Fordyce James, Blank Fidela S j, Pekow Penelope, Smithline Howard A, Ritter George, Gehlbach Stephen, Benjamin Evan, Henneman Philip L
Department of Emergency Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
Ann Emerg Med. 2003 Sep;42(3):324-33. doi: 10.1016/s0196-0644(03)00398-6.
We describe errors occurring in a busy ED.
This is a prospective, observational study of reported errors at an academic emergency department (ED) with 100000 annual visits. Trained personnel interviewed all ED staff with direct patient contact, during and at the end of every shift, by using standardized data sheets.
One thousand nine hundred thirty-five ED patients registered during the 7-day study period in the summer of 2001. Four hundred error reports were generated, identifying 346 nonduplicative errors (18 per 100 registered patients; 95% confidence interval [CI] 15.9 to 20.0). Forty percent of errors were reported by nurses, 25% by providers, 19% by clerical staff, 13% by technicians and orderlies, and 3% multiple reporters. Errors reported for every 100 hours worked were similar for all groups (5.5; 95% CI 5.2 to 5.9). Errors were categorized as 22% diagnostic studies, 16% administrative procedures, 16% pharmacotherapy, 13% documentation, 12% communication, 11% environmental, and 9% other. Patients involved in errors were more likely to be older (P <.0001) and more likely to have higher visit level intensity (P <.0001) than registered ED patients. Ninety-eight percent of errors did not have a significant adverse outcome. Seven errors (0.36 per 100 registered patients; 95% CI 0.14 to 0.72) were associated with an adverse outcome.
Reported errors occurred in almost every aspect of emergency care. Ninety-eight percent of errors in the ED do not result in adverse outcomes. System changes need to be implemented to reduce ED errors.
我们描述了繁忙急诊科中发生的差错。
这是一项对一家年就诊量达100000人次的学术性急诊科上报差错进行的前瞻性观察研究。经过培训的人员在每个班次期间及结束时，使用标准化数据表对所有与患者有直接接触的急诊科工作人员进行访谈。
在2001年夏季为期7天的研究期间，有1935名急诊科患者登记就诊。共产生了400份差错报告，识别出346个非重复差错（每100名登记患者中有18个；95%置信区间[CI]为15.9至20.0）。40%的差错由护士上报，25%由医疗服务提供者上报，19%由文职人员上报，13%由技术人员和勤杂工上报，3%由多名上报者上报。所有组每工作100小时上报的差错数相似（5.5；95%CI为5.2至5.9）。差错分类如下：诊断性检查占22%，行政程序占16%，药物治疗占16%，文件记录占13%，沟通占12%，环境因素占11%，其他占9%。与登记的急诊科患者相比，发生差错的患者年龄更大（P<.0001），就诊级别强度更高的可能性也更大（P<.0001）。98%的差错未产生显著不良后果。7个差错（每100名登记患者中有0.36个；95%CI为0.14至0.72）与不良后果相关。
上报的差错几乎发生在急诊护理的各个方面。急诊科98%的差错未导致不良后果。需要实施系统变革以减少急诊科差错。
