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On the ordinates axis: number of patients infected with HIV with warts and condylomatas throughout our study. On the abscissa axis: the year, from 1998 to 2012.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Almudena Nuno-Gonzalez, Juan Emilio Losa Garcia, José Luis López Estebaranz, María Dolores Martin-Rios" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Almudena" "apellidos" => "Nuno-Gonzalez" ] 1 => array:2 [ "nombre" => "Juan Emilio" "apellidos" => "Losa Garcia" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "López Estebaranz" ] 3 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Martin-Rios" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317300374" "doi" => "10.1016/j.medcli.2016.12.034" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317300374?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617302772?idApp=UINPBA00004N" "url" => "/23870206/0000014800000009/v2_201706121018/S2387020617302772/v2_201706121018/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The importance of patient safety" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "405" "paginaFinal" => "407" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Josep Arimany-Manso, Carles Martin-Fumadó" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Josep" "apellidos" => "Arimany-Manso" "email" => array:1 [ 0 => "josep.arimany@comb.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carles" "apellidos" => "Martin-Fumadó" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Cataluña, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Medicina Legal y Forense, Departamento de Salud Pública, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institut de Medicina Legal i Ciències Forenses de Catalunya, Departament de Justícia, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Medicina, Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La importancia de la seguridad clínica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Over the last few years, the practice of medicine has undergone a profound change. It has gone from simple, slightly ineffective and relatively safe to become complex, effective but potentially dangerous.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Zero risk does not exist in any activity; human beings in any field of work make errors, but errors can be prevented by designing systems that make errors difficult and correct decisions easy. These systems have been implemented successfully in fields such as air and rail navigation.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The safety of the patient, understood as the group of actions oriented towards eliminating, reducing and mitigating the adverse results produced as a consequence of the process of health care, has gradually increased in importance within the fundamentals of current medical practice, where there is constant medical, scientific and technological evolution, and in which a permanent effort is required from medical professionals to adopt a good standard of medical praxis. In today's context, clinical safety has become a concern of the first order.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This process of adaptation to the culture of patient safety has been progressive. There was a first phase, in the eighties, in which efforts were focussed on professional liability and its assurance. There was a second phase, in the nineties, with risk management as protagonist, and a third phase (the current one) in which efforts are directed towards the improvement of patient safety. Throughout the whole process, countries such as the USA have faced different “malpractice crises” which have been an enormous challenge for the health system.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The report <span class="elsevierStyleItalic">To Err Is Human</span>, published in 1999 by the Institute of Medicine<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> was, without any doubt, that which, by showing the existing situation with regard to clinical safety, gave the first impulse towards the imperious necessity, within health institutions, for the development of improvements in the field of patient safety, defined by the report itself as the absence of avoidable lesions or complications produced as a consequence of the health care received. In addition, the document also highlights the recommendation to follow the Hippocratic principle of “<span class="elsevierStyleItalic">primum non nocere”</span> and the need to establish notification systems for errors and adverse events. This document was followed by the publication in 2015 of the report <span class="elsevierStyleItalic">Improving Diagnosis in Health Care</span>, which focuses on diagnostic errors.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Another influential milestone was the set of propositions established by Reason<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> in the year 2000, which, through the well-known “Swiss cheese” model, allowed the visualisation of accidents occurring due to multiple factors and which, even if defences exist to prevent said accidents, the linking of multiple aligned errors allows accidents or adverse effects to take place.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Later, in 2002, the World Health Organisation adopted resolution WHAS 55.18 which proposed that member countries pay maximum attention to patient safety and that they establish and consolidate systems with a scientific basis, necessary to improve patient safety and the quality of health care. As a consequence of that, shortly afterwards, and with the aim of coordinating, spreading and accelerating the improvements in patient safety matters throughout the world, the World Health Organisation set in motion the World Alliance for Patient Safety in October 2004.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Since then, actions in this regard have been intensified, being incorporated progressively into health policies. In our environment, patient safety has been included in all quality assurance plans in the autonomous communities. In 2005, the Ministry of Health, Social Services and Equality began to develop, in collaboration with the autonomous communities, the patient safety strategy of the National Health System, based on international recommendations and those of Spanish experts. Following a line of continuity, the “Patient Safety Strategy of the National Health System 2015–2020” is oriented towards promoting and improving safety culture in health organisations, incorporating health risk management, training professionals and patients in basic aspects of patient safety and implementing safe practices, involving patients and citizens.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In parallel, scientific societies have intensified efforts intended to improve clinical safety. Currently there are common strategies aimed at said proposal in the exercise of any medical specialisation, including among such strategies training in clinical safety matters, quality and professional responsibility among medical professionals,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> with initial training provided to resident medical interns<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> being fundamental. On the other hand, the promotion of evidence-based medicine is also common, as is the use of standardised surgical checklists and tools, which are clear and visual, in order to facilitate the development of medical activity and to avoid errors, the use of protocols and clinical practice guidelines to guarantee the quality of the medical act and even the implementation of new methodologies such as the Lean,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> which have also shown their efficiency in aspects of clinical safety. However, it is also unquestionable that there are certain differences, both at international level<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> and within our context,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> according to the medical specialisation, which has determined the use of different specific strategies for the improvement of clinical safety in said specialisations, such as, for example, experiences in the safe prescription of drugs in primary care<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> or recommendations for socio-health centres.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In anaesthesiology, a pioneering specialisation in patient safety measures, the “Helsinki Declaration on Patient Safety in Anaesthesiology” of 2010 was a milestone in the efforts to promote safe perioperative care.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> The Declaration represents the common opinion, shared in Europe, regarding the measures considered feasible and valuable to improve patient surgical safety in 2010, and recommends the practical steps that all anaesthesiologists and all anaesthesiology departments should incorporate into their medical practice. Therefore, the Declaration is an authorised document that European anaesthesiologists can use to introduce safety measures in local and national areas, presenting it before health services, hospital managers or anaesthesiology department directors.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In gynaecology and obstetrics there are also measures suggested after the analysis of complaints regarding presumed medical professional liability. The identification of relevant factors has proposed better risk management, influencing some particular detected aspects which deserve special attention in medical-legal questions, such as medical action on extraneous retained objects, tying of the Fallopian tubes, ultrasound diagnosis or newborns with neurological alterations.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Likewise, focussing efforts on preventing incidents associated with childbirth care is suggested. This would include those cases related to the interpretation of cardiotocographic trace and caesarean times.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Also, in the field of ophthalmology, there have been numerous and continual efforts from societies and organisations such as the American Board of Ophthalmology or the Academy of Ophthalmology in the field of clinical safety,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> highlighting the inclusion of patient safety in certification examinations, the surgical checklist and specific recommendations to eliminate errors, clinical practice improvement courses, the preparation of diverse clinical practice guides <span class="elsevierStyleItalic">(Preferred Practice Patterns)</span> or the registry <span class="elsevierStyleItalic">Intelligent Research in Sight</span> (IRIS).</p><p id="par0060" class="elsevierStylePara elsevierViewall">In urology, although it is not a high-risk specialisation in terms of professional medical liability, the risk of complaints is considerable and the consequences of complaints are significant. The analysis of diseases that receive complaints in said specialisation help us to discover the most frequent adverse events, as well as to adopt the appropriate informational measures to avoid them, by applying the appropriate diagnostic measures, as in the case of testicular torsion, and to take appropriate cautionary measures, as in the case of vasectomy.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">There are also numerous efforts made in patient safety matters in orthopaedic surgery and traumatology: the American Academy of Orthopaedic Surgeons, the European Federation of National Associations of Orthopaedics and Traumatology, the Sociedad Española de Cirugía Ortopédica y Traumatología (Spanish Society of Orthopaedic Surgery and Traumatology), and the Sociedad Española de Cirugía de Cadera (Spanish Society of Hip Surgery) prepare agreed-upon patient safety instruments such as surgical checklists, protocols and clinical practice guidelines and have specific patient safety committees.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> It is worth highlighting that in our environment this is the specialisation with the most frequent complaints, so the learning potential derived from analysis of cases relative to said specialisation is enormous.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">From the above paragraphs we can deduce that each medical specialisation, without exception, has developed, in addition to the strategies common to the exercise of medicine, a series of specific skills belonging to each of them in the field of clinical safety.</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the other hand, with the aim of linking the concepts of medical professional liability and clinical safety, direct management is proposed in accordance with the principles and values of the medical collective. This management allows the adoption of beneficial measures such as data analysis, the identification of areas of risk and guiding actions in clinical safety (clinical practice guidelines, quality programmes, etc.),<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> as well as paying individualised attention to professionals, considered the second victim in medical errors.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Professional medical liability, a concept closely tied at the present time to clinical safety, is defined as the obligation of doctors to repair and satisfy the consequences of their actions, omissions and errors, whether voluntary or involuntary, within certain limits, committed in the exercise of their profession.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> To improve communication with the patient contributes to reducing errors, which reinforces the role of the programmes to increase safety which promotes a more active role from the patient.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> In fact, the lack of explanation, or an apology to the patient, if appropriate, can be seen as very negative by them and, in some cases, it becomes a powerful stimulus to present a complaint.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Thus, it is worth highlighting once more the enormous value of medical records (also computerised) not only as a clinical, treatment, research and teaching document, but also as a fundamental element in the medical-legal field. The informed consent, of great ethical, medical and legal importance, is a patient's right, included in the medical act, and it forms part of the doctor–patient communication process. The informed consent must be presented in writing according to that established by law.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Meanwhile, the World Alliance for Patient Safety itself, in its report on research into patient safety, insists that, in order to understand the magnitude and causes of the harm caused to patients and to find innovative solutions or to adapt demonstrably effective solutions to different contexts, more knowledge is required, as well as taking better advantage of the available knowledge. Since its establishment in 2005, the research programme of the World Alliance for Patient Safety has focussed on disseminating and promoting research into the improvement of care safety, identifying methods and instruments for research in this multidisciplinary sphere, developing training alternatives in patient safety research designed to equip leaders for change in health care, financing promising patient safety research projects, creating a platform which favours exchange and communication between researchers and users, backing research projects in developing countries and countries with economies in transition, and summarising and disseminating knowledge about the lack of care safety and effective solutions for the reduction of the problem.</p><p id="par0095" class="elsevierStylePara elsevierViewall">It is necessary to establish, once the existing barriers have been overcome, the so-called clinical safety culture.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> Said clinical safety culture should be understood positively among professionals and patients, not necessarily tied to medical liability complaints, but gathering the information derived from them, contributing to the enhancement of the benefits of patients, professionals and society in general.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24,25</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arimany-Manso J, Martin-Fumadó C. 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Journal Information
Vol. 148. Issue 9.
Pages 405-407 (May 2017)
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Vol. 148. Issue 9.
Pages 405-407 (May 2017)
Editorial
The importance of patient safety
La importancia de la seguridad clínica
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6
a Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Cataluña, Barcelona, Spain
b Unidad de Medicina Legal y Forense, Departamento de Salud Pública, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
c Institut de Medicina Legal i Ciències Forenses de Catalunya, Departament de Justícia, Barcelona, Spain
d Departamento de Medicina, Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
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