Hendrie James, Sammartino Luke, Silvapulle Mervyn J, Braitberg George
Emergency Department, Austin Health, Victoria, Australia.
Emerg Med Australas. 2007 Feb;19(1):16-24. doi: 10.1111/j.1742-6723.2006.00896.x.
The study was performed to determine the incidence, outcome and preventability of adverse events (AE) in an ED.
The Quality in Australian Health Care Study methodology, modified to the ED, was utilized. Case histories of patients presenting to a tertiary hospital ED were screened for events. Events detected were classified, using a 104-item data collection instrument, entered on Excel and analysed statistically using MINITAB.
A total of 5345 patients presented during the study period. Three thousand three hundred and thirty-two patients completed full evaluation and comprised the study population. One hundred and ninety-four events were detected. Except where specified, events with management causation < or = 3 were excluded. This excluded 24 events (12.4%) leaving 170 for analysis. Of patients suffering an event, 53.5% occurred prior ED attendance, 41.7% of AE occurred within the ED, and 4.7% had contributions from both. The overall event rate, detected by the screening process, was 5.1%, with an incident rate of 1.98% and AE rate of 3.12%. The ED AE rate was 1.0%. If only those with management causation = 1 are excluded, then the overall event rate was 5.52%, with an AE rate of 3.33%. Fifty-five per cent of events were judged to be preventable (preventability score > or = 3). Events resulting in death and disability were more likely to be preventable (P < or = 0.04).
In conclusion, the Quality in Australian Health Care Study methodology has been utilized to provide data on incidents and AE in an ED.
本研究旨在确定急诊科不良事件（AE）的发生率、结局及可预防性。
采用针对急诊科进行修改的澳大利亚医疗保健质量研究方法。对一家三级医院急诊科就诊患者的病历进行事件筛查。使用104项数据收集工具对检测到的事件进行分类，录入Excel并使用MINITAB进行统计分析。
研究期间共有5345名患者就诊。3332名患者完成了全面评估并构成研究人群。共检测到194起事件。除另有规定外，管理因果关系≤3的事件被排除。这排除了24起事件（12.4%），剩余170起进行分析。在发生事件的患者中，53.5%的事件发生在急诊科就诊之前，41.7%的不良事件发生在急诊科内，4.7%的事件二者均有促成因素。通过筛查过程检测到的总体事件发生率为5.1%，发生率为1.98%，不良事件发生率为3.1%。急诊科不良事件发生率为1.0%。若仅排除管理因果关系=1的事件，则总体事件发生率为5.52%，不良事件发生率为3.33%。55%的事件被判定为可预防（可预防性评分≥3）。导致死亡和残疾的事件更有可能是可预防的（P≤0.04）。
总之，已采用澳大利亚医疗保健质量研究方法来提供急诊科事件和不良事件的数据。
