Rate of undesirable events at beginning of academic year: retrospective cohort study.
Rate of undesirable events at beginning of academic year: retrospective cohort study.
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DOI：
10.1136/bmj.b3974
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发表时间：
2009-10-13
期刊：
影响因子：
--
通讯作者：
Wu CL
中科院分区：
文献类型：
--
作者：
Haller G;Myles PS;Taffé P;Perneger TV;Wu CL
目的了解学员在开学之初提供护理服务后，不良事件发生率是否增加。使用管理和患者记录数据设计回溯性队列研究。背景设在澳大利亚墨尔本的大学附属医院。研究对象1995年至2000年间，19名 560名接受麻醉手术的患者，由第一至第五年的实习生首次在医院工作。主要结果衡量绝对事故率、绝对减少率和不良事件的比率。结果不良事件的发生率在学年开始时高于其他时间(绝对事件发生率为137vs107/1000病人小时，相对发生率下降28%，P<；0.001)。不良事件的总体调整比率为1.40，95%可信区间为1.24至1.58。这种额外的风险对所有居民来说都是如此，无论他们的资历水平如何。超额风险在第一个月以后逐渐降低，到第四个月后趋势完全消失(第四个月的比率比为1.21，0.93比1.57)。最重要的下降是中枢和周围神经损伤(相对差异82%)，患者氧合不足(66%)，在手术室呕吐/吸入(53%)，以及气管插管技术失败(49%)。结论：无论学员的临床经验如何，在学年开始时，不良事件的发生率都更高。这表明，其他几个因素，如对工作环境的了解，团队合作和沟通，可能是导致增长的原因。
Objective To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year. Design Retrospective cohort study using administrative and patient record data. Setting University affiliated hospital in Melbourne, Australia. Participants 19 560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000). Main outcome measures Absolute event rates, absolute rate reduction, and rate ratios of undesirable events. Results The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%). Conclusions The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.
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影响因子：
1
作者：
Booth, JG;Casella, G;Hobert, JP
通讯作者：
Hobert, JP
影响因子：
10.7
作者：
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通讯作者：
Short, TG
DOI：
10.1308/003588402760452691
发表时间：
2002-09-01
影响因子：
1.4
作者：
Cosgrove, CM;Thornberry, DJ;Ashley, S
通讯作者：
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影响因子：
3
作者：
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通讯作者：
Bakaeen, FaisaL G.
影响因子：
168.9
作者：
Andrews, LB;Stocking, C;Siegler, M
通讯作者：
Siegler, M