Adverse events in patients with return emergency department visits.
Adverse events in patients with return emergency department visits.
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DOI：
10.1136/bmjqs-2014-003194
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发表时间：
2015-02
影响因子：
5.4
通讯作者：
Forster A
中科院分区：
文献类型：
--
作者：
Calder L;Pozgay A;Riff S;Rothwell D;Youngson E;Mojaverian N;Cwinn A;Forster A
本研究描述了7天内因不良事件（定义为与接受的医疗保健相关的不良结局）而返回急诊科（艾德）的比例。 前瞻性队列研究。我们在2010年5月至6月在三级护理艾德使用电子触发不良事件监测系统，以检查索引访视后7天内的艾德报告。 三名经过培训的护士中的一名确定访视是否与索引急诊护理相关。对于此类记录，由三名经过培训的急诊医生中的一名进行不良事件确定。采用描述性统计、χ2检验和Logistic回归分析方法对不良事件的类型和严重程度进行分析。在13495例首次艾德访视中，923例（6.8%）在7天内返回艾德。 所有患者的中位年龄为47岁，52.8%为女性。 护理复查后，211例需要医师复查。其中，53次访视为不良事件（阳性预测值（PPV）= 5.7%，95% CI 4.4%-7.4%），30次（56.6%）是可预防的。常见的不良事件类型涉及管理、诊断或药物问题。我们观察到1例潜在可预防的死亡和58.5%的导致短暂残疾的不良事件。72小时内返回截止的改良触发器导致入院的PPV为11.9%（95% CI 6.8%至18.9%）。 我们的电子触发器有效地识别了12%的艾德患者在72小时内返回，需要住院的不良事件。 鉴于已识别不良事件的高度可预防性，该触发器也有望作为性能测量工具。
This study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received. Prospective cohort study. We used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit. One of three trained nurses determined whether the visit was related to index emergency care. For such records, one of three trained emergency physicians conducted adverse event determinations. We determined adverse event type and severity and analysed the data with descriptive statistics, χ2 tests and logistic regression. Of 13 495 index ED visits, 923 (6.8%) were followed by ED returns within 7 days. The median age of all patients was 47 years and 52.8% were women. After nursing review, 211 cases required physician review. Of these, 53 visits were adverse events (positive predictive value (PPV)=5.7%, 95% CI 4.4% to 7.4%) and 30 (56.6%) were preventable. Common adverse event types involved management, diagnostic or medication issues. We observed one potentially preventable death and 58.5% of adverse events resulting in transient disability. The PPV of a modified trigger with a cut-off of return within 72 h, resulting in admission was 11.9% (95% CI 6.8% to 18.9%). Our electronic trigger efficiently identified adverse events among 12% of patients with ED returns within 72 h, requiring hospital admission. Given the high degree of preventability of the identified adverse events, this trigger also holds promise as a performance measurement tool.
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影响因子：
14.6
作者：
Baker, GR;Norton, PG;Tamblyn, R
通讯作者：
Tamblyn, R
影响因子：
158.5
作者：
BRENNAN, TA;LEAPE, LL;HIATT, HH
通讯作者：
HIATT, HH
影响因子：
1.5
作者：
JONES J;CLARK W;DOUGHERTY J
通讯作者：
DOUGHERTY J
影响因子：
6.2
作者：
Chem, CH;How, CK;Graff, L
通讯作者：
Graff, L
影响因子：
6.2
作者：
Ross, Michael A.;Hemphill, Robin R.;Clark, Carol
通讯作者：
Clark, Carol