Sistema de gestión de incidentes críticos y eventos adversos en los ámbitos área, servicio o unidad hospitalarios. Puesta en marcha en tres fases

Abstract

Introduction: The purpose of this article is to present a model for clinical risk management based on technological and organisational advances with proven effect. Designed for a single clinical Unit, the model is open to other notification systems and health care clinical units.

Material and method: The model has three implementation phases. The first phase involved studying the existing safety system and objectively measured the culture of patient safety. The second phase included development and implementation of a system for the management of critical incidents with creation of a team of specialists. The third phase was the development of the technological and organizational base for horizontal and vertical integration, for internal and external training, and opening the system to other clinical units.

Results: We found an unstructured, non-confidential, potentially punitive model of clinical risk management without efficacy criteria. There was an unsatisfactory safety culture level for all of the evaluation issues. The introduction of a system for critical incident management gave the basis for the optimization and evaluation of the patient safety related processes.

Conclusions: Our model for clinical risk management is a simple, useful and efficient example for introducing a patient safety strategy in a hospital clinical unit.