Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes
Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes
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DOI：
10.1016/j.annemergmed.2004.08.012
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发表时间：
2005-01-01
影响因子：
6.2
通讯作者：
Graff, L
中科院分区：
文献类型：
--
作者：
Chem, CH;How, CK;Graff, L
研究目的：我们评估了不良事件的电话随访质量改进programme.Methods的影响：这是一个之前和之后的干预比较的基础上前瞻性收集的数据在三级医院急诊科（艾德）（82,000次访问，每年）。前半部分（2001年4月15日至7月31日）作为对照，后半部分（2001年8月1日至11月15日）作为干预，向医生反馈出院患者的电话随访结果，并对住院医师进行关于严重疾病的不确定表现和对选定患者进行额外评估（观察单位，住院）的必要性的培训。对高风险患者进行电话随访，并对3天回访进行回顾性审查，以量化结局指标：对ED和临床显著不良事件（严重误诊或错误管理计划的回访）的回访。结果：高风险患者入组：干预前4,139例出院患者中有566例（13.7%），干预后3,507例出院患者中有397例（11.3%）。质量改进计划将入组患者的回访率从10.1%（57/566）降至4.9%（19/397）（5.2%差异，95% CI 1.8%至8.8%），临床显著不良事件从4.1%（23/566）降至1.5%（6/397）（差异为2.6%，95% CI为0.3%至4.8%）。对于所有艾德出院患者，临床显著不良事件从0.9%（39/4，139）降至0.4%（15/3，507）（0.5%差异，95% CI 0.1%至0.9%）。结论：通过对艾德出院患者进行电话随访和住院医师教育，提高出院质量，可减少出院患者不良事件的发生。
Study objective: We evaluate the effect on adverse events of a telephone follow-up quality improvement program.Methods: This was a before-and-after intervention comparison based on prospectively collected data in a tertiary care hospital emergency department (ED) (82,000 visits per year). The first half (April 15 to July 31, 2001) served as control, and the second half (August 1 to November 15, 2001) served as intervention with feedback to physicians on telephone follow-up outcomes of discharged patients and resident training about the uncertain presentations of serious diseases and the need to use additional evaluation on selected patients (observation unit, hospital admission). Telephone follow-up of the high-risk patients and retrospective review of 3-day return visits were used to quantify outcome measures: return visits to EDs and clinically significant adverse events (return visits with serious misdiagnoses or an erroneous management plan). The differences in proportions of outcomes were measured with 95% confidence intervals (CIs).Results: High-risk patients were enrolled: 566 (13.7%) of 4,139 discharged patients in the before-intervention period and 397 (11.3%) of 3,507 in the after-intervention period. The quality improvement initiative decreased return visits on enrolled patients from 10.1% (57/566) to 4.9% (19/397) (5.2% difference with 95% CI 1.8% to 8.8%) and decreased clinically significant adverse events from 4.1% (23/566) to 1.5% (6/397) (2.6% difference with 95% CI 0.3% to 4.8%). For all ED discharged patients, clinically significant adverse events decreased from 0.9% (39/4,139) to 0.4% (15/3,507) (0.5% difference with 95% CI 0.1% to 0.9%). During the study, the observation rate increased 4.3% (95% CI 2.8% to 5.7%), and the admission rate increased 3.4% (95% CI 2.1% to 4.8%).Conclusion: A quality improvement program with feedback to physicians of telephone follow-up and resident education can decrease clinically significant adverse events in ED discharged patients.