Thornlow Deirdre K, Merwin Elizabeth
School of Nursing, Duke University, Durham, North Carolina, USA.
Health Care Manage Rev. 2009 Jul-Sep;34(3):262-72. doi: 10.1097/HMR.0b013e3181a16bce.
Given the trend toward eliminating reimbursement for "never events," hospital administrators are challenged to implement practices designed to prevent their occurrence. Little evidence exists, however, that patient safety practices, as evaluated using accreditation criteria, are related to the achievement of patient safety outcomes.
The aim of this study was to examine the relationship between patient safety practices, as measured by accreditation standards, and patient safety outcomes as measured by hospital rates of infections, decubitus ulcers, postoperative respiratory failure, and failure to rescue.
Secondary data were used to examine relationships between patient-safety-related accreditation standards and patient outcomes in U.S. acute care hospitals. Accreditation performance areas were reduced into subscores to represent patient safety practices. Outcome rates were calculated using the Agency for Healthcare Research and Quality Patient Safety Indicator software. Multivariate regression was performed to determine the significance of the relationships.
Three of four multivariate models significantly explained variance in hospital patient safety indicator rates. Accreditation standards reflecting patient safety practices were related to some outcomes but not others. Rates of infections and decubitus ulcers occurred more frequently in hospitals with poorer performance in utilizing patient safety practices, but no differences were noted in rates of postoperative respiratory failure or failure to rescue.
Certain adverse events, such as infections and decubiti, may be reduced by preventive protocols that are reflected in accreditation standards, whereas other events, such as failure to rescue and postoperative respiratory failure, may require multifaceted strategies that are less easily translated into protocols. Our approach may have influenced the observed associations yet represents progress toward assessing whether safety practices, as measured by accreditation standards, are related to patient outcomes.
鉴于“零容忍事件”报销取消的趋势，医院管理人员面临着实施旨在预防此类事件发生的措施的挑战。然而，几乎没有证据表明，按照认证标准评估的患者安全措施与患者安全结果的实现有关。
本研究的目的是检验以认证标准衡量的患者安全措施与以医院感染率、褥疮、术后呼吸衰竭和抢救失败率衡量的患者安全结果之间的关系。
使用二手数据研究美国急症护理医院中与患者安全相关的认证标准和患者结果之间的关系。将认证绩效领域简化为子分数以代表患者安全措施。使用医疗保健研究与质量局患者安全指标软件计算结果率。进行多变量回归以确定关系的显著性。
四个多变量模型中的三个显著解释了医院患者安全指标率的方差。反映患者安全措施的认证标准与某些结果相关，但与其他结果无关。在利用患者安全措施方面表现较差的医院中，感染和褥疮的发生率更高，但术后呼吸衰竭或抢救失败率没有差异。
某些不良事件，如感染和褥疮，可能通过认证标准中反映的预防方案来减少，而其他事件，如抢救失败和术后呼吸衰竭，可能需要多方面的策略，这些策略不太容易转化为方案。我们的方法可能影响了观察到的关联，但代表了朝着评估按照认证标准衡量的安全措施是否与患者结果相关迈出的一步。
