Pronovost Peter, Holzmueller Christine G, Needham Dale M, Sexton J Bryan, Miller Marlene, Berenholtz Sean, Wu Albert W, Perl Trish M, Davis Richard, Baker David, Winner Laura, Morlock Laura
The Johns Hopkins University, Department of Anesthesiology & Critical Care Medicine, USA
Crit Care Med. 2006 Jul;34(7):1988-95. doi: 10.1097/01.CCM.0000226412.12612.B6.
Our institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this model in intensive care units.
We focus on measures of safety rather than broader measures of quality. The measures will allow health care organizations to evaluate whether they are safer now than in the past by answering the following questions: How often do we harm patients? How often do patients receive the appropriate interventions? How do we know we learned from defects? How well have we created a culture of safety? The first two measures are rate based, whereas the latter two are qualitative. To improve care within institutions, caregivers must be engaged, must participate in the selection and development of measures, and must receive feedback regarding their performance. The following attributes should be considered when evaluating potential safety measures: Measures must be important to the organization, must be valid (represent what they intend to measure), must be reliable (produce similar results when used repeatedly), must be feasible (affordable to collect data), must be usable for the people expected to employ the data to improve safety, and must have universal applicability within the entire institution.
Health care institutions.
Health care currently lacks a robust safety score card. We developed four aggregate measures of patient safety and present how we applied them to intensive care units in an academic medical center. The same measures are being applied to nearly 200 intensive care units as part of ongoing collaborative projects. The measures include how often do we harm patients, how often do we do what we should (i.e., use evidence-based medicine), how do we know we learned from mistakes, and how well do we improve culture. Measures collected by different departments can then be aggregated to provide a hospital level safety score card.
The science of measuring patient safety is immature. This article is a starting point for developing feasible and scientifically sound approaches to measure safety within an institution. Institutions will need to find a balance between measures that are scientifically sound, affordable, usable, and easily applied across the institution.
与许多机构一样，我们的机构也在努力制定能够回答“我们如何知道自己更安全了？”这一问题的衡量标准。我们的目标是提出一个评估患者安全绩效的框架，并描述我们如何在重症监护病房应用该模型。
我们关注安全指标而非更广泛的质量指标。这些指标将使医疗保健机构能够通过回答以下问题来评估他们现在是否比过去更安全：我们对患者造成伤害的频率有多高？患者接受适当干预的频率有多高？我们如何知道自己从缺陷中吸取了教训？我们营造安全文化的效果如何？前两个指标是基于比率的，而后两个是定性的。为了在机构内改善护理，护理人员必须积极参与，必须参与指标的选择和制定，并且必须收到有关其绩效的反馈。在评估潜在的安全指标时应考虑以下属性：指标必须对组织很重要，必须有效（代表它们打算衡量的内容），必须可靠（重复使用时产生相似的结果），必须可行（收集数据的成本可承受），必须可供预期使用这些数据以改善安全的人员使用，并且必须在整个机构内具有普遍适用性。
医疗保健机构。
医疗保健目前缺乏一个强大的安全记分卡。我们制定了四项患者安全综合指标，并展示了我们如何将其应用于一家学术医疗中心的重症监护病房。作为正在进行的合作项目的一部分，相同的指标正在应用于近200个重症监护病房。这些指标包括我们对患者造成伤害的频率有多高、我们做应该做的事情（即使用循证医学）的频率有多高、我们如何知道自己从错误中吸取了教训以及我们改善文化的效果如何。然后可以汇总不同部门收集的指标，以提供医院层面的安全记分卡。
衡量患者安全的科学尚不成熟。本文是开发可行且科学合理的方法以衡量机构内安全的起点。机构需要在科学合理、经济实惠、可用且易于在整个机构应用的指标之间找到平衡。
