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research-article2014

AJMXXX10.1177/1062860614526635American Journal of Medical QualityTomas Vecina et al

Letter to the Editor American Journal of Medical Quality 2014, Vol. 29(4) 362­–363 © 2014 by the American College of Medical Quality Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614526635 ajmq.sagepub.com

Measuring Patient Safety in the Emergency Department: The Spanish Experience To the Editor: In their recently published article, “Measuring Patient Safety in the Emergency Department,” Pham et al1 suggest the need to establish a framework to measure safety in the emergency department (ED). The authors propose 4 major domains for measuring patient safety: (a) how often patients are harmed, (b) how often appropriate interventions are delivered, (c) how well errors in the system are identified and corrected, and (d) ED safety culture. In Spain, the Spanish Society of Emergency Medicine (SEMES) has developed a policy for improving patient safety in the ED known as the SEMES—Patient Safety Program,2 which is based on 4 areas of action: (a) knowing the ED’s safety culture, (b) creating a national network of patient safety specialists capable of developing a culture of safety in all EDs in Spain, (c) analyzing what incidents and adverse events the patients who are treated in the EDs have, and (d) developing and promoting safe clinical practices and tools for risk self-assessment. According to data from the Spanish Ministry of Health, Social Services and Equality, the Spanish public health system sees 26.1 million emergency visits from a population of 47.2 million inhabitants3,4 every year. However, emergency medicine is not recognized as a medical specialty in our country. After 4 years, the SEMES—Patient Safety Program has allowed us 1. To know the safety culture of Spanish EDs5 by means of the Hospital Survey on Patient Safety Culture (HSOPS) of the Agency on Healthcare Research and Quality6 2. To create a network of 231 specialists and instructors in patient safety in the ED, who, in turn, have trained the rest of the professionals in local hospitals and/or prehospital emergency services2 3. To discover that at least 12% of the patients seen in the ED may suffer from some kind of incident that affects their safety; this was identified by the EVADUR (Adverse Events in Emergency Department) study,7 which also determined that medication, procedures and care, and communication are the 3 principal domains that need to be improved in Spanish EDs

4. To design a map of risks in the ED; after validating the map in 23 EDs, a total of 1368 risk situations were identified that cover the complete attending process; 180 of these risk situations are considered to be essential when evaluating EDs in Spain These actions are combined with specific strategies for medication reconciliation8 and peripheral intravenous catheter9 use in the ED. In addition, the instructors presented 80 specific actions in workshops about patient safety in the ED in 2011 and presented 110 actions in 2013. Recently, we created a new strategy that has taken the form of a currently ongoing campaign titled: “The Safety of the Patient in the Emergency Department Is in Our Hands.” The aim is to disseminate 10 recommendations based on the experience described previously10 and to have all ED professionals learn and remember them. The model developed by SEMES has allowed us to measure patient safety in the ED and to reach the professionals who work in different EDs. Thanks to the data obtained through the 4 areas of action of our model, we have a basis for developing individual and collective improvement actions in EDs. The experience we have gained with our model is in line with the framework proposed by Pham et al,1 even though, as the authors state, improving quality and safety in the ED is an emerging branch of study. This is why it is necessary to reach an agreement and to prioritize what actions to take on the basis of good scientific evidence. Santiago Tomas-Vecina, PhD Hospital Municipal de Badalona—BSA, Badalona, Spain Manel R. Chanovas-Borrás, MD Tomas Vecina et alHospital Verge de la Cinta, IISPV, Tortosa, Spain Fermí Roqueta-Egea, MD Fundació Althaia Xarxa Assistencial i Universitària de Manresa, Manresa, Spain Tomas Toranzo-Cepeda, MD Hospital Virgen de la Concha, Zamora, Spain

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Tomas Vecina et al References 1. Pham JC, Alblaihed L, Cheung DS, et al. Measuring patient safety in the emergency department. Am J Med Qual. 2014;29(2):99-104. 2. Tomás Vecina S, Chánovas Borrás M, Roqueta F, Toranzo T. Patient safety in emergency medicine: report on 4 years’ implementation of a program designed for the Spanish Society of Emergency Medicine (SEMES). Emergencias. 2012;24:225-233. 3. Ministerio de Sanidad, Servicios Sociales e Igualdad. Informe anual del Sistema Nacional de Salud, 2011. http:// www.msssi.gob.es/organizacion/sns/planCalidadSNS/ pdf/equidad/informeAnualSNS2011/Informe_anual_ SNS_2011.pdf. Accessed September 5, 2013. 4. Miró Ò. State of emergency medicine in Spain. Int J Emerg Med. 2010;3:219-226. 5. Roqueta Egea F, Tomás Vecina S, Chanovas Borràs MR. Patient safety culture in 30 Spanish hospital emergency departments: results of the Agency for Healthcare Research and Quality’s hospital survey on patient safety culture. Emergencias. 2011;23:356-364.

6. Agency for Healthcare Research and Quality. Hospital survey on patient safety culture. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/ index.html. Accessed February 8, 2014. 7. Tomás Vecina S, Chanovas Borràs MR, Roqueta F, Alcaraz J, Toranzo Cepeda T. Adverse events related to Spanish hospital emergency department care: the EVADUR study. Emergencias. 2010;22:415-428. 8. Calderón Hernánz B, Oliver Noguera A, Tomas Vecina S, et al. Medication reconciliation in emergency departments. Emergencias. 2013;25:204-217. 9. Tomás Vecina S, Chanovas Borràs MR, Roqueta Egea F, Bueno Dominguez MJ. Adverse events associated with vascular catheters in emergency. Med Clin (Barc). 2013;140(7):334-335. 10. Fundación MAPFRE—Sociedad Española de Medicina de Urgencias y Emergencias. En Urgencias, la Seguridad del Paciente está en tus manos: 2012. http://www. fundacionmapfre.org/fundacion/es_es/prevencionsalud-medio-ambiente/campanas-divulgativas/seguridadpaciente-tus-manos/default.jsp. Accessed February 11, 2014.

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Measuring Patient Safety in the Emergency Department: The Spanish Experience.

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