Identifying Risks and Opportunities in Outpatient Surgical Patient Safety: A Qualitative Analysis of Veterans Health Administration Staff Perceptions.
Identifying Risks and Opportunities in Outpatient Surgical Patient Safety: A Qualitative Analysis of Veterans Health Administration Staff Perceptions.
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DOI：
10.1097/pts.0000000000000311
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发表时间：
2021-04-01
影响因子：
2.2
通讯作者：
Rivard PE
中科院分区：
文献类型：
--
作者：
Mull HJ;Rosen AK;Charns MP;Itani KMF;Rivard PE
人们对门诊手术中的患者安全风险知之甚少。住院患者手术不良事件(AE)的危险因素包括患者(例如，高龄)、手术过程(例如，术前评估不足)或结构相关特征(例如，手术量低)；然而，这些因素可能不同于门诊护理，因为在门诊护理中，手术通常是选择性的，在年轻/健康的患者中。我们进行了一项探索性的定性研究项目，以确定门诊手术中不良反应的危险因素。在文献回顾的基础上，我们建立了与外科AEs相关的患者、过程和结构因素的概念框架。这一框架为我们的半结构化访谈指南提供了1)关于参与者经历的特定门诊AE的开放式问题，以及2)门诊外科患者总体安全风险因素。我们采访了全国退伍军人管理局的外科工作人员。根据概念框架中的类别对结果进行编码，并使用内容分析确定其他主题。代表不同外科角色的14名提供者参与其中。10个人报告目睹了AE，每个人都在我们的概念框架中就风险因素提供了意见。我们没有发现患者种族/年龄、手术技术或手术量影响患者安全的证据。新出现的因素包括患者依从性、术后患者评估/指导、手术室设备需求和安全文化。外科工作人员熟悉门诊手术中的不良反应和患者安全问题。我们的结果表明，手术提供者的护理过程，而不是一成不变的患者特征，可能会影响AEs的发生。我们确定的因素可能有助于对门诊外科AEs进行更有针对性的研究。
Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AE) risk factors include patient- (e.g., advanced age), process- (e.g., inadequate preoperative assessment), or structure-related characteristics (e.g., low surgical volume); however, these factors may differ from outpatient care where surgeries are often elective and in younger/healthier patients. We undertook an exploratory qualitative research project to identify risk factors for AEs in outpatient surgery. We developed a conceptual framework of patient, process and structure factors associated with surgical AEs based on a literature review. This framework informed our semi-structured interview guide with 1) open-ended questions about a specific outpatient AE that the participant experienced and 2) outpatient surgical patient safety risk factors in general. We interviewed nation-wide VA surgical staff. Results were coded based on categories in the conceptual framework and additional themes were identified using content analysis. Fourteen providers representing diverse surgical roles participated. Ten reported witnessing an AE and everyone provided input on risk factors in our conceptual framework. We did not find evidence that patient race/age, surgical technique, or surgical volume affected patient safety. Emerging factors included patient compliance, postoperative patient assessments/instruction, operating room equipment needs and safety culture. Surgical staff are familiar with AEs and patient safety problems in outpatient surgery. Our results show that processes of care undertaken by surgical providers, as opposed to immutable patient characteristics, may affect the occurrence of AEs. The factors we identified may facilitate more targeted research on outpatient surgical AEs.