• Rev Esp Anestesiol Reanim (Engl Ed) · May 2018

    Observational Study

    What have we learned from reporting safety incidents in the Surgical Block?: Cross-sectional descriptive study of two-years of activity of a multidisciplinary analytical group.

    • F Caba Barrientos, A Rodríguez Morillo, R Galisteo Domínguez, M Del Nozal Nalda, C V Almeida González, and M Echevarría Moreno.
    • Grupo local de SENSAR, Unidad de Gestión Clínica de Anestesia y Reanimación, Hospital Universitario Nuestra Señora de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España. Electronic address: fcababarrientos@gmail.com.
    • Rev Esp Anestesiol Reanim (Engl Ed). 2018 May 1; 65 (5): 258-268.

    Background And ObjectivesIncident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS).Material And MethodCross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed.ResultsBetween March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken.ConclusionsThe activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels.Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

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