Abstract Introduction: WHO recommends interprofessional education (IPE) in which two or more students from different health professions learn together to work together in the future. In clinical simulation, students carry out health actions similar to reality but without any risk to the patient. Clinical simulation has been seen as a good method to promote IPE. Objective: To implement a pilot IPE experience in clinical simulation with university students (medicine and nursing) and professional training (nursing assistant practitioner). In case of success, this method can be introduced into regular courses. Method: Two multidisciplinary pilot experiences were carried out. Three clinical cases were designed where students from the three studies had to intervene. In each of the cases, a student of each of the three degrees assumed the first contact with the situation. In all cases, the four phases of the clinical simulation were followed and at the end of each experience, the students answered a satisfaction survey on their perception of learning, instructors, organizational aspects and general satisfaction. Results: The pilot experiences were considered successful due to the positive perception of the teachers involvedad and the great satisfaction generated among the participating students. Conclusions: Based on the success of these pilot tests, IPE has now been introduced into the regulated official curricula of medical and nursing programs where simulations are carried out with students of these careers and nursing assistants. The participation of non-university students is highlighted, which could stimulate similar experiences in health science studies.

Resumen Introducción: La WHO recomienda la educación interprofesional (EIP) donde 2 o más estudiantes de 2 o más profesiones sanitarias aprenden juntos para trabajar juntos en el futuro. La simulación clínica, donde los estudiantes realizan acciones sanitarias parecidas a la realidad, pero sin riesgo para el paciente, se ha visto como un buen método para fomentar la EIP. Objetivo: Implementar unas experiencias piloto de EIP en simulación clínica con estudiantes universitarios (de medicina y de enfermería) y de formación profesional (de auxiliares de enfermería) para que en el caso de éxito introducirlas en los estudios reglados de Medicina y de Enfermería. Métodos: Se realizaron 2 experiencias piloto multidisciplinarias en el campo de la simulación clínica. Se diseñaron 3 casos clínicos donde tenían que intervenir alumnos de los 3 estudios. En cada uno de los casos, el primer contacto con la situación lo asumía un estudiante de cada una de las 3 titulaciones. En todos los casos se siguieron las 4 fases de la simulación clínica y al finalizar cada experiencia los estudiantes participantes contestaron una encuesta de satisfacción sobre su percepción de aprendizaje, instructores, aspectos organizativos y satisfacción general. Resultados: Las experiencias piloto fueron consideradas exitosas por la percepción positiva de los profesores implicados manifestada en reuniones posteriores de reflexión y por la gran satisfacción generada entre los estudiantes participantes. Conclusiones: A partir del éxito de las pruebas piloto, la educación interprofesional se ha introducido en los currículums reglados de los estudios de medicina y de enfermería donde se realizan simulaciones con estudiantes de dichas carreras y de auxiliares de enfermería. Se resalta el hecho novedoso de la participación de estudiantes no universitarios que podría estimular experiencias similares en estudios de ciencias de la salud.

Objective: To identify opportunities for disclosing information on medical errors in Spain and issuing an apology, as well as legal-ethical barriers. Method: A cross-sectional study was conducted through a questionnaire sent to health law and bioethics experts (n = 46). Results: A total of 39 experts (84.7%) responded that health providers should always disclose adverse events and 38 experts (82.6%) were in favour of issuing an apology. Thirty experts (65.2%) reported that disclosure of errors would not lead to professional liability. The main opportunity for increasing disclosure was by enhancing trust in the physician-patient relationship and the main barrier was fear of the outcomes of disclosing medical errors. Conclusions: There is a broad agreement on the lack of liability following disclosure/apology on adverse events and the need to develop a strategy for disclosure among support for physicians.

Objetivo: Identificar las oportunidades y las barreras legales-éticas sobre la comunicación y disculpa del error médico en España. Método: Estudio transversal a 46 expertos/as en derecho sanitario-bioética. Resultados: 39 (84,7%) respondieron que siempre deberían comunicarse los eventos y 38 (82,6%) se mostraron a favor de una disculpa. Treinta expertos/as (65,2%) declararon que si se realizaba una comunicación de errores, esta no devengaría responsabilidad profesional. Se identificó como oportunidad la mejora de la confianza médico/a-paciente, y como barrera principal, el miedo a las consecuencias de la comunicación. Discusión: existe un consenso sobre la falta de responsabilidad derivada de una comunicación-disculpa y la necesidad de iniciar un programa de comunicación a través del soporte a los/las médicos/as.

Objective: To identify opportunities for disclosing information on medical errors in Spain and issuing an apology, as well as legal-ethical barriers. Method: A cross-sectional study was conducted through a questionnaire sent to health law and bioethics experts (n = 46). Results: A total of 39 experts (84.7%) responded that health providers should always disclose adverse events and 38 experts (82.6%) were in favour of issuing an apology. Thirty experts (65.2%) reported that disclosure of errors would not lead to professional liability. The main opportunity for increasing disclosure was by enhancing trust in the physician-patient relationship and the main barrier was fear of the outcomes of disclosing medical errors. Conclusions: There is a broad agreement on the lack of liability following disclosure/apology on adverse events and the need to develop a strategy for disclosure among support for physicians.

Objetivo: Identificar las oportunidades y las barreras legales-éticas sobre la comunicación y disculpa del error médico en España. Método: Estudio transversal a 46 expertos/as en derecho sanitario-bioética. Resultados: 39 (84,7%) respondieron que siempre deberían comunicarse los eventos y 38 (82,6%) se mostraron a favor de una disculpa. Treinta expertos/as (65,2%) declararon que si se realizaba una comunicación de errores, esta no devengaría responsabilidad profesional. Se identificó como oportunidad la mejora de la confianza médico/a-paciente, y como barrera principal, el miedo a las consecuencias de la comunicación. Discusión: existe un consenso sobre la falta de responsabilidad derivada de una comunicación-disculpa y la necesidad de iniciar un programa de comunicación a través del soporte a los/las médicos/as.

Objective: To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. Methods: A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. Results: This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Conclusions: Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System.

Objetivo: Evaluar la incidencia y los costes de los eventos adversos presentes en el Conjunto Mínimo Básico de Datos (CMBD) en los hospitales españoles en el período 2008-2010. Método: Estudio retrospectivo que estima el coste incremental por episodio, según la presencia de eventos adversos. El coste se obtiene de la Red Española de Costes Hospitalarios (RECH), creada a partir de los registros de costes por paciente basados en actividades y CMBD. Los eventos adversos se han identificado mediante Indicadores de Seguridad del Paciente (validados en el Sistema Sanitario español) de la Agency of Healthcare Research and Quality, junto a indicadores del proyecto europeo EuroDRG. Resultados: Se incluyen 245.320 episodios, con un coste de 1.308.791.871 €. Aproximadamente 17.000 episodios (6,8%) sufrieron un evento adverso, lo que representa un 16,2% del coste total. Los eventos adversos, ajustados por el Grupo Relacionado por el Diagnóstico, añaden un coste incremental medio que oscila entre 5.260 € y 11.905 €. Seis de los diez eventos adversos con mayor coste incremental son posteriores a intervenciones quirúrgicas. El coste incremental total de los eventos adversos es de 88.268.906€, un 6,7% adicional del total del gasto sanitario. Conclusiones: Valorando su impacto, los eventos adversos representan relevantes costes que pueden revertirse en mejora de la calidad y la seguridad del sistema de salud.

Objective: To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010. Methods: A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project. Results: This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure. Conclusions: Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System.

Objetivo: Evaluar la incidencia y los costes de los eventos adversos presentes en el Conjunto Mínimo Básico de Datos (CMBD) en los hospitales españoles en el período 2008-2010. Método: Estudio retrospectivo que estima el coste incremental por episodio, según la presencia de eventos adversos. El coste se obtiene de la Red Española de Costes Hospitalarios (RECH), creada a partir de los registros de costes por paciente basados en actividades y CMBD. Los eventos adversos se han identificado mediante Indicadores de Seguridad del Paciente (validados en el Sistema Sanitario español) de la Agency of Healthcare Research and Quality, junto a indicadores del proyecto europeo EuroDRG. Resultados: Se incluyen 245.320 episodios, con un coste de 1.308.791.871 €. Aproximadamente 17.000 episodios (6,8%) sufrieron un evento adverso, lo que representa un 16,2% del coste total. Los eventos adversos, ajustados por el Grupo Relacionado por el Diagnóstico, añaden un coste incremental medio que oscila entre 5.260 € y 11.905 €. Seis de los diez eventos adversos con mayor coste incremental son posteriores a intervenciones quirúrgicas. El coste incremental total de los eventos adversos es de 88.268.906€, un 6,7% adicional del total del gasto sanitario. Conclusiones: Valorando su impacto, los eventos adversos representan relevantes costes que pueden revertirse en mejora de la calidad y la seguridad del sistema de salud.