Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review.
Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review.
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DOI：
10.1136/bmjqs-2020-011405
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发表时间：
2021-12
影响因子：
5.4
通讯作者：
Carson-Stevens A
中科院分区：
文献类型：
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作者：
Avery AJ;Sheehan C;Bell B;Armstrong S;Ashcroft DM;Boyd MJ;Chuter A;Cooper A;Donnelly A;Edwards A;Evans HP;Hellard S;Lymn J;Mehta R;Rodgers S;Sheikh A;Smith P;Williams H;Campbell SM;Carson-Stevens A
估计英格兰初级保健中可避免的重大伤害的发生率;描述相关患者安全事件并对其进行分类，并提出建议，以缓解导致事件的可改善因素的风险。回顾性病例记录审查。确定了有重大健康问题的患者，并对伤害的可避免性和严重性进行了临床判断。识别并记录导致可避免伤害的因素。初级保健. 13名全科医生（GP）对来自英格兰三个地区的12个随机选择的全科诊所登记的14，407名初级保健患者样本进行了回顾性病例记录审查（总名单规模：92，255名患者）。至少被认为是“可能避免”的重大伤害的发生率以及安全事故的性质。认为至少很可能避免的重大损害发生率为35.6（95% CI 23.3 - 48.0）/100 000患者-年（57.9，95% CI 42.2 - 73.7，基于敏感性分析）。总共发现了74例可避免的伤害，涉及72名患者。三种类型的事件占90%以上的问题：诊断问题占45/74（60.8%）原发事件，其次是药物相关问题（n=19，25.7%）和延迟转诊（n=8，10.8%）。在59例（79.7%）病例中，如果全科医生采取了与循证指南一致的行动，则可以更快（n=48）或预防（n=11）发现重大伤害。在英国，初级保健可能会造成大量可避免的重大伤害，其中诊断错误占大多数伤害。根据我们发现的促成因素，可以通过更有效地实施现有的信息技术，加强团队协调和沟通，以及更大的个人和信息护理连续性来改善。
To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded. Primary care. Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients). The incidence of significant harm considered at least ‘probably avoidable’ and the nature of the safety incidents. The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines. There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.
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影响因子：
2.9
作者：
Bell BG;Campbell S;Carson-Stevens A;Evans HP;Cooper A;Sheehan C;Rodgers S;Johnson C;Edwards A;Armstrong S;Mehta R;Chuter A;Donnelly A;Ashcroft DM;Lymn J;Smith P;Sheikh A;Boyd M;Avery AJ
通讯作者：
Avery AJ
荷兰总体实践中患者安全事件的患病率和后果：回顾性医疗记录审查研究。
DOI：
10.1186/1748-5908-6-37
发表时间：
2011-04-06
期刊：
Implementation science : IS
影响因子：
--
作者：
Gaal S;Verstappen W;Wolters R;Lankveld H;van Weel C;Wensing M
通讯作者：
Wensing M
影响因子：
11.4
作者：
Makeham, Meredith A. B.;Kidd, Michael R.;Stromer, Simone
通讯作者：
Stromer, Simone
影响因子：
5.4
作者：
Amelung, Dorothee;Whitaker, Katriina L.;Black, Georgia
通讯作者：
Black, Georgia
影响因子：
5.9
作者：
Lyratzopoulos, Georgios;Mendonca, Silvia C.;Abel, Gary A.
通讯作者：
Abel, Gary A.