The Canadian Adverse Events Study:: the incidence of adverse events among hospital patients in Canada
The Canadian Adverse Events Study:: the incidence of adverse events among hospital patients in Canada
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DOI：
10.1503/cmaj.1040498
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发表时间：
2004-05-25
影响因子：
14.6
通讯作者：
Tamblyn, R
中科院分区：
文献类型：
--
作者：
Baker, GR;Norton, PG;Tamblyn, R
背景：对不良事件（ae）的研究强调了提高患者安全的必要性。ae是由卫生保健管理引起的意外伤害或并发症，导致死亡、残疾或住院时间延长。我们估计了加拿大急症医院患者不良事件的发生率。方法：我们在5个省（不列颠哥伦比亚省、阿尔伯塔省、安大略省、魁北克省和新斯科舍省）各随机选择1所教学医院、1所大型社区医院和2所小型社区医院，并对每家医院2000财政年度非精神科、非产科成人患者的随机抽样图表进行审查。训练有素的审查员筛选了所有符合条件的图表，医生审查了阳性筛选的图表，以确定ae并确定其可预防性。结果：3745例病例中，1527例（40.8%）至少有1个筛查标准。医师审稿人在255个图表中发现ae。调整抽样策略后，AE率为每100例住院患者7.5例（95%置信区间[CI] 5.7-9.3）。在不良事件患者中，36.9% （95% CI 32.0%-41.8%）发生了可预防的事件，20.8% （95% CI 7.8%-33.8%）死亡。医师审稿人估计1521个额外的住院天数与不良事件有关。尽管男性和女性的不良事件发生率相同，但发生不良事件的患者明显比未发生不良事件的患者年龄大（平均年龄[和标准差]64.9 [16.7]vs . 62.0[18.4]岁；p = 0.016）。解释：在我们的研究中，不良事件的总发病率为7.5%，这表明，在加拿大每年近250万例与研究类型相似的住院患者中，约18.5万例与不良事件有关，其中近7万例是可以预防的。
Background: Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.Methods: We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability.Results: At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7-9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were Significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).Interpretation: The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.