriza la seguridad del paciente, tanto en pediatría ambulatoria como de internación

OBJECTIVE:To create a hospital pediatric inpatient experience survey based on the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS® Hospital Survey).DESIGN:Survey development based on: (i) Translation and back translation, (ii) Review by experts, (iii) Cultural adaptation: qualitative evaluation of dimensions with reformulation and adaptation of items, (iv) Local cognitive evaluation and (v) Final measurement of its psychometric properties. Inspection, content validity and reliability assessment through internal consistency (Cronbach's alpha coefficient) and inter-item correlation. Factor analysis matrix: extraction, selection and rotation.SETTING:Two pediatric hospitals in Buenos Aires, Argentina: Hospital de Pediatría 'Garrahan' (HG) and Hospital de Niños 'Ricardo Gutiérrez' (HRG).PARTICIPANTS:Parents or caregivers of pediatric patients hospitalized for at least 24 h.RESULTS:A feasible and easy to administer 21-item instrument was developed. One thousand and thirty-two surveys were analyzed, 630 (61%) in HG and 402 (39%) in HRG. Population: mothers of admitted children were interviewed 85% of the time, 61% (625) had completed minor schooling to high school education; 365 families (35%) had unsatisfied basic needs and 51% (529) did not have health insurance. Reliability: adequate Cronbach's alpha scores were found with correlation 0.7 or higher in most domains. Validity: a direct correlation was observed between overall positive opinion and quality of care perceived with the survey, and an indirect correlation (perceived low quality) with higher level of schooling and health insurance ownership.CONCLUSION:An instrument with adequate psychometric properties was adapted to evaluate patients and families' perceptions of quality of care received during children's hospitalization.

Patient safety and quality of care has become a challenge for health systems. Health care is an increasingly complex and risky activity, as it represents a combination of human, technological and organizational processes. It is necessary, therefore, to take effective actions to reduce the adverse events and mitigate its impact. This glossary is a local adaptation of key terms and concepts from the international bibliographic sources. The aim is providing a common language for assessing patient safety processes and compare them.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.The sentinel event identified was undiagnosed adolescent pregnancy before the indication of potentially harmful treatments or diagnostic methods. The team performed a root -cause analysis where the following causes were identified: a) Paediatrician bias: not thinking about adolescent sexual behaviour, incomplete questionnaires, insufficient training in adolescent interviews. b) Social factors: legal issues, ambiguous contraceptive recommendations. c) Hospital factors: lack of guidelines for counselling adolescents. d) Host risk factors: cultural barriers, lack of confidence. Regardless of any previous negative pregnancy test results, any time that a new potentially harmful procedure is indicated in a fertile female patient, a test of pregnancy diagnosed might be performed.

espanolObjetivo Adaptar la encuesta H-CAHPS de satisfaccion de pacientes adultos a la poblacion pediatrica en dos hospitales de Argentina, medir su validez y fiabilidad y evaluar las percepciones de pacientes y familias sobre la calidad de la atencion recibida. Material y metodologia Estudio transversal cualitativo y cuantitativo en dos hospitales pediatricos de Buenos Aires. Etapas de adaptacion: traduccion /retraduccion, revision por pares, evaluacion cualitativa, evaluacion cognitiva y validacion. Se administraron 1.032 encuestas: el 85% de los entrevistados eran madres, el 61% tenian escolaridad menor a secundaria completa, el 35% de las familias tenian necesidades basicas insatisfechas y el 51% no tenian cobertura sanitaria. Resultados Fiabilidad: score de Alfa Cronbach a nivel de todo el instrumento. Correlacion > 0.7 (grupal) y 0.9 (individual). Validez: se observo relacion directa con el bajo nivel educativo y relacion inversa con la presencia de cobertura sanitaria. Conclusion: La adaptacion a la poblacion pediatrica del cuestionario H-CAHPS es un instrumento fiable y valido para la evaluacion estandarizada de las percepciones de ninos internados, a traves de sus cuidadores EnglishObjective: To adapt the H-CAHPS adult patient satisfaction questionnaire to the pediatric population of two Argentinean hospitals, measuring its validity and reliability, and evaluating patient and family perception referred to the care received. Materials and methods: A qualitative and quantitative cross-sectional study was made in two pediatric hospitals of Buenos Aires. Adaptation stages: translation / backtranslation, peer review, qualitative evaluation, cognitive evaluation and validation. A total of 1,032 questionnaires were administered: 85% of those interviewed were mothers, 61% had completed less than secondary education, basic needs were not covered in 35% of the families, and 51% had no medical coverage. Results: Reliability: Cronbach�s alpha score at global instrument level. Correlation > 0.7 (group) and 0.9 (individual). Validity: A direct correlation was observed to low educational level, together with an inverse correlation to the presence of medical coverage. Conclusion: Adaptation of the H-CAHPS to the pediatric population shows the instrument to be reliable and valid for the standardized assessment of perception among hospitalized children, through their caregivers.

Objective: To adapt the H-CAHPS adult patient satisfaction questionnaire to the pediatric population of two Argentinean hospitals, measuring its validity and reliability, and evaluating patient and family perception refe- rred to the care received. Materials and methods: A qualitative and quantitative cross-sectional study was made in two pediatric hospi- tals of Buenos Aires. Adaptation stages: translation / backtranslation, peer review, qualitative evaluation, cog- nitive evaluation and validation. A total of 1,032 questionnaires were administered: 85% of those interviewed were mothers, 61% had completed less than secondary education, basic needs were not covered in 35% of the families, and 51% had no medical coverage. Results: Reliability: Cronbach's alpha score at global instrument level. Correlation > 0.7 (group) and 0.9 (in- dividual). Validity: A direct correlation was observed to low educational level, together with an inverse corre- lation to the presence of medical coverage. Conclusion: Adaptation of the H-CAHPS to the pediatric population shows the instrument to be reliable and valid for the standardized assessment of perception among hospitalized children, through their caregivers.

Patient safety in the operating room is a topic of universal concern. Several studies support the existence of a high percentage of complications and a high mortality rate in surgical procedures (0.5 to 5%). The World Health Organization (WHO) has proposed the implementation of surgical check list in order to improve patient safety in the operating room. In Hospital Garrahan, 9600 surgeries and surgical anesthesia for more than 8000 studies and other invasive procedures are performed per year. WHO checklist adaptation and implementation was considered an institutional priority. We describe difficulties and solutions in implementing the surgical checklist. Surgical team involvement in project planning and development was essential.

Patient safety in the operating room is a topic of universal concern. Several studies support the existence of a high percentage of complications and a high mortality rate in surgical procedures (0.5 to 5%). The World Health Organization (WHO) has proposed the implementation of surgical check list in order to improve patient safety in the operating room. In Hospital Garrahan, 9600 surgeries and surgical anesthesia for more than 8000 studies and other invasive procedures are performed per year. WHO checklist adaptation and implementation was considered an institutional priority. We describe difficulties and solutions in implementing the surgical checklist. Surgical team involvement in project planning and development was essential.

INTRODUCTION:Patient misidentification continues to be a quality and safety significant issue. The Joint Commission International listed patient identification as the first of ten life-saving patient-safety solutions. Identification wrist bands are the goal in the identification strategy. At the Hospital Nacional de Pediatría "Prof. Dr. J.P. Garrahan" we inquired about perception and agreement of this practice within hospital staff and parents.METHOD:A short questionnaire was used with; in the first part a four point Lickert scale, and in the second one an open unstructured response. The questionnaire was distributed among health care workers and parent's patients. For families, the third question was not administrated. The survey explored about purpose and opportunity regarding the use of wrist band identification. A one day cutoff was made to obtain baseline data for properly use of identification bands.RESULTS:A total of 300 questionnaires were analyzed, 100 for each cluster (physicians, nurses, and parents); 82% responded that the wrist band should stay along the whole hospitalizing period. A range of 64% to 74% within the groups responded that it is helpful to prevent errors. There was no statistical difference between parents and physicians. Overall, percentage of patient with correct identification band in the hospital was 34%.CONCLUSIONS:We concluded that the wrist band identification is not a health care workers priority behavior yet. Initiatives on safety patient identifications, including families and healthcare workers, must be developed in the near future.

We report the case of a 15-year-old female patient, native of the province of Chaco, diagnosed with lymphoblastic leukemia 2 years ago. She was currently in maintenance therapy, with good response to treatment. Twenty days before she began with headache and fever. At admission, blood cultures were negative, and brain computed tomography showed a hypodense lesion with involvement of white matter in left occipital-parietal area. A brain MRI was performed, and a hypointense left occipital lesion was observed in T1. The lesion showed peripheral gadolinium enhancing and was hyperintense on T2, with a hypodense central area surrounded by significant edema with mass effect. Chagas serology was positive, as well as the parasitemia. The patient was treated with benznidazole, with good response to therapy: a significant clinical improvement and mass reduction were observed, within the first month of treatment.