Schwappach David L B
Research Institute for Public Health and Addiction, Konradstrasse 32, 8031 Zurich, Switzerland.
BMC Health Serv Res. 2008 Mar 20;8:59. doi: 10.1186/1472-6963-8-59.
Involvement of patients in the detection and prevention of safety related events and medical errors have been widely recommended. However, it has also been questioned whether patients at large are willing and able to identify safety-related events in their care. The aim of this study was to develop and pilot test a brief patient safety survey applicable to inpatient care in Swiss hospitals.
A survey instrument was developed in an iterative procedure. The instrument asks patients to report whether they have experienced specific undesirable events during their hospital stay. The preliminary version was developed together with experts and tested in focus groups with patients. The adapted survey instrument was pilot-tested in random samples of patients of two Swiss hospitals (n = 400). Responders to the survey that had reported experience of any incident were sampled for qualitative interviews (n = 18). Based on the interview, the researcher classified the reported incidents as confirmed or discarded.
The survey was generally well accepted in the focus groups and interviews. In the quantitative pilot test, 125 patients returned the survey (response rate: 31%). The mean age of responders was 55 years (range 17-91, SD 18 years) and 62.5% were female. The 125 participating patients reported 94 "definitive" and 34 "uncertain" events. 14% of the patients rated any of the experienced events as "serious". The definitive and uncertain events reported with highest frequency were phlebitis, missing hand hygiene, allergic drug reaction, unavailability of documents, and infection. 23% of patients reported some or serious concerns about their safety. The qualitative interviews indicate that both, the extent of patients' uncertainty in the classification of events and the likelihood of confirmation by the interviewer vary very much by type of incident. Unexpectedly, many patients reported problems and incidents related to food and dietary intake. Overall, the in-depth interviews confirmed experiences from the focus groups that many patients feel reluctant to report undesirable events without acknowledging the presence or absence of individual responsibility or failure. Many patients reported that they did not ask or communicate about errors or near misses with staff and some patients even develop strategies to improve their safety but do not disclose these to staff.
Many patients experience undesirable events during hospitalization and a significant number of patients is seriously concerned about their safety. Surveying patients about experiences with safety-related events in hospital seems a valuable tool for identifying and monitoring problematic areas of care and undesirable events. Evidence from the qualitative interviews indicates that safety remains an unsaid word between patients and their care providers.
广泛推荐患者参与安全相关事件及医疗差错的发现与预防。然而，广大患者是否愿意且能够识别其医疗过程中的安全相关事件也受到质疑。本研究的目的是开发并试点测试一种适用于瑞士医院住院治疗的简短患者安全调查问卷。
通过迭代程序开发了一种调查工具。该工具要求患者报告他们在住院期间是否经历过特定的不良事件。初步版本是与专家共同开发的，并在患者焦点小组中进行了测试。经过调整的调查工具在瑞士两家医院的患者随机样本中进行了试点测试（n = 400）。对报告有任何事件经历的调查受访者进行了定性访谈抽样（n = 18）。基于访谈，研究人员将报告的事件分类为已确认或排除。
该调查在焦点小组和访谈中普遍得到认可。在定量试点测试中，125名患者返回了调查问卷（回复率：31%）。受访者的平均年龄为55岁（范围17 - 91岁，标准差18岁），62.5%为女性。125名参与患者报告了94起“确定”事件和34起“不确定”事件。14%的患者将任何经历的事件评为“严重”。报告频率最高的确定和不确定事件是静脉炎、手卫生缺失、药物过敏反应、文件不可用以及感染。23%的患者报告对其安全存在一些或严重担忧。定性访谈表明，患者对事件分类的不确定程度以及访谈者确认的可能性因事件类型而异。出乎意料的是，许多患者报告了与食物和饮食摄入相关的问题和事件。总体而言，深入访谈证实了焦点小组的经验，即许多患者在不确认个人责任或失误是否存在的情况下，不愿意报告不良事件。许多患者报告他们没有向工作人员询问或沟通错误或险些发生的失误，一些患者甚至制定了提高自身安全的策略，但未向工作人员透露。
许多患者在住院期间经历不良事件，并且相当数量的患者严重关注自身安全。就医院安全相关事件经历对患者进行调查似乎是识别和监测护理问题领域及不良事件的有价值工具。定性访谈的证据表明，安全在患者与其护理提供者之间仍是一个未说出口的话题。
