Resumen de Uso de pruebas complementarias en urgencias y su relación con incidentes de seguridad

Julian Alcaraz Martínez, Jesús María Aranaz Andrés, Antonia del Amor Cantero Sandoval, Pascual Piñera Salmerón, J. Mas Luzón, J.A. Serrano Martínez, E. González Garro

• español

  Objetivo Analizar el uso de pruebas complementarias y su relación con incidentes de seguridad en servicios de urgencias hospitalarios.

  Metodología Se analizó a 935 pacientes atendidos en 9 servicios de urgencia de la Región de Murcia. Fuente de datos para detección de los incidentes: la historia y los informes de Urgencia, observación presencial y encuesta telefónica a la semana del alta.

  Análisis estadístico: se utilizaron la t de Student para variables cuantitativas, la chi al cuadrado para las cualitativas y el test de ANOVA.

  Resultados Se utilizó catéter venoso periférico en 397 pacientes (42,4%; IC del 95%: 39,3-45,5%), con diferencias significativas entre centros (p < 0,01) (rango: 37-81,8%). Así mismo se ha comprobado que en 23,4% (IC del 95%: 19,2-27,6%) de los casos, no se utilizó la vía después de la primera extracción. Se solicitaron pruebas radiológicas a 351 pacientes (37,7% [IC del 95%: 34,6-40,8%]), con diferencias significativas entre centros (p < 0,01). Se detectó a 95 pacientes con incidentes: 10,2% (IC del 95%: 8,3-12,1%). Se ha evidenciado mayor proporción de incidentes de seguridad en los pacientes en que se ha usado catéter venoso periférico (12,8%) frente a los que no se ha usado (8,5%) (p = 0,03), en los que se ha pedido una radiografía (12,8%) frente a los que no (8,6%) (p = 0,04) y tuvieron mayor estancia los casos con incidente (media 248,9) frente a los que no (media 164,1’) (p< 0,001).

  Conclusión Se constata la variabilidad entre centros y la relación del uso de catéter venoso periférico y pruebas radiológicas con la aparición de incidentes de seguridad en Urgencias.

• English

  Objective To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments.

  Methodology An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care.

  Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test.

  Results A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9 minutes) than in those where there were none (mean 164.1 minutes) (P<.001). No statistically significant differences were found in the other parameters studied.

  Conclusion A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.