The incidence and severity of adverse events affecting patients after discharge from the hospital
The incidence and severity of adverse events affecting patients after discharge from the hospital
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DOI：
10.7326/0003-4819-138-3-200302040-00007
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发表时间：
2003-02-04
影响因子：
39.2
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Forster, AJ;Murff, HJ;Bates, DW
背景：对住院患者的研究发现安全是一个重大问题，但关于出院后发生的伤害的数据很少。在此过渡期间，患者可能很脆弱。目的：描述出院后影响患者的不良事件的发生率、严重程度、可预防性和“可改善性”，并制定在此期间提高患者安全的策略。设计：前瞻性队列研究。地点：三级护理学术医院。患者：连续 400 名从普通医疗服务出院回家的患者。测量：三个主要结果均为不良 事件，定义为因医疗处理而发生的伤害；可预防的不良事件，定义为被判断为由错误引起的不良事件；可改善的不良事件，定义为严重程度可以降低的不良事件。出院后的病程是通过在每位患者出院后约 3 周进行病历审查和结构化电话访谈来确定的。结果由独立医生审查确定。结果：76 名患者出院后出现不良事件（19% [95% Cl，15% 至 23%]）。其中，23 例发生了可预防的不良事件（6% [Cl，4% 至 9%]），24 例发生了可改善的不良事件（6% [Cl，4% 至 9%]）。 3% 的伤害是严重的实验室异常，65% 是症状，30% 是与非永久性残疾相关的症状，3% 是永久性残疾。药物不良事件是最常见的不良事件类型（66% [Cl，55% 至 76%]），其次是手术相关损伤（17% [Cl，86% 至 26%]）。在导致至少非永久性残疾的 25 种不良事件中，12 种是可以预防的（48% [Cl，28% 至 68%]），6 种是可以改善的（24% [Cl，7% 至 41%]）。 结论：不良事件在出院期间频繁发生，许多不良事件可以通过简单的策略来预防或改善。
Background: Studies of hospitalized patients identify safety as a significant problem, but few data are available regarding injuries occurring after discharge. Patients may be vulnerable during this transition period.Objective: To describe the incidence, severity, preventability, and "ameliorability" of adverse events affecting patients after discharge from the hospital and to develop strategies for improving patient safety during this interval.Design: Prospective cohort study.Setting: A tertiary care academic hospital.Patients: 400 consecutive patients discharged home from the general medical service.Measurements: The three main outcomes were adverse events, defined as injuries occurring as a result of medical management; preventable adverse events, defined as adverse events judged to have been caused by an error; and ameliorable adverse events, defined as adverse events whose severity could have been decreased. Posthospital course was determined by performing a medical record review and a structured telephone interview approximately 3 weeks after each patient's discharge. Outcomes were determined by independent physician reviews.Results: Seventy-six patients had adverse events after discharge (19% [95% Cl, 15% to 23%]). Of these, 23 had preventable adverse events (6% [Cl, 4% to 9%]) and 24 held ameliorable adverse events (6% [Cl, 4% to 9%]). Three percent of injuries were serious laboratory abnormalities, 65% were symptoms, 30% were symptoms associated with a nonpermanent disability, and 3% were permanent disabilities. Adverse drug events were the most common type of adverse event (66% [Cl, 55% to 76%]), followed by procedure-related injuries (17% [Cl, 86% to 26%]). Of the 25 adverse events resulting in at least a nonpermanent disability, 12 were preventable (48% [Cl, 28% to 68%]) and 6 were ameliorable (24% [Cl, 7% to 41%]).Conclusion: Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies.