外科住院护理的安全性:队列研究

The BMJ Pub Date : 2024-11-13 DOI:10.1136/bmj-2024-080480
Antoine Duclos, Michelle L Frits, Christine Iannaccone, Stuart R Lipsitz, Zara Cooper, Joel S Weissman, David W Bates
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Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable. Results Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. 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引用次数: 0

摘要

目的 估计与围手术期护理相关的不良事件的频率、严重程度和可预防性,并描述相关环境和专业。设计 多中心回顾性队列研究。地点 11 家美国医院。参与者 1009 名患者,从 2018 年期间入院接受手术的 64 121 名成人中随机抽取。主要结果测量 采用触发法评估住院患者围手术期护理期间的不良事件,识别以前与类似事件相关的信息,并对电子健康记录进行全面审查。接受过培训的护士会查看所有记录,并标记可能发生不良事件的入院患者,然后由医生进行裁定,确认事件的发生和特征。如果不良事件导致严重伤害,需要大量干预或长时间恢复,涉及危及生命的事件,或导致死亡结果,则被归类为重大不良事件。潜在的可预防事件包括确定、可能或可能可预防的事件。结果 在接受复查的 1009 名患者中,38.0%(95% 置信区间为 32.6 至 43.4)的患者发生了不良事件,15.9%(12.7 至 19.0)的患者发生了重大不良事件。在已发现的 593 例不良事件中,353 例(59.5%)可能可以预防,123 例(20.7%)肯定或可能可以预防。最常见的不良事件与外科手术有关(292 例,占 49.3%),其次是药物不良事件(158 例,占 26.6%)、医护相关感染(74 例,占 12.4%)、患者护理事件(66 例,占 11.2%)和输血反应(3 例,占 0.5%)。不良事件最常发生在普通护理病房(289 例,48.8%),其次是手术室(155 例,26.1%)、重症监护病房(77 例,13.0%)、恢复室(20 例,3.3%)、急诊科(11 例,1.8%)和其他院内地点(42 例,7.0%)。涉及最多的职业是主治医师(531 人,占 89.5%),其次是护士(349 人,占 58.9%)、住院医师(294 人,占 49.5%)、高级医师(169 人,占 28.5%)和研究员(68 人,占 11.5%)。结论 在超过三分之一的入院手术患者中发现了不良事件,其中近一半的事件被归类为重大事件,大部分都是可以预防的。这些发现强调,在整个围手术期护理过程中,所有医护人员都必须不断改进患者安全。补充方法 S3 显示了用于数据准备和分析的 SAS 代码。由于保密要求,本项目的数据主要保留给麻省总医院布里格姆分院的直接研究团队。不过,通过联系主要研究人员(DWB),可以在安全的服务器上访问去标识化的数据。此外,有兴趣的研究人员还可获得项目使用的协议和不良事件图表审查培训手册,以及有关数据管理和分析的更多详细信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety of inpatient care in surgical settings: cohort study
Objectives To estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned. Design Multicenter retrospective cohort study. Setting 11 US hospitals. Participants 1009 patients from a randomly selected sample of 64 121 adults admitted for surgery during 2018. Main outcome measures Adverse events during inpatient perioperative care were assessed using a trigger method, identifying information previously associated with similar events, and from a comprehensive review of electronic health records. Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable. Results Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were related to surgical procedures (n=292, 49.3%), followed by adverse drug events (n=158, 26.6%), healthcare associated infections (n=74, 12.4%), patient care events (n=66, 11.2%), and blood transfusion reactions (n=3, 0.5%). Adverse events were most frequent in general care units (n=289, 48.8%), followed by operating rooms (n=155, 26.1%), intensive care units (n=77, 13.0%), recovery rooms (n=20, 3.3%), emergency departments (n=11, 1.8%), and other in-hospital locations (n=42, 7.0%). Professions most involved were attending physicians (n=531, 89.5%), followed by nurses (n=349, 58.9%), residents (n=294, 49.5%), advanced level practitioners (n=169, 28.5%), and fellows (n=68, 11.5%). Conclusions Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care. Supplementary method S3 shows the SAS code for data preparation and analysis. Owing to confidentiality requirements, the data for this project are primarily reserved for the immediate research team at Mass General Brigham. However, deidentified data can be accessed on secured servers by contacting the principal investigator (DWB). Additionally, the protocol and adverse events chart review training manual used for the project, along with further details about data management and analysis, are available to interested researchers.
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