Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Room 3218, Madison, WI 53706, USA.
Appl Ergon. 2010 Sep;41(5):674-81. doi: 10.1016/j.apergo.2009.12.007. Epub 2010 Feb 13.
The study and practice of patient safety has seen a surge over the last 10 years. New resident training and staffing policies, health information technologies, error reporting systems, team models of care, training methods, patient involvement, information handoff strategies, just cultures, and many other interventions have been mandated or attempted to improve the safety of patient care. While some of these interventions focus on individual providers and others focus on organization-level changes, little, if any, patient safety research has purposefully sought to understand how variables at different levels, such as the provider level or organization level, interact to impact patient safety outcomes such as errors, adverse drug events, or patient harm. Looking at relationships across levels is important because adverse events might be related to variables at different levels; consider that adverse events may be nested within patients, patients nested within nurses and physicians, nurses and physicians nested within shifts, shifts nested within hospital units, and so forth. Because these nested levels exist, they may exert as yet untested influence on the levels below. In this paper the impact of levels on theory, measurement, analysis and intervention in patient safety research is discussed.
在过去的 10 年中，患者安全的研究和实践得到了迅猛发展。新的住院医师培训和人员配备政策、医疗信息技术、错误报告系统、护理团队模式、培训方法、患者参与、信息交接策略、公正文化以及许多其他干预措施已经被强制实施或尝试实施，以提高患者护理的安全性。虽然这些干预措施中的一些侧重于个体提供者，而另一些则侧重于组织层面的改变，但几乎没有任何患者安全研究有意试图了解提供者层面或组织层面等不同层面的变量如何相互作用，从而影响患者安全结果，如错误、药物不良事件或患者伤害。跨层次研究关系很重要，因为不良事件可能与不同层次的变量有关；例如，不良事件可能嵌套在患者中，患者嵌套在护士和医生中，护士和医生嵌套在班次中，班次嵌套在医院病房中，依此类推。由于存在这些嵌套层次，它们可能对下面的层次产生尚未经过测试的影响。本文讨论了患者安全研究中理论、测量、分析和干预的层次影响。
