Evans R S, Pestotnik S L, Classen D C, Bass S B, Burke J P
Department of Medical Informatics, LDS Hospital, Salt Lake City, Utah.
Proc Annu Symp Comput Appl Med Care. 1992:437-41.
Adverse drug events (ADEs) are a serious health problem and are the leading adverse event experienced by hospitalized patients. Numerous hospitals have used different methods to improve the reporting of ADEs but few have undertaken studies aimed at the prevention of ADEs. We found that computerized ADE surveillance identified significantly more ADEs than our previous voluntary reporting method. Moreover, the computerized ADE surveillance system created a database of ADEs which allowed us to analyze the ADEs and design methods for prevention. We found that computer alerts of previously known drug allergies generated when drugs were ordered significantly reduced the number of type B ADEs, 56 vs 8 (p < 0.001). In addition, we found that the timely surveillance of ADEs combined with physician notification reduced the number of severe ADEs, 41 vs 12 (p < 0.001). Initial analysis of the ADE database has shown that on average patients with type B ADEs are hospitalized longer (17 vs 14 days) and have larger hospitalization costs ($30,617 vs $23,256) than patients with type A ADEs. Patients with severe ADEs also are hospitalized longer (20 vs 13 days) and have larger hospitalization costs ($38,007 vs $22,474) than patients with moderate ADEs. This indicates that the prevention and early treatment of ADEs can reduce the length of hospitalization and result in a considerable cost savings to the hospital.
药品不良事件（ADEs）是一个严重的健康问题，也是住院患者经历的主要不良事件。许多医院采用了不同方法来改善ADEs的报告情况，但很少有医院开展旨在预防ADEs的研究。我们发现，计算机化的ADE监测比我们之前的自愿报告方法识别出的ADEs显著更多。此外，计算机化的ADE监测系统创建了一个ADEs数据库，这使我们能够分析ADEs并设计预防方法。我们发现，在下达药物医嘱时生成的已知药物过敏的计算机警报显著减少了B型ADEs的数量，从56例降至8例（p < 0.001）。此外，我们发现，对ADEs的及时监测并结合医生通知减少了严重ADEs的数量，从41例降至12例（p < 0.001）。对ADE数据库的初步分析表明，平均而言，B型ADEs患者的住院时间更长（17天对14天），住院费用更高（30,617美元对23,256美元），高于A型ADEs患者。严重ADEs患者的住院时间也更长（20天对13天），住院费用更高（38,007美元对22,474美元），高于中度ADEs患者。这表明，ADEs的预防和早期治疗可以缩短住院时间，并为医院节省可观的成本。
