Critical Care Clinicians' Experiences of Patient Safety During the COVID-19 Pandemic.
Critical Care Clinicians' Experiences of Patient Safety During the COVID-19 Pandemic.
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重症监护临床医生在 COVID-19 大流行期间患者安全的经验。
DOI：
10.1097/pts.0000000000001060
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发表时间：
2022
影响因子：
2.2
通讯作者：
Adelman,JasonS
中科院分区：
文献类型：
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作者：
Rosen,Amanda;Carter,Danielle;Applebaum,JoR;Southern,WilliamN;Brodie,Daniel;Schwartz,Joseph;Cornelius,Talea;Shelton,RachelC;Yip,NatalieH;Pincus,HaroldA;Hwang,Calvin;Cooke,Joseph;Adelman,JasonS
在COVID-19大流行期间，医院和系统层面的因素如何影响重症监护室（ICU）的患者安全尚不清楚。我们试图了解如何大流行加剧了预先存在的患者安全问题，并创造了新的患者安全的挑战，在ICU在美国。MethodsWe进行了一项全国性的，多机构，混合方法的调查，重症监护临床医生引出的经验，在大流行期间的患者安全。该调查通过电子邮件通过重症监护医学会listserv传播。数据被报告为有效百分比，按COVID病例数和流行高峰进行比较;对自由文本回复进行分析并按主题进行编码。在一般病人安全方面，61%的人认为，与大流行前相比，情况更加危险。与照顾大多数非COVID-19患者或没有COVID-19患者的人相比，照顾大多数COVID-19患者的人更有可能认为护理更危险（比值比，4.89; 95%CI，2.49-9.59）。在自由文本回复中，提供者确定了与大流行适应相关的患者安全风险，如呼吸机相关的肺损伤、用药和诊断错误、过度镇静、氧气装置移除和福尔斯falls.ConclusionsIncreased COVID-19病例负担与一线ICU临床医生对不太安全的患者护理环境的看法显著相关。定性分析的结果确定了美国ICU的特定患者安全危害，这是COVID-19大流行期间医院和供应商压力的下游后果。
ObjectiveIt is unknown how hospital-and systems-level factors have impacted patient safety in the intensive care unit (ICU) during the COVID-19 pandemic. We sought to understand how the pandemic has exacerbated preexisting patient safety issues and created novel patient safety challenges in ICUs in the United States.MethodsWe performed a national, multi-institutional, mixed-methods survey of critical care clinicians to elicit experiences related to patient safety during the pandemic. The survey was disseminated via email through the Society of Critical Care Medicine listserv. Data were reported as valid percentages, compared by COVID caseload and peak of the pandemic; free-text responses were analyzed and coded for themes.ResultsWe received 335 survey responses. On general patient safety, 61% felt that conditions were more hazardous when compared with the prepandemic period. Those who took care of mostly COVID-19 patients were more likely to perceive that care was more hazardous (odds ratio, 4.89; 95% CI, 2.49–9.59) compared with those who took care of mostly non–COVID-19 or no COVID-19 patients. In free-text responses, providers identified patient safety risks related to pandemic adaptations, such as ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls.ConclusionsIncreased COVID-19 case burden was significantly associated with perceptions of a less safe patient care environment by frontline ICU clinicians. Results of the qualitative analysis identified specific patient safety hazards in ICUs across the United States as downstream consequences of hospital and provider strain during periods of the COVID-19 pandemic.