Winning Projects III Edition Quirónsalud Awards for the Best Initiatives on Patient Safety

First Prize

Implementing a Rapid Response System in a referral teaching hospital. Effectiveness and cost-effectiveness study of the intervention.

 

Research site

Hospital Universitario Y Politécnico La Fe

Principal investigator

Mr. Álvaro Castellanos Ortega

Research team

Mr. Salvador Peiró

Mr. Luis de Hevia

Mr. Ricardo Gimeno

Ms. Marisa Correcher

Mr. Aníbal García

Ms. Teresa Aldabó

Project summary

Background

Certain hospital deaths may be predicted and prevented. Early detection of clinical deterioration in patients admitted to hospital wards and the introduction of an appropriate rapid-intervention system improves survival and reduces the incidence of serious adverse events. Deterioration of admitted patients may be predicted if nursing staff correctly interpret changes in vital signs during the 6 to 24 hours prior to the onset of a serious adverse event.

Objectives

A rapid response service is a patient-safety mechanism that works toward the following objectives:  

1) Ensure quality care for all admitted patients by preventing and anticipating severe clinical deterioration;

2) Reduce hospital mortality and adverse events (sudden death, unexpected cardiac arrest, and urgent ICU admission) due to admission to the incorrect ward, improper care, or delays in recognizing the seriousness of the patient’s condition, thereby ensuring that the hospital experience is the least traumatic as possible for patients, their family members, and health professionals.

3) Promote interdisciplinary support and collaboration among hospital services to ensure continuity of care and train other professionals in early recognition and management of patients in potentially serious condition.

Functioning

Detection of clinically severe conditions is based on a system by which clinical parameters are recorded by nursing staff; when abnormal, these can be easily recognized, quantified, and interpreted by these members of hospital staff. Following recognition, the system is activated with a telephone call or electronic alert, which triggers rapid response from an intensivist. This care is individualized based on the needs of the patients and the nature of the clinical condition. The process comes to a close once the patient has been relocated to a more appropriate ward in terms of their safety, comfort, and the overall efficiency of the system.

Second Prize

Implementation of a surveillance program for hospital-acquired sepsis in very-low-birth-weight newborns admitted to Spanish intensive care units (NeoKissEs)

 

Research site

Instituto de Investigación Sanitaria Biocruces

Principal investigator

Mr. José Ignacio Villate Navarro

Research team

Mr. José Ignacio Pijoán Zubizarreta

Ms. Cristina Barcelona Alfonso

Ms. María Cruz López Herrera

Ms. Marisela Madrid Aguilar

Ms. María García Franco

Mr. José María Hernández Hernández

Mr. Javier Pérez López

Collaborators from hospitals that are part of the NeoKissEs-PI13/00587 System

 

Project summary

In very-low-birth-weight (VLBW, <1,500 g) newborns, the most common manifestation of health-care-associated infection is hospital-acquired sepsis. Continuous measurement and assessment of the frequency of this condition and its associated risk factors may further prevention efforts.

Since 2014, our group at Hospital Universitario Cruces/Biocruces has been a national leader in the fight to reduce sepsis in newborns, thanks to the work we have carried out under the funded research project PI13/00587*. We have introduced a system for epidemiological surveillance of hospital-acquired sepsis known as “NeoKissEs,” studying VLBW infants admitted to neonatal units in public and private hospitals throughout Spain.

Currently, our aim is to consolidate the use of our surveillance system and expand its application to more hospitals. In doing this, we will broaden the scope with which we monitor the incidence of hospital-acquired sepsis, promoting comparisons between hospitals and assessing the interventions undertaken to improve care quality by preventing these infections.   

To date, NeoKissEs has been implemented in 46 hospitals across 15 regions of Spain. All are tertiary health centers, and the teams that lead the implementation project are trained by neonatologists and nursing professionals. The program has its own website providing access to the protocol, case record form, video tutorials, and real-time reports containing relevant statistics. Three yearly reports have been issued, containing information on the primary indicators of the initiative. These documents seek to drive self-assessment and comparative analysis among participating units.

In late 2017, we expanded the number of participating hospitals, and we now have data on more than 7,000 VLBW infants and over 2,000 episodes of primary hospital-acquired sepsis. In 2014, the incidence rate per 1,000 patient-days was 9.7 (95% confidence interval (CI), 8.9–10.6), while this rate was 8.8 (95% CI, 8.1–9.5) in 2015 and 8.6 (95% CI, 7.9–9.3) in 2016. There is a high degree of inter-unit variability in these rates, which creates a need to perform an in-depth study of the possible explanatory factors and strengthen the culture of patient safety. Using this conceptual and ethical framework, and now that we have reached our initial target of implementing the NeoKissEs system, the coordinating team have now embarked on a new multi-center research project (PI17/00565)* aimed at implementing a multifactorial intervention study related to central-line use, the impact of which will be measured using the NeoKissEs surveillance system in order to reduce the incidence of hospital-acquired sepsis associated with the use of these catheters in newborns.

*(Funded by the Carlos III Health Institute and co-financed by the European Regional Development Fund (ERDF). “A way of making Europe”)

Honorable Mention

Prosthetic Infection Zero

 

Research site

Fundación Jiménez Díaz

Principal investigator

Ms. María Dolores Martín Ríos

Research team

Mr. Emilio Calvo Crespo

Mr. Raul Parrón Cambero

Mr. Alvaro Aruñón Rubio

Mr. Ignacio Gadea Gironés

Mr. Jaime Esteban Moreno

Mr. Ricardo Fernández Roblas

Mr. Luis Enrique Muñoz Alameda

Ms. Paz Bardón Iglesias

Ms. Sandra Sacristán Colmenarejo

Ms. Sofía Álvarez Gallardo

Mr. Jaime Lastras Pardo

Mr. Javier Bécares Martínez

Ms. Carolina Del Valle Giraldez García

Mr. Gonzalo de las Casas Cámara

Ms. Laura Rubio Cirilo

 

Project summary

Health-care-associated infections (HAIs) are the cause of substantial morbidity and mortality, and 25% of all HAIs are surgical-site infections (SSIs).

Patients who develop an SSI are 60% more likely to be admitted to the intensive care unit, have a 5-fold greater tendency to be hospitalized, and are twice as likely to die than patients who do not have SSIs. SSIs lead to prolonged hospitalization and considerably higher care costs, and also take a high emotional toll on patients and families. These consequences have especially substantial implications for prosthetic infections.

Therefore, the aim of this study is to reduce the incidence of SSIs in hip and knee replacement surgery by taking a comprehensive approach that includes evidence-based prevention and control measures.