Using a Pediatric Trigger Tool to Estimate Total Harm Burden Hospital-acquired Conditions Represent.
Using a Pediatric Trigger Tool to Estimate Total Harm Burden Hospital-acquired Conditions Represent.
复制标题
使用儿科触发工具来估计医院获得性病症所代表的总伤害负担。
DOI：
10.1097/pq9.0000000000000081
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发表时间：
2018
影响因子：
1.1
通讯作者：
Sharek,PaulJ
中科院分区：
文献类型：
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作者：
Stockwell,DavidC;Landrigan,ChristopherP;Schuster,MarkA;Klugman,Darren;Bisarya,Hema;Classen,DavidC;Dizon,ZoelleB;Hall,Matt;Wood,Matthew;Sharek,PaulJ
方法：我们对之前使用儿科全因伤害测量工具识别的240种伤害进行了回顾性分析，该工具是一种触发工具，适用于病历，可全面识别伤害。原始样本包括2012年2月从6家儿童医院随机选择的600名患者。排除了康复、产科、新生儿护理和精神病住院患者。如果事件描述可能符合CMS定义的9种HAC之一的定义，则将240种已识别伤害归类为HAC。HAC评估由2位合著者独立进行，并使用Cohen's Kappa.Results进行比较：2012年2月，使用儿科全球触发工具，在6家儿童医院确定了240例伤害。共同作者对HAC分类的一致性较高（Kappa= 0.77）。在协调差异后，在240个识别出的伤害中，有58个（24.2%; 95%置信区间：9.1-31.7%）被归类为CMS定义的HAC.Conclusions：由儿科专用触发工具检测到的所有伤害中有四分之一由HACs代表。虽然大量工作集中在识别和最大限度地减少HAC上，但为了更好地理解并最终缓解损害，可能需要更全面的损害识别和量化来解决使用这种方法识别的事件。
Methods:We conducted a retrospective review of 240 harms previously identified using the Pediatric All-Cause Harm Measurement Tool, a trigger tool that is applied to medical records to comprehensively identify harms. The original sample included 600 randomly selected patients from 6 children’s hospitals in February 2012. Patients with rehabilitation, obstetric, newborn nursery, and psychiatric admissions were excluded. The 240 identified harms were classified as a HAC if the event description potentially met the definition of 1 of the 9 CMS-defined HACs. HAC assessment was performed independently by 2 coauthors and compared using Cohen’s Kappa.Results:Two hundred forty harms across 6 children’s hospitals were identified in February 2012 using a pediatric global trigger tool. Agreement between the coauthors on HAC classification was high (Kappa= 0.77). After reconciling differences, of the 240 identified harms, 58 (24.2%; 95% confidence interval: 9.1–31.7%) were classified as a CMS-defined HAC.Conclusions:One-fourth of all harms detected by a pediatric-specific trigger tool are represented by HACs. Although substantial effort is focused on identifying and minimizing HACs, to better understand and ultimately mitigate harm, more comprehensive harm identification and quantification may be needed to address events unidentified using this approach.