A facilitated survey instrument captures significantly more anesthesia events than does traditional voluntary event reporting
A facilitated survey instrument captures significantly more anesthesia events than does traditional voluntary event reporting
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DOI：
10.1097/01.anes.0000291440.08068.21
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发表时间：
2007-12-01
期刊：
影响因子：
8.8
通讯作者：
Weinger, Matthew B.
中科院分区：
文献类型：
--
作者：
Oken, Andrew;Rasmussen, Mark D.;Weinger, Matthew B.
背景：本研究旨在评价主动调查方法检测麻醉非常规事件（NRE）的有效性。一个NRE是临床医生或观察员认为从最佳护理的基础上的临床situation.Methods的背景下偏离临床护理的任何方面：一个全面的开放式非常规事件调查（CONES）的开发，以引起NRE。由多个简短的开放式问题组成的CONES，在麻醉后监护室对麻醉提供者进行管理。CONES数据进行了比较，从同一家医院的麻醉质量保证（QA）过程中，依赖于自我报告的预定义的不良事件。结果：CONES采访后，183例不同的病人，麻醉，手术的复杂性。55例患者至少有一次NRE（发生率为30.4%）。在相同的30个月期间，QA过程捕获了159例病例，在进行的8，303例麻醉手术中，96.8%包含至少1例NRE（总发生率为1.9%）。CONES数据更能代表整体手术人群。CONES和QA数据在NRE发生率（P < 0.001）、患者影响（74.5% vs. 96.2%; P < 0.001）和损伤（23.6% vs. 60.3%）方面存在显著差异。QA组的结局更严重（P < 0.001）。外推的CONES数据表明，麻醉相关的患者损伤的总体发病率显着较高（7.7%与QA方法仅1.0%）。结论：一个积极的监测工具，使用NRE结构确定了大量的临床病例与潜在的患者安全问题。这种方法可能是对自我报告的传统质量保证方法的有益补充。
Background: This study sought to evaluate the effectiveness of an active survey method for detecting anesthesia nonroutine events (NREs). An NRE is any aspect of clinical care perceived by clinicians or observers as a deviation from optimal care based on the context of the clinical situation.Methods: A Comprehensive Open-ended Nonroutine Event Survey (CONES) was developed to elicit NREs. CONES, which consisted of multiple brief open-ended questions, was administered to anesthesia providers in the postanesthesia care unit. CONES data were compared with those from the same hospital's anesthesia quality assurance (QA) process, which relied on self-reporting of predefined adverse events.Results: CONES interviews were conducted after 183 cases of varying patient, anesthesia, and surgical complexity. Fifty-five cases had at least one NRE (30.4% incidence). During the same 30-month period, the QA process captured 159 cases with 96.8% containing at least one NRE among the 8,303 anesthetic procedures conducted (1.9% overall incidence). The CONES data were more representative of the overall surgical population. There were significant differences in NRE incidence (P < 0.001), patient impact (74.5% vs. 96.2%; P < 0.001), and injury (23.6% vs. 60.3%) between CONES and QA data. Outcomes were more severe in the QA group (P < 0.001). Extrapolation of the CONES data suggested a significantly higher overall incidence of anesthesia-related patient injury (7.7% vs. only 1.0% with the QA method).Conclusions: An active surveillance tool using the NRE construct identified a large number of clinical cases with potential patient safety concerns. This approach may be a useful complement to more traditional QA methods of self-reporting.