Schutz A L, Counte M A, Meurer S
Saint Louis University, School of Public Health, Salus Center, Saint Louis, MO, USA.
Ergonomics. 2007 Sep;50(9):1451-84. doi: 10.1080/00140130701346765.
The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: 'patient safety'; 'medical errors'; 'adverse event'; 'iatrogenic'; and truncated options for 'improve'. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.
本研究的目的是在一个基于组织工效学原理并强调影响患者安全的结构因素的概念框架内，回顾患者安全改进措施。文献综述纳入了131项以英文发表的关于患者安全改进策略的研究，这些研究是通过检索Medline、Ovid Healthstar、PubMed和CINAHL获取的。检索关键词包括：“患者安全”；“医疗差错”；“不良事件”；“医源性的”；以及“改进”的截断选项。本文提供的多层次、分层框架整合了质量管理原则和组织工效学理论，并根据社会技术系统要素在三个结构层面上对患者安全措施进行了组织：卫生政策及相关医疗保健组织；医疗保健服务组织；以及医疗保健微观系统。利用该概念框架，本次对患者安全改进措施的综述强调了需要考虑所有改进建议对医疗保健系统内每个结构组成部分的影响。该综述还支持患者安全研究需要从探索性的一维报告发展为多层次的综合研究。
