院前重大事件监测系统介绍——最终结果。

Introduction of a prehospital critical incident monitoring system--final results.

机构信息

Geelong Hospital Emergency Department, Barwon Health, Victoria, Australia.

出版信息

Prehosp Disaster Med. 2010 Nov-Dec;25(6):515-20. doi: 10.1017/s1049023x00008694.

DOI:10.1017/s1049023x00008694

PMID:21181685

Abstract

BACKGROUND

Incident monitoring has been shown to improve patient care and has been adopted widely in the hospital care setting. There are limited data on incident monitoring in the prehospital setting.

HYPOTHESIS

A high-yield, systems-oriented, incident monitoring process can be implemented successfully in a prehospital setting.

METHODS

This prospective, descriptive study outlines the implementation of an incident monitoring process in a regional prehospital setting. Both trauma care and non-trauma care were monitored by a system of anonymous reporting and chart review with debriefing for trauma cases that met major trauma criteria. A committee reviewed all identified cases and coded and logged all incidents and provider recommendations.

RESULTS

There were 454 incidents identified from 230 cases (mean=2.0; 95% CI 1.8-2.1 per case). Anonymous reporting resulted in the identification of 113 incidents from 69 cases (1.6l per case 95% CI=1.4-1.9 per case) Major trauma cases generated 266 incidents from 134 cases (mean=2.0; 95% CI=1.8-2.2 per case), and there were 74 incidents from 26 combined cases (mean=2.9; 95% CI=2.2-3.5 per case). One incident was uncategorized. There were 315 (69.4%) incidents categorized as management problems and 123 (27.1%) were system problems. Prolonged scene time was the most common incident in both management and system categories; 56 (17.8%) and 18 (14.6%) respectively. Mitigating circumstances were found in 111 (24.4%) incidents. The most common incident-related patient outcome was none/near miss (127 (28%)). Incident monitoring most commonly led to generalized feedback (105 (23.1%)) or specific trend analysis (140 (30.8%)). Reports to higher or external bodies occurred in 18 incidents (4.0%).

CONCLUSIONS

The project has been implemented successfully in a regional prehospital settling. The methodology, utilizing a number of incident detection techniques, results in a high yield of incidents over a broad range of error types. The large proportion of "near miss" type incidents allows for incident assessment without demonstrable patient harm. Many incidents were mitigated and the majority represented management-type issues.

摘要

背景

事件监测已被证明可以改善患者护理，并已在医院护理环境中广泛采用。在院前环境中，关于事件监测的数据有限。

假设

在院前环境中，可以成功实施一种高产量、面向系统的事件监测过程。

方法

本前瞻性描述性研究概述了在区域院前环境中实施事件监测过程。通过对符合重大创伤标准的创伤病例进行匿名报告和图表审查，并对创伤病例进行汇报来监测创伤和非创伤护理。一个委员会审查了所有确定的病例，并对所有事件和提供者建议进行编码和记录。

结果

从 230 例病例中发现了 454 起事件（平均每例 2.0；95%置信区间 1.8-2.1 例）。匿名报告从 69 例病例中发现了 113 起事件（平均每例 1.61 例，95%置信区间为 1.4-1.9 例）。重大创伤病例从 134 例病例中产生了 266 起事件（平均每例 2.0；95%置信区间为 1.8-2.2 例），26 例联合病例中有 74 例（平均每例 2.9 例，95%置信区间为 2.2-3.5 例）。有 1 起事件未分类。315 起（69.4%）事件被归类为管理问题，123 起（27.1%）为系统问题。现场时间延长是管理和系统类别中最常见的事件；分别为 56（17.8%）和 18（14.6%）。在 111 起（24.4%）事件中发现了缓解情况。与事件相关的患者结果最常见的是无/近错过（127（28%））。事件监测最常见的结果是一般性反馈（105（23.1%））或特定趋势分析（140（30.8%））。向更高或外部机构报告的情况发生在 18 起事件中（4.0%）。