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%X LE REX EN ANESTHESIE-REANIMATION&! ECProfesseur Jean MARTY SAR Hpital Henri MONDOR Prsident de la SFARZDAAaAA 0   OBJECTIFS& EAnalyse des vnements indsirables ou du processus de soins Selon un modle systmique Pour identifier les dfauts de soins et les erreurs systmes Afin de matriser les risques pour les rduire (amlioration continue de la qualit)v=CC=C C cICB J    $ Dfinitions& EEvnements indsirables graves: provoquant un dcs, une hospitalisation prolonge, un handicap ou une menace vitale. Evnement porteur de risques mdicaux Dfauts de soins Erreurs systmes Complications vitables$C TTaux de dcs en rapport avec l anesthsie4+*g f   FACTEURS DE PROGRES,G   Dcret du 5 Dcembre 1994 Recommandations de la SFAR Confrences de consensus et d experts Rdaction de procdures pour harmoniser les pratiquesC DANALYSE SYSTEMIQUE DES DECES PERI-OPERATOIRE ET MESURES CORRECTRICES,EDG ZIdentification des dfauts de soins Facteurs systmiques contributifs Mesures correctrices[[ RESULTATS, G  Le nombre de dfauts de soins et de facteurs systmiques contributifs est plus lev quand les dcs sont vitables Les facteurs de corrections principaux sont d amliorer les procdures et la qualit du dossier mdical*C )Dfauts de soins identifis par le comit**)G 4,7 2,2 DDS par patient 3,0 2,1 DDS grave par patient 1,5 1,7 DDS dltre par patient 15,1 9,4 ES par patient Si le DDS est grave: 3,5 1,8 ES par DDS vs 2,1 1,3 ES par DDS (p<0,0001) Si le DDS est dltre: 4,0 2,0 ES par DDS vs 2,8 1,6 ES par DDS (p<0,0001)& P "  Comparaison des dcs vitables et non vitables dtermins par les comits d experts*WVG.Nombre de DDS: 4,1 2,1 vs 5,8 2,0 (p=0,001)* Nombre de DDS graves: 2,4 2,0 vs 4,1 1,9 (p=0,01)* Nombre de DDS dltres: 0,7 1,1 vs 3,0 1,6 (p<0,0001)* Nombre d ES: 12,4 8,7 vs 19,5 9,0 (p=0,001)* Nombre d actions correctrices: 1,0 1,1 vs 1,5 1,1 (p=0,075),PBb % Conclusions& E"Le REX est efficace pour dpister les dfauts de soins et les problmes organisationnels. L analyse des vnements porteurs de risque donne autant d informations dans un contexte plus simple. 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