Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy
Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy
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DOI：
10.1377/hlthaff.2018.0718
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发表时间：
2018-11-01
期刊：
影响因子：
9.7
通讯作者：
Delaney, Kathleen R.
中科院分区：
文献类型：
--
作者：
Shields, Morgan C.;Stewart, Maureen T.;Delaney, Kathleen R.
行为卫生保健在采取有力措施改善患者安全方面进展缓慢。这种滞后在住院精神病治疗中尤其明显，因为那里存在身体和心理伤害的风险。最近的调查性新闻报道引起了公众对据称的虐待、疏忽、人手不足、性侵犯、不当用药、病人自残、卫生条件差以及不适当的约束和隔离等事件的关注。然而，描述不安全体验范围的经验证据有限。虽然循证住院精神病学要求护理是创伤知情的，但市场失灵和缺乏与以患者为中心的护理相一致的支付，使患者容易受到伤害。现有的监管机制试图提供问责，但这些机制并不完善。此外，研究也很少。很少有卫生服务研究人员研究住院精神病学，这个问题并不是研究者的优先事项，而且住院精神病学的数据被排除在国家质量调查之外。若干政策杠杆可以开始解决这些缺陷。这些措施包括将激励措施与以患者为中心的护理相结合，将创伤知情护理纳入认证和监测，对关键事件进行趋势分析，以及提高研究能力。
Behavioral health care has been slow to take up robust efforts to improve patient safety. This lag is especially apparent in inpatient psychiatry, where there is risk for physical and psychological harm. Recent investigative journalism has provoked public concern about instances of alleged abuse, negligence, understaffing, sexual assault, inappropriate medication use, patient self-harm, poor sanitation, and inappropriate restraint and seclusion. However, empirical evidence describing the scope of unsafe experiences is limited. While evidence-based inpatient psychiatry requires care to be trauma-informed, market failures and a lack of payment alignment with patient-centered care leave patients vulnerable to harm. Existing regulatory mechanisms attempt to provide accountability; however, these mechanisms are imperfect. Furthermore, research is sparse. Few health services researchers study inpatient psychiatry, the issue has not been a priority among research fenders, and data on inpatient psychiatry is excluded from national surveys of quality. Several policy levers could begin to address these deficiencies. These include aligning incentives with patient-centered care, building trauma-informed care into accreditation and monitoring, conducting trend analyses of critical incidents, and improving research capacity.