医学教学单位中的结构化跨学科查房：提高患者安全
Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.
作者信息
O'Leary Kevin J, Buck Ryan, Fligiel Helene M, Haviley Corinne, Slade Maureen E, Landler Matthew P, Kulkarni Nita, Hinami Keiki, Lee Jungwha, Cohen Samuel E, Williams Mark V, Wayne Diane B
机构信息
Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E Ontario St, Seventh Floor, Chicago, IL 60611, USA.
出版信息
Arch Intern Med. 2011 Apr 11;171(7):678-84. doi: 10.1001/archinternmed.2011.128.
BACKGROUND
Effective collaboration and teamwork is essential to providing safe hospital care. The objective of this study was to assess the effect of an intervention designed to improve interdisciplinary collaboration and lower the rate of adverse events (AEs).
METHODS
The study was a controlled trial of an intervention, Structured Inter-Disciplinary Rounds, implemented in 1 of 2 similar medical teaching units in a tertiary care academic hospital. The intervention combined a structured format for communication with a forum for regular interdisciplinary meetings. We conducted a retrospective medical record review evaluating 370 randomly selected patients admitted to the intervention and control units (n = 185 each) in the 24 weeks after and 185 admitted to the intervention unit in the 24 weeks before the implementation of Structured Inter-Disciplinary Rounds (N = 555). Medical records were screened for AEs. Two hospitalists confirmed the presence of AEs and assessed their preventability and severity in a masked fashion. We used multivariable Poisson regression models to compare the adjusted incidence of AEs in the intervention unit to that in concurrent and historic control units.
RESULTS
The rate of AEs was 3.9 per 100 patient-days for the intervention unit compared with 7.2 and 7.7 per 100 patient-days, respectively, for the concurrent and historic control units (adjusted rate ratio, 0.54; P = .005; and 0.51; P = .001). The rate of preventable AEs was 0.9 per 100 patient-days for the intervention unit compared with 2.8 and 2.1 per 100 patient-days for the concurrent and historic control units (adjusted rate ratio, 0.27; P = .002; and 0.37; P = .02). The low number of AEs rated as serious or life-threatening precluded statistical analysis for differences in rates of events classified as serious or serious and preventable.
CONCLUSION
Structured Inter-Disciplinary Rounds significantly reduced the adjusted rate of AEs in a medical teaching unit.
背景
有效的协作和团队合作对于提供安全的医院护理至关重要。本研究的目的是评估一项旨在改善跨学科协作并降低不良事件（AE）发生率的干预措施的效果。
方法
该研究是一项针对结构化跨学科查房干预措施的对照试验，在一家三级医疗学术医院的两个相似医学教学单元中的一个实施。该干预措施将结构化沟通形式与定期跨学科会议论坛相结合。我们进行了一项回顾性病历审查，评估了在结构化跨学科查房实施后24周内随机选择的入住干预组和对照组（每组n = 185）的370例患者，以及在实施结构化跨学科查房前24周内入住干预组的185例患者（N = 555）。对病历进行不良事件筛查。两名住院医师以盲法确认不良事件的存在，并评估其可预防性和严重程度。我们使用多变量泊松回归模型比较干预组与同期和历史对照组中不良事件的调整发病率。
结果
干预组的不良事件发生率为每100患者日3.9例，同期和历史对照组分别为每100患者日7.2例和7.7例（调整率比分别为0.54；P = 0.005；和0.51；P = 0.001）。干预组可预防不良事件的发生率为每100患者日0.9例，同期和历史对照组分别为每100患者日2.8例和2.1例（调整率比分别为0.27；P = 0.002；和0.37；P = 0.02）。被评为严重或危及生命的不良事件数量较少，无法对分类为严重或严重且可预防的事件发生率差异进行统计分析。
结论
结构化跨学科查房显著降低了医学教学单元中不良事件的调整发生率。
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