■尽管非常重视提供安全护理,严重的患者伤害发生。虽然大多数护理发生在门诊,对门诊不良事件(AE)的认识仍然有限.
■在门诊环境中测量不良事件。
■电子健康记录(EHR)的回顾性审查。
■2018年马萨诸塞州有11个门诊。
■3103名接受门诊治疗的患者。
■使用触发方法,护士评审员确定了可能的不良事件,医生对其进行了裁决,严重程度排名,并评估了可预防性。使用广义估计方程来评估至少有1次AE与年龄的关系,性别,种族,和主要保险。分析了不同地点的AE率变化。
■3103名患者(平均年龄,52岁)更常见的是女性(59.8%),白色(75.1%),讲英语的人(90.8%),和私人保险(70.4%),2018年平均有4次门诊就诊。总的来说,7.0%(95%CI,4.6%至9.3%)的患者发生至少1次不良事件(每年每100名患者发生8.6次事件)。药物不良事件是最常见的AE(63.8%),其次是卫生保健相关感染(14.8%)和手术或手术事件(14.2%).17.4%的不良事件严重,2.1%危及生命,永远不会致命。总的来说,23.2%的不良事件是可以预防的。与年龄65至84岁相比,年龄18至44岁至少有1次不良事件的发生率较低(标准化风险差异,-0.05[CI,-0.09至-0.02]),并且与黑人种族比与亚洲种族(标准化风险差异,0.09[CI,0.01至0.17])。在研究地点,1.8%至23.6%的患者发生至少1次AE,AE的临床类别差异很大。
■回顾性EHR审查可能会错过AE。
■门诊病人的伤害比较常见,而且往往很严重。药物不良事件最常见。老年人的比率更高。迫切需要采取干预措施来减少门诊伤害。
■受控风险保险公司和哈佛医疗机构风险管理基金会。
UNASSIGNED: Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited.
UNASSIGNED: To measure AEs in the outpatient setting.
UNASSIGNED: Retrospective
review of the electronic health record (EHR).
UNASSIGNED: 11 outpatient sites in Massachusetts in 2018.
UNASSIGNED: 3103 patients who received outpatient care.
UNASSIGNED: Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites.
UNASSIGNED: The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially.
UNASSIGNED: Retrospective EHR
review may miss AEs.
UNASSIGNED: Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed.
UNASSIGNED: Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.