Do medical inpatients who report poor service quality experience more adverse events and medical errors?
Do medical inpatients who report poor service quality experience more adverse events and medical errors?
复制标题
DOI：
10.1097/mlr.0b013e3181589ba4
复制
发表时间：
2008-02-01
期刊：
影响因子：
3
通讯作者：
Weingart, Saul N.
中科院分区：
文献类型：
--
作者：
Taylor, Benjamin B.;Marcantonio, Edward R.;Weingart, Saul N.
目的：服务质量缺陷在医疗保健中很常见。然而，关于服务质量与不良事件和医疗差错的发生之间的关系，人们知之甚少。我们假设，报告服务质量差的患者经历不良事件和医疗差错的风险增加。对象和方法：患者在入院期间和入院后就住院期间遇到的问题进行访谈。我们使用这些信息来识别服务质量缺陷。然后，我们进行了一项盲目的回溯性图表回顾，以独立确定不良事件和错误。结果：228名参与者(平均年龄63岁，男性占37%)报告了183项服务质量缺陷。在图表回顾中确定的52起事件中，患者经历了34起不良事件，11起死里逃生，7起低风险错误。任何服务质量缺陷的存在都会使任何不良事件、死里逃生或低风险错误的概率增加一倍以上(调整后的优势比=2.5；95%可信区间=1.2-5.4)。涉及护理协调不良的服务质量缺陷(调整后的优势比=4.4；95%可信区间=1.4~14.0)与不良事件和医疗差错的发生有关。报告服务质量事件的患者可能有助于识别患者的安全隐患。
Purpose: Service quality deficiencies are common in health care. However, little is known about the relationship between service quality and the occurrence of adverse events and medical errors. We hypothesized that patients who reported poor service quality were at increased risk of experiencing adverse events and medical errors.Subjects and Methods: Patients were interviewed during and after their admissions regarding problems experienced during the hospitalizations. We used this information to identify service quality deficiencies. We then performed a blinded, retrospective chart review to independently identify adverse events and errors. We used multivariable methods to analyze whether patients who reported service quality deficiencies (obtained by patient report) experienced any adverse event, close call, or low risk error (ascertained by chart review).Results: The 228 participants (mean age 63 years, 37% male) reported 183 service quality deficiencies. Of the 52 incidents identified on chart review, patients experienced 34 adverse events, 11 close calls, and 7 low risk errors. The presence of any service quality deficiency more than doubled the odds of any adverse event, close call, or low risk error (adjusted odds ratio = 2.5; 95% confidence interval = 1.2-5.4). Service quality deficiencies involving poor coordination of care (adjusted odds ratio = 4.4; 95% confidence interval = 1.4-14.0) were associated with the occurrence of adverse events and medical errors.Conclusions: Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.