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Castellanos-Ortega A, Broch MJ, Barrios M, Fuentes-Dura MC, Sancerni-Beitia MD, Vicent C, Gimeno R, Ramírez P, Pérez F, García-Ros R. Acceptance and validity of the methods used to implement a competency based medical education programme in an Intensive Care Department of a teaching referral center. Med Intensiva 2021; 45:411-420. [PMID: 34563341 DOI: 10.1016/j.medine.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES 1. To determine the satisfaction of tutors and residents with a specific methodology used to implement CoBaTrICE. 2. To determine the reliability and validity of the global rating scales designed ad hoc to assess the performance of the residents for training purposes. DESIGN Prospective cohort study. PARTICIPANTS All the residents and tutors of the ICU Department of the Hospital Universitario y Politécnico la Fe de Valencia. INTERVENTION CoBaTrICE implementation started in March 2016, it was based on: (1) Training the tutors in feedback techniques; (2) Performing multiple objective and structured work based assessments to achieve the competences of the program; and (3) The use of an electronic portfolio to promote learning reflection and to collect the evidence that learning was taking place. METHODS The acceptance of CoBaTrICE was explored through a satisfaction survey conducted after 9 months of implementation of the training program. The 15 residents and 5 tutors of the ICU Department were asked about the methodology of the formative assessments, the quality of the feedback, self-learning regulation and the electronic portfolio usefulness. The validity of the global rating scales was assessed through the tests alfa de Cronbach, reliability and generalizability indexes, and intraclass correlation coefficient. RESULTS The implementation of CoBaTrICE was satisfactory in all the dimensions studied. The global rating scales used for formative purposes showed reliability and validity. CONCLUSIONS The methodology used to implement CoBaTrICE was highly valued by tutors and residents. The global rating scales used for formative purposes showed reliability and validity.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M J Broch
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Barrios
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M C Fuentes-Dura
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - M D Sancerni-Beitia
- Departamento de Metodología de Ciencias del Comportamiento, Universidad de Valencia, Valencia, Spain
| | - C Vicent
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R Gimeno
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - F Pérez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R García-Ros
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, Valencia, Spain.
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Porcel JM, Bagüeste G, Liesa L, Bielsa S. Research productivity during residency training in Spain: Comparison among medical specialties lasting 5 years. Rev Clin Esp 2021:S2254-8874(21)00124-7. [PMID: 34294597 DOI: 10.1016/j.rceng.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the quantity and quality of publications during the residency training period in Cardiology, Intensive Care Medicine, Internal Medicine and Medical Oncology in Spain. METHODS A retrospective cohort study of residents from 4 specialties lasting 5 years (2014-2019). The number and type of publications indexed in PubMed®, the names of the journals and their bibliometric indexes (impact factor and quartiles), and author's positions were evaluated. RESULTS The 649 residents included in the study generated 801 publications (publication/resident ratio 1.23). Cardiology residents published significantly more (ratio 2.57) and Intensive Care Medicine residents less (ratio 0.42) than the remaining specialties (Internal Medicine, ratio 1.06; Medical Oncology, ratio 0.76; p < .001). Overall, only 44.5% of residents participated in a publication, with 27.6% participating in an original article; this latter percentage increased significantly among cardiologists (47.7%; p < .001). The predominant types of publications were original articles (47.9%) and clinical reports (36.8%). The proportion of publications in first quartile journals was higher for Cardiology residents (44.6% of total). The resident was the first or last author in only one-third of the publications. Scientific productivity was related to specialty, but not to gender or the size of the hospital in which the residency training occurred. CONCLUSIONS Intensive Care Medicine, Internal Medicine and Medical Oncology residents publish insufficiently, while the scientific production from Cardiology residents could be considered acceptable.
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Ramírez P, Garnacho-Montero J. [Invasive aspergillosis in critically ill patients]. Rev Iberoam Micol 2019; 35:210-216. [PMID: 30554674 DOI: 10.1016/j.riam.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 01/06/2023] Open
Abstract
Critically ill patients without severe immunosuppression make up a population in which invasive aspergillosis (IA) has been identified as an emergent pathology. Chronic treatment with corticosteroids, chronic obstructive pulmonary disease, and liver cirrhosis are repeatedly identified risk factors. However, due to the non-specificity of the symptoms and signs in the critical patient, and the relative low diagnostic capacity of the complementary tests, the diagnosis of the IA is a challenge for the specialist in critical care medicine. The application of diagnostic algorithms adapted to critical patients, in whom activation will depend on the isolation of Aspergillus in a respiratory specimen, is the most efficient diagnostic methodology in this population. Among the diagnostic approaches, the determination of galactomannan in bronchoalveolar fluid is the most useful diagnostic test. Once the suspicion is established, treatment should be started as soon as possible. Voriconazole, amphotericin B, and isavuconazole are the most effective treatments. Although voriconazole and amphotericin B are the drugs with the most scientific evidence, they are related with adverse effects and pharmacokinetic difficulties. Therefore, isavuconazole, which has shown high efficacy and safety in other populations, is a potential alternative of great interest for critically ill patients.
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Affiliation(s)
- Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen de la Macarena, Sevilla, España
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Raimondi N, Quintero Villareal A, Valdivia Nuñez A, Martín Delgado MC. The Pan American and Iberian Federation of Critical Medicine and Intensive Therapy develops its Strategic Plan. Med Intensiva 2018; 43:176-179. [PMID: 30482556 DOI: 10.1016/j.medin.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
The Pan-American and Iberian Federation of Critical Medicine and Intensive Therapy, A.C. (FEPIMCTI), has prepared its Strategic Plan for the next 5 years. In this Plan, it defines its course towards the future, establishes its long-term objectives and works to achieve success. Its strategic objectives are framed in consolidating the legal, fiscal and administrative structure, the updating of its statutes, the implementation of a process management system encompassed in a quality culture, the implementation of committees of experts, achieving academic excellence by developing training programs and giving visibility to the Federation. Their main values refer to equity, professionalism, respect and social solidarity. The implementation of the Strategic Plan in a collaborative manner must serve as a driving force for change to position FEPIMCTI as a relevant Scientific Society in the Critical Medicine of its member countries.
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Affiliation(s)
- N Raimondi
- División de Terapia intensiva, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | | | - A Valdivia Nuñez
- Consultor independiente en Gestión Estratégica y Administración, Estado de México, México
| | - M C Martín Delgado
- Servicio Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
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Olaechea Astigarraga PM, Bodí Saera M, Martín Delgado MC, Holanda Peña MS, García de Lorenzo Y Mateos A, Gordo Vidal F. Document on the state of affairs of the Spanish model of Intensive Care Medicine. SEMICYUC Strategic Plan 2018-2022. Med Intensiva 2018; 43:47-51. [PMID: 29898831 DOI: 10.1016/j.medin.2018.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022]
Abstract
The role of Critical Care Medicine in Spain requires continuous revision and reflection. We have values and strengths that are evidenced in our daily work and by their important effects in routine hospital activity. Other medical specialties seeking to assume activities referred to critical patient care, as well as a number of other circumstances, may have a negative impact upon our routine duties. This article reflects the impressions of an important number of members of the Planning, Organization and Management Task Force of the Spanish Society of Critical Medicine Society (Grupo de Trabajo de Planificación, Organización y Gestión; GTPOG-SEMICYUC). The actions required to upgrade our Critical Care Medicine model are presented, evolving towards a broader view such as the 'ICU without walls' or 'Expanded ICU'. The subject is addressed from three complementary standpoints: actions involving the administrative authorities; actions required on the part of our scientific Society; and initiatives to be implemented locally in each Intensive Care Unit (led by the corresponding Unit representatives) at both hospital level and involving the regional authorities.
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Affiliation(s)
| | - M Bodí Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
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Zapatero A, Dot I, Diaz Y, Gracia MP, Pérez-Terán P, Climent C, Masclans JR, Nolla J. Severe vitamin D deficiency upon admission in critically ill patients is related to acute kidney injury and a poor prognosis. Med Intensiva 2017; 42:216-224. [PMID: 28847615 DOI: 10.1016/j.medin.2017.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the prevalence of vitamin D deficiency in critically ill patients upon admission to an Intensive Care Unit (ICU) and its prognostic implications. DESIGN A single-center, prospective observational study was carried out from January to November 2015. Patients were followed-up on until death or hospital discharge. SETTING The department of Critical Care Medicine of a university hospital. PATIENTS All adults admitted to the ICU during the study period, without known factors capable of altering serum 25(OH)D concentration. INTERVENTIONS Determination of serum 25(OH)D levels within the first 24h following admission to the ICU. MAIN VARIABLES OF INTEREST Prevalence and mortality at 28 days. RESULTS The study included 135 patients, of which 74% presented deficient serum 25(OH)D levels upon admission to the ICU. Non-survivors showed significantly lower levels than survivors (8.14ng/ml [6.17-11.53] vs. 12ng/ml [7.1-20.30]; P=.04], and the serum 25(OH)D levels were independently associated to mortality (OR 2.86; 95% CI 1.05-7.86; P=.04]. The area under the ROC curve was 0.61 (95% CI 0.51-0.75), and the best cut-off point for predicting mortality was 10.9ng/ml. Patients with serum 25(OH)D<10.9ng/ml also showed higher acute kidney injury rates (13 vs. 29%; P=.02). CONCLUSION Vitamin D deficiency is highly prevalent upon admission to the ICU. Severe Vitamin D deficiency (25[OH]D<10.9ng/ml) upon admission to the ICU is associated to acute kidney injury and mortality.
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Affiliation(s)
- A Zapatero
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
| | - I Dot
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - Y Diaz
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - M P Gracia
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - P Pérez-Terán
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - C Climent
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - J R Masclans
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Pompeu Fabra, Barcelona, España
| | - J Nolla
- Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Pompeu Fabra, Barcelona, España
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Chico-Fernández M, Terceros-Almanza LL, Mudarra-Reche CC. Innovation and new trends in critical trauma disease. Med Intensiva 2014; 39:179-88. [PMID: 25449666 DOI: 10.1016/j.medin.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/05/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC.
| | - L L Terceros-Almanza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
| | - C C Mudarra-Reche
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
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Martín Delgado MC, Merino de Cos P, Sirgo Rodríguez G, Álvarez Rodríguez J, Gutiérrez Cía I, Obón Azuara B, Alonso Ovies Á. Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine. Med Intensiva 2014; 39:263-71. [PMID: 25063357 DOI: 10.1016/j.medin.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore contributing factors (CF) associated to related critical patients safety incidents. DESIGN SYREC study pos hoc analysis. SETTING A total of 79 Intensive Care Departments were involved. PATIENTS The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. MAIN VARIABLES The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. RESULTS A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. CONCLUSIONS The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss.
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Affiliation(s)
- M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - G Sirgo Rodríguez
- Unidad de Cuidados Intensivos, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, Tarragona, España
| | - J Álvarez Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - I Gutiérrez Cía
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Zaragoza, España
| | - B Obón Azuara
- Servicio de Medicina Preventiva y Salud Pública, Hospital Clínico Universitario, Zaragoza, España
| | - Á Alonso Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Castellanos-Ortega A, Rothen HU, Franco N, Rayo LA, Martín-Loeches I, Ramírez P, Cuñat de la Hoz J. Training in intensive care medicine. A challenge within reach. Med Intensiva 2014; 38:305-10. [PMID: 24589154 DOI: 10.1016/j.medin.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
Abstract
The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.
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Affiliation(s)
- A Castellanos-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - H U Rothen
- Department of Intensive Care Medicine, University Hospital of Bern, Berna, Suiza
| | - N Franco
- Servicio de Medicina Intensiva, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - L A Rayo
- Servicio de Medicina Intensiva, Hospital Son Espases, Palma de Mallorca, España
| | - I Martín-Loeches
- Servicio de Medicina Intensiva, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - P Ramírez
- Servicio de Medicina Intensiva, Hospital La Fe, Valencia, España
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Merino P, Bustamante E, Campillo-Artero C, Bartual E, Tuero G, Marí J. Patient safety certification in a Department of Intensive Care Medicine: our experience with standard UNE 179003:2013. Med Intensiva 2013; 38:297-304. [PMID: 24315791 DOI: 10.1016/j.medin.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
Abstract
Systematic and structured methods must be used to ensure that healthcare risks are effectively managed. Spanish standard UNE 179003:2013 provides healthcare organizations with a framework and a systematic protocol for managing patient safety from a clinical and organizational perspective. Furthermore, it is useful in securing an efficient balance among health risk, health outcomes and costs. The UNE 179003:2013 certifies that a clinical service complies with rules and operating procedures aimed at reducing the incidence of adverse events. It also requires mandatory continuous improvement, given that the standard entails frequent monitoring of the risk management system through periodic audits. The aims of this paper are to describe the UNE 179003:2013 certification process in an Intensive Care Unit, propose a risk management program for critical patients, and offer some recommendations regarding its implementation.
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Affiliation(s)
- P Merino
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España.
| | - E Bustamante
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | | | - E Bartual
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - G Tuero
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J Marí
- Unidad de Calidad, Hospital Can Misses, Ibiza, España
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