McKinney Patricia A, Jones Samantha, Parslow Roger, Davey Nicola, Darowski Mark, Chaudhry Bill, Stack Charles, Parry Gareth, Draper Elizabeth S
Paediatric Epidemiology Group, University of Leeds, Leeds LS2 9LN.
BMJ. 2005 Apr 16;330(7496):877-9. doi: 10.1136/bmj.38404.650208.AE. Epub 2005 Mar 18.
To investigate the feasibility of obtaining signed consent for submission of patient identifiable data to a national clinical audit database and to identify factors influencing the consent process and its success.
Feasibility study.
Seven paediatric intensive care units in England.
Parents/guardians of patients, or patients aged 12-16 years old, approached consecutively over three months for signed consent for submission of patient identifiable data to the national clinical audit database the Paediatric Intensive Care Audit Network (PICANet).
The numbers and proportions of admissions for which signed consent was given, refused, or not obtained (form not returned or form partially completed but not signed), by age, sex, level of deprivation, ethnicity (South Asian or not), paediatric index of mortality score, length of hospital stay (days in paediatric intensive care).
One unit did not start and one did not fully implement the protocol, so analysis excluded these two units. Consent was obtained for 182 of 422 admissions (43%) (range by unit 9% to 84%). Most (101/182; 55%) consents were taken by staff nurses. One refusal (0.2%) was received. Consent rates were significantly better for children who were more severely ill on admission and for hospital stays of six days or more, and significantly poorer for children aged 10-14 years. Long hospital stays and children aged 10-14 years remained significant in a stepwise regression model of the factors that were significant in the univariate model.
Systematically obtaining individual signed consent for sharing patient identifiable information with an externally located clinical audit database is difficult. Obtaining such consent is unlikely to be successful unless additional resources are specifically allocated to training, staff time, and administrative support.
探讨获取患者可识别数据提交至国家临床审计数据库的签署同意书的可行性,并确定影响同意过程及其成功率的因素。
可行性研究。
英格兰的7个儿科重症监护病房。
连续三个月接触的患者的父母/监护人,或12 - 16岁的患者,以获取将患者可识别数据提交至国家临床审计数据库儿科重症监护审计网络(PICANet)的签署同意书。
按年龄、性别、贫困程度、种族(是否为南亚裔)、儿科死亡率指数评分、住院时间(儿科重症监护病房天数),给出签署同意书、拒绝同意书或未获得同意书(表格未返回或表格部分填写但未签署)的入院人数及比例。
一个单位未启动,一个单位未完全实施该方案,因此分析排除这两个单位。422例入院患者中有182例(43%)获得同意(各单位范围为9%至84%)。大多数(101/182;55%)同意书由护士获取。收到一份拒绝同意书(0.2%)。入院时病情较重的儿童以及住院6天或更长时间的儿童同意率明显更高,而10 - 14岁儿童的同意率明显更低。在单变量模型中具有显著意义的因素的逐步回归模型中,住院时间长和10 - 14岁儿童仍然具有显著意义。
系统地获取患者签署同意书以与外部临床审计数据库共享患者可识别信息很困难。除非专门分配额外资源用于培训、工作人员时间和行政支持,否则不太可能成功获得此类同意书。