定义与衡量患者安全。

Defining and measuring patient safety.

作者信息

Pronovost Peter J, Thompson David A, Holzmueller Christine G, Lubomski Lisa H, Morlock Laura L

机构信息

Department of Anesthesiology & Critical Care Medicine, Surgery and Health Policy & Management, The Johns Hopkins University School of Medicine, 901 South Bond Street, Suite 318, Baltimore, MD 21231, USA.

出版信息

Crit Care Clin. 2005 Jan;21(1):1-19, vii. doi: 10.1016/j.ccc.2004.07.006.

DOI:10.1016/j.ccc.2004.07.006

PMID:15579349

Abstract

Despite the growing demand for improved safety in health care, debate remains regarding the magnitude of the problem and the degree to which harm is preventable. To a great extent, this debate stems from variation in the definition and methods for measuring safety, its "shadow" error, and the degree of preventability. This article reviews the definition of safety and error, discusses approaches to measuring safety, and provides a framework for investigating incidents that unveils how the systems under which care is delivered may contribute to adverse incidents.

摘要

尽管对提高医疗保健安全性的需求不断增长，但关于该问题的严重程度以及伤害可预防的程度仍存在争议。在很大程度上，这场争论源于安全定义和测量方法的差异、其“隐性”误差以及可预防程度。本文回顾了安全和错误的定义，讨论了测量安全的方法，并提供了一个调查事件的框架，揭示了提供护理的系统可能如何导致不良事件。