Predictors of Adverse Events and Medical Errors Among Adult Inpatients of Psychiatric Units of Acute Care General Hospitals.
Predictors of Adverse Events and Medical Errors Among Adult Inpatients of Psychiatric Units of Acute Care General Hospitals.
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急症综合医院精神科成人住院患者不良事件和医疗错误的预测因素。
DOI：
10.1176/appi.ps.201800110
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Marcus,StevenC
中科院分区：
文献类型：
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作者：
Vermeulen,JentienM;Doedens,Paul;Cullen,SaraW;vanTricht,MirjamJ;Hermann,Richard;Frankel,Martin;deHaan,Lieuwe;Marcus,StevenC
本研究的目的是确定相关因素的发生不良事件（AE）或医疗差错（ME）住院精神病hospitalizations.MethodsA全概率随机抽样4,371图表从14个住院精神科病房在急性护理综合医院在宾夕法尼亚州进行了审查，在两个阶段的过程中，包括筛选和标记的护士，然后由精神科医生审查。计算总体AE和ME发生率，然后按患者和医院因素分层。未调整和调整的logistic回归模型检查预测的AE和MEs. ResultsA AE被确定在14.5%的住院治疗（95%置信区间[CI]=11.7-17.9），和ME被确定在9.0%（CI=7.5-11.0）。在校正分析中，住院时间较长的患者和年龄较大的患者发生AE或ME的几率较高。年龄31-42岁（与18-30岁相比）、有商业保险（与Medicare或Medicaid或未保险相比）或在高容量医院治疗（与低、中或非常高相比）的患者发生AE的几率较低。患者年龄54岁或以上（与18-30岁相比），在周末入院，住进农村医院（与城市相比），或在非常高容量的医院（与高）治疗更有可能经历ME.ConclusionsThis研究提供了深入了解的因素，使患者和医院的患者安全事件的风险增加。这些信息可用于定制改善策略，以提高在综合医院精神科治疗的患者的安全性。
ObjectiveThe aim of this study was to identify factors associated with the occurrence of adverse events (AEs) or medical errors (MEs) during inpatient psychiatric hospitalizations.MethodsA full-probability random sample of 4,371 charts from 14 inpatient psychiatric units at acute care general hospitals in Pennsylvania were reviewed in a two-stage process that comprised screening and flagging by nurses followed by review by psychiatrists. AE and ME rates were calculated overall and then stratified by patient and hospital factors. Unadjusted and adjusted logistic regression models examined predictors of AEs and MEs.ResultsAn AE was identified in 14.5% of hospitalizations (95% confidence interval [CI]=11.7–17.9), and an ME was identified in 9.0% (CI=7.5–11.0). In adjusted analyses, patients with a longer length of stay and older patients had higher odds of experiencing an AE or an ME. Patients ages 31–42 (compared with ages 18–30), with commercial insurance (compared with Medicare or Medicaid or uninsured), or treated at high-volume hospitals (compared with low, medium, or very high) had lower odds of an AE. Patients age 54 or older (compared with ages 18–30), admitted during the weekend, admitted to rural hospitals (compared with urban), or treated at very-high-volume hospitals (compared with high) were more likely to experience an ME.ConclusionsThis study provides insight into factors that put patients and hospitals at increased risk of patient safety events. This information can be used to tailor improvement strategies that enhance the safety of patients treated on general hospital psychiatric units.