Elder Nancy C, Dovey Susan M
Dept of Family Medicine, University of Cincinnati, PO Box 670582, Eden Avenue and Albert Sabin Way, Cincinnati, OH 45267-0582, USA.
J Fam Pract. 2002 Nov;51(11):927-32.
To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings.
Systematic review and synthesis of the medical literature.
We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field.
Process errors and preventable adverse events.
Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed primary care medical errors. A variety of quantitative and qualitative methods were used in the studies. Extraction of results from the studies led to a classification of 3 main categories of preventable adverse events: diagnosis, treatment, and preventive services. Process errors were classified into 4 categories: clinician, communication, administration, and blunt end.
Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have patient, consumer, or other health care provider input.
描述并分类门诊基层医疗环境中医疗护理过程中的差错及可预防的不良事件。
对医学文献进行系统综述与综合分析。
我们使用医学主题词“医疗差错”检索了1965年至2001年3月期间的MEDLINE和Cochrane图书馆，并通过添加家庭医疗、初级卫生保健、医师/家庭或门诊护理对检索词进行了修改，且将检索范围限定为英文出版物。还查阅了患者安全和基层医疗组织的已发表书目及网站，以获取未发表的报告、演讲资料，并找到指向其他有相关工作的网站、期刊或研究者的线索。从所审查论文的参考文献以及该领域的经典论文中识别出了其他论文。
过程差错及可预防的不良事件。
四项原创性研究直接研究并描述了基层医疗中的医疗差错和不良事件，另外三项研究间接涉及基层医疗差错。这些研究采用了多种定量和定性方法。对研究结果的提炼得出了可预防不良事件的三大主要类别：诊断、治疗和预防服务。过程差错分为四类：临床医生、沟通、管理和间接环节。
关于基层医疗环境中医疗差错的原创性研究包括数量有限的小型研究，这些研究主要从医生的角度对医疗差错和可预防的不良事件进行了丰富的描述。我们描述了一种从这些研究中得出的分类方法该方法基于基层医疗的实际情况，为未来的流行病学和干预性研究提供了一个起点。缺少的是有患者、消费者或其他医疗服务提供者参与的研究。
