An alternative strategy for studying adverse events in medical care
An alternative strategy for studying adverse events in medical care
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DOI：
10.1016/s0140-6736(96)08268-2
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发表时间：
1997-02-01
期刊：
影响因子：
168.9
通讯作者：
Siegler, M
中科院分区：
文献类型：
--
作者：
Andrews, LB;Stocking, C;Siegler, M
背景关于医院中与不适当护理相关的不良事件的频率的数据来自对医疗记录的研究，好像它们代表了不良事件的真实记录。在一项前瞻性的观察性设计中，我们分析了在一所大学医学院附属的大型城市教学医院的三个单元住院的所有患者护理期间不良事件的讨论。讨论在例行的临床会议上进行。方法接受过定性观察研究的人种学家参加了三个研究单位的日班、平日、定期查房、住院医生查房、护士换班、个案会议和其他预定会议以及各种部门和科室会议。他们记录了在这些会议上讨论的患者护理期间的所有不良事件，并制定了一个分类方案来对数据进行编码。收集了卫生保健提供者自己对患者接受的护理的适当性的评估的数据，以评估不良事件的性质和影响，以及卫生保健提供者和患者如何应对不良事件。在研究中的1047名患者中，185人(17.7%)据说至少有一次严重的不良事件；最初的事件与患者潜在疾病的严重程度有关。住院时间长的患者比住院时间短的患者有更多的不良事件。每住院一天，发生不良事件的可能性增加约6%。37.8%的不良事件是由个人引起的，15.6%的不良事件是相互作用的，9.8%的不良事件是由行政决策引起的。虽然17.7%的患者经历了导致住院时间延长和患者费用增加的严重事件，但在1047名患者中，只有1.2%(13人)提出了赔偿要求。这项研究表明，不良事件的潜在原因有很大范围，必须仔细关注交互或行政原因造成的错误。医疗保健提供者自己对不良事件的讨论可以作为主动预防错误的良好数据来源。
Background Data about the frequency of adverse events related to inappropriate care in hospitals come from studies of medical records as if they represented a true record of adverse events. In a prospective, observational design we analysed discussion of adverse events during the care of all patients admitted to three units of a large, urban teaching hospital affiliated to a university medical school. Discussion took place during routine clinical meetings. We undertook the study to enhance understanding of the incidence and scope of adverse events as a basis for preventing them.Methods Ethnographers trained in qualitative observational research attended day-shift, weekday, regularly scheduled attending rounds, residents' work rounds, nursing shift changes, case conferences, and other scheduled meetings in three study units as well as various departmental and section meetings. They recorded all adverse events during patient care discussed at these meetings and developed a classification scheme to code the data. Data were collected about health-care providers' own assessments about the appropriateness of the care that patients received to assess the nature and impact of adverse events and how health-care providers and patients responded to the adverse events.Findings Of the 1047 patients in the study, 185 (17.7%) were said to have had at least one serious adverse event; having an initial event was linked to the seriousness of the patient's underlying illness. Patients with long slays in hospital had more adverse events than those with short stays. The likelihood of experiencing an adverse event increased about 6% for each day of hospital stay. 37.8% of adverse events were caused by an individual, 15.6% had interactive causes, and 9.8% were due to administrative decisions. Although 17.7% of patients experienced serious events that led to longer hospital stays and increased costs to the patients, only 1.2% (13) of the 1047 patients made claims for compensation.Interpretation This study shows that there is a wide range of potential causes of adverse events that should be considered, and that careful attention must be paid to errors with interactive or administrative causes. Healthcare providers' own discussions of adverse events can be a good source of data for proactive error prevention.