Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program
Detecting and reducing hospital adverse events: outcomes of the Wimmera clinical risk management program
复制标题
检测和减少医院不良事件：Wimmera 临床风险管理计划的成果
DOI：
10.5694/j.1326-5377.2002.tb04363.x
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发表时间：
2001
影响因子：
11.4
通讯作者：
David W Leembruggen
中科院分区：
文献类型：
--
作者：
A. Wolff;J. Bourke;lan A Campbell;David W Leembruggen
目标
确定检测医院不良患者事件、分析其风险并采取行动的综合临床风险管理计划是否可以改变不良事件的发生率。
设计
在逐步实施风险管理计划的八年中对患者不良事件进行的纵向调查。
参与者和环境
维多利亚州威默拉地区的一家乡村基地医院有 49,834 名住院患者（1991 年 7 月至 1999 年 9 月）和 20,050 名急诊科患者（1997 年 10 月至 1999 年 9 月）。
主要成果指标
通过医疗记录审查、临床事件和全科医生报告发现的不良事件发生率。
结果
研究第一年和第八年期间，住院患者不良事件的年发生率从占所有出院患者的 1.35%（69 起事件）下降到 0.74%（49 起事件）（P<0.001）。绝对风险降低为 0.61%（95% CI，0.23%-0.99%），相对风险降低为 44.9%（95% CI，16.9%-72.9%）。在监测的第一季度和第八季度之间，急诊科不良事件的季度发生率从占所有就诊人数的 3.26%（84 起事件）下降到 0.48%（12 起事件）（P<0.001）。绝对风险降低为 2.78%（95% CI，2.04%-3.52%），相对风险降低为 85.3%（95% CI，62.7%-100%）。
结论
作为综合临床风险管理计划的一部分，可以使用多种检测方法和临床改进策略来检测患者不良事件，并降低其发生频率。
OBJECTIVES
To determine if an integrated clinical risk management program that detects adverse patient events in a hospital, analyses their risk and takes action can alter the rate of adverse events.
DESIGN
Longitudinal survey of adverse patient events over eight years of progressive implementation of the risk management program.
PARTICIPANTS AND SETTING
49,834 inpatients (July 1991 to September 1999) and 20,050 emergency department patients (October 1997 to September 1999) at a rural base hospital in the Wimmera region of Victoria.
MAIN OUTCOME MEASURES
Rates of adverse events detected by medical record review and clinical incident and general practitioner reporting.
RESULTS
The annual rate of inpatient adverse events decreased between the first and eighth years of the study from 1.35% of all patient discharges (69 events) to 0.74% (49 events) (P<0.001). Absolute risk reduction was 0.61% (95% CI, 0.23%-0.99%), and relative risk reduction was 44.9% (95% CI, 16.9%-72.9%). The quarterly rate of emergency department adverse events decreased between the first and eighth quarters of monitoring from 3.26% of all attendances (84 events) to 0.48% (12 events) (P< 0.001). Absolute risk reduction was 2.78% (95% CI, 2.04%-3.52%), and relative risk reduction was 85.3% (95% CI, 62.7%-100%).
CONCLUSIONS
Adverse patient events can be detected, and their frequency reduced, using multiple detection methods and clinical improvement strategies as part of an integrated clinical risk management program.