Medicina defensiva en los servicios de urgencias hospitalarias

Background: Hospital emergency services have specific care characteristics that make them more vulnerable to the risk of legal claims. The fact of suffering a legal claim for professional practice is a very traumatic event. The objective of this study was to find out the opinion of the professionals of the hospital emergency services in Spain on the importance of practices associated with defensive medicine. Methods: Survey of 1,449 professionals from public and private hospital emergency services throughout the national territory was made, in the period between March 13th and April 3rd, 2017. A univariate analysis was performed to identify variables in relation to the practice of defensive medicine, and the determination of the groups of greater association (chi2 test) to evaluate these variables. Results: 96.1% expressed the need to strengthen their medical-legal training. 91.3% of the cases felt more legal pressure and 88.7% declared that they act conditioned by the threat of judicial claim. Regarding patient treatments, 89.8% stated that they perform diagnostic tests that may not be necessary and 63% of professionals stated that they extend the stay of patients in the emergency department. As for the healthcare organization, 88% declared that they do not feel protected by the structure and 79.1% do not felt support from the center’s management. Conclusions: Practices associated with defensive medicine are frequent in our country, with a high proportion of criminal proceedings, and the two main causes are dispensable diagnostic tests and unnecessary prolongation of length of stay. Fundamentos: Los Servicios de Urgencias Hospitalarias presentan características asistenciales específicas que los hacen más vulnerables al riesgo de reclamaciones legales. El hecho de sufrir una reclamación judicial por la praxis profesional es un evento muy traumático. El objetivo de este estudio fue conocer la opinión de los profesionales de los Servicios de Urgencias Hospitalarias en España sobre la importancia de las prácticas asociadas a la medicina defensiva. Métodos: Se realizó un estudio mediante encuesta a 1.449 profesionales de Servicios de Urgencias Hospitalarias públicas y privadas de todo el territorio nacional, en el periodo comprendido entre el 13 de marzo y el 3 de abril de 2017. Se realizó un análisis univariante para la identificación de variables en relación con la práctica de la medicina defensiva, así como la determinación de los grupos de mayor asociación