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Background: The service level agreement establishes the quality requirements for those services contracted by the Basque Government Health Department from Osakidetza-Servicio Vasco de Salud. Acute cerebrovascular disease (ACVD) is one of the care processes with quality specifications., Objective: To outline the procedure adopted to evaluate ACVD care and the results obtained in four hospitals in Vizcaya between 2003 and 2007., Material and Methods: In 2003, a work group consisting of clinicians, hospital and quality assurance managers, and experts from the Regional Health Board chose a series of indicators which would be measured by an external auditor. This group reviews the results annually and sets objectives for the following financial year., Results: The improvement in almost all the indicators has been significant, and those with high ratings from the beginning have maintained their level. The percentage of patients who had a CAT scan in the first six hours after arriving at hospital increased from 57% to 85%, and the administration of anticoagulants within 12 hours increased from 70% of cases to 90%. The fibrinolysis rate was 3.8% in two hospitals. The percentage of patients who began rehabilitation whilst admitted was less than 3%., Conclusions: After operating for five years, the procedure adopted, which involves collaboration between clinical, management and planning staff, has been shown to be viable and effective in improving the quality of ACVD care.

Objective: To improve the quality of the clinical information documents received by surgical patients when discharged from the Hospital., Material and Methods: A preliminary analysis of the quality of the surgical discharge form (SDF) included information regarding the time of issue (provisional vs. definitive), legibility/standardization (typewritten, hand-written with or without a standardised format), technical quality (complete vs. incomplete) and retrievability (electronically storage or not). This analysis showed that 39% of the forms were either provisional, incomplete or were standardised formats (59%) or hand-written as a simple medical note (41%). We have redesigned the methodology for filling in the SDF and their storage using the resources available in our Hospital. We designated a common surgical secretary to fill in all the SDF and designed 81 standard formats in Word for all the surgical procedures. A consensus protocol was also developed with the different surgical departments for the completion, distribution and monitoring of the SDF. Finally we established a Windows-based computerised system for centralized storage/retrieval of the discharge forms that could be easily accessed by internet., Results: All the SDF are standardised and electronically stored. The patient receives a typewritten form at the time of discharge. The dates for the first surgical or outpatient review are included in 98% of the SDF from hospitalised patients and in 100% of the SDF from major ambulatory surgery patients. We did not reach the expected outcome for minor surgical procedures., Conclusions: The extensive standardisation of the SDF, together with the new methods for completing them, has shown to be an efficient measure to maximise the quality of the clinical information given to the patient and to minimise the waiting time from the physician confirming discharge to the patient eventually leaving the hospital.

Objectives: To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain., Methods: It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions., Results: Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered., Conclusions: This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

Objective: To analize the number, characteristics and content of the articles on quality evaluation of health records and information systems published by Spanish authors in biomedical journals (1983-1992)., Material and Methods: Sources were IME and MEDLINE databases, journal summaries and bibliographies from the retrieved items. Originals or review articles and communications were included. Variables analyzed were: publication date; kind of document; coauthorship number; authors/items ratio; institutions where the authors work; journal of publication. The content analysis included the main aspects studied and the kind of document or system investigated., Results: 87 documents were retrieved, 74 being original papers and 13 communications. Along the period a gradual growth was observed and a maximum was reached in 1991 with 18 items. The total number of authors was 370, 5 authors with three or more items. The maximum number of items per author was 6. The ratio authors/items was 4.1. The most productive institutions were hospitals and governmental centers. Twenty four different journals were identified, 5 publishing the 74.4% of papers. 61 (82.4%) of the 74 articles correspond to evaluative research and 13 (17.6%) dealt with questions related with quality but were not evaluative researches. The questions more frequently evaluated in the 61 articles were the completeness of data in clinical records (22 articles); the accuracy of data recorded in the documents used for death certification (7 articles) and the accuracy of data recorded in the Hospital Patient's Logbook (5 articles)., Discussion: An increase of scientific production in this field and its concentration in a reduced number of magazines has taken place in Spain in the past few years of study. The content in most of the articles is about formal aspects of clinic and sanitary information.

Background: The registration book for admission and discharge of patients was the basis of a survey of hospital morbidity and the main source of information concerning the diseases attended in the hospitals in Spain. The aim of this study was to evaluate the quality of this information from the data of a hospital with a computerized patient registration system., Methods: The sample collected from the registration book in 1985 by the National Institute of Statistics studied three types of errors: the main error being selection of diagnosis, coding and transcription of the principal diagnosis, and comparison of data contained in the patient discharge form., Results: In the 896 releases studied an error oscillating between 1 and 2% was found in transcription. The principal diagnosis had been erroneously selected in 26% of the reports with more than one diagnosis. Important coding errors were found in 11%. Transfer between different hospital wards or death were variables found to increase the probability of error., Conclusions: Hospital registers should be submitted to quality control processes in which the physicians facilitating the data should participate.