Seward E, Greig E, Preston S, Harris R A, Borrill Z, Wardle T D, Burnham R, Driscoll P, Harrison B D W, Lowe D C, Pearson M G
Newham General Hospital.
Clin Med (Lond). 2003 Sep-Oct;3(5):425-34. doi: 10.7861/clinmedicine.3-5-425.
In this retrospective pilot study we examine the feasibility of establishing a confidential enquiry into why some patients die after emergency admission to hospital. After excluding those who died in the first hour or who were admitted for palliative care, pairs of physicians were able to collect quantitative and qualitative data on 200 consecutive deaths. Both physicians reported shortfalls of care in 14 patients and one of the pair in 25 patients whose deaths would not have been the expected outcome. In 25, the shortfalls of care may have contributed to their deaths. Major problems were delays in seeing doctors, inaccurate diagnoses, delays in investigations and initiation of treatment. They occurred mostly in those admitted at night. It is possible that establishing the correct diagnosis and starting appropriate treatment may have been delayed in 64% of the 200 patients. The headline figures appear worse than some previous external assessment studies but this study did concentrate on those in whom problems were more likely. Nevertheless, the frequency is too high to be overlooked. In this feasibility study we have demonstrated that it is practicable for local staff to collect and assess data in hospitals and that the types of problems identified are relevant to anyone planning how to organise emergency care. A larger definitive study should be performed.
在这项回顾性试点研究中，我们探讨了针对某些患者在急诊入院后死亡原因开展保密调查的可行性。在排除了入院后首小时内死亡的患者以及因姑息治疗入院的患者后，医生对连续200例死亡病例收集了定量和定性数据。两位医生均报告称，14例患者存在护理不足的情况，另有25例患者的死亡并非预期结果，其中一位医生认为存在护理不足。在25例患者中，护理不足可能导致了他们的死亡。主要问题包括看诊延迟、诊断不准确、检查延迟以及治疗启动延迟。这些问题大多发生在夜间入院的患者身上。在这200例患者中，64%的患者可能在确诊和开始适当治疗方面出现了延迟。总体数据看起来比之前一些外部评估研究的结果更糟，但本研究确实聚焦于那些更可能出现问题的患者。尽管如此，该频率过高不容忽视。在这项可行性研究中，我们证明了当地工作人员在医院收集和评估数据是可行的，而且所发现的问题类型对于任何规划如何组织急诊护理的人来说都具有相关性。应该开展一项更大规模的确证性研究。
