Department of Emergency Medicine, Johns Hopkins University School of Medicine, 5801 Smith Avenue, Baltimore, MD 21209, USA.
J Patient Saf. 2010 Sep;6(3):147-52. doi: 10.1097/pts.0b013e3181ed623a.
The Patient Safety and Quality Improvement Act (PSQIA) of 2005, inspired by the Institute of Medicine's (IOM) 1999 report To Err Is Human, affords federal protections in exchange for error disclosures. However, the PSQIA is unlikely to be effective unless frontline providers are aware of its existence. In this study, we assessed the quantity of publications regarding this protection within the medical literature.
Four reviewers independently evaluated 2060 safety-related articles, identified through a PubMed database search, to determine whether they discussed actual (or proposed) national legal protections for voluntary reporting of medical errors. Using a reviewer method based on a standard Delphi consensus model, agreement was achieved if at least 3 of 4 reviewers agreed with the decision.
Articles were separated into pre-IOM report (1990-1999) and post-IOM report (2000-2008) literature. No articles were determined to be "on topic" in the pre-IOM period (n = 624). Twenty-seven articles were considered "on topic" in the post-IOM period (n = 1436), constituting 1.8% of the period total (95% confidence interval, 1.2%-2.6%). Of the 27 on topic articles, 7 appeared in practice-related journals, whereas the remaining 20 were in journals with a health policy or health care administration focus.
Few published studies were found in clinical journals describing the PSQIA. This raises serious concerns and indicates that physicians may not be aware of the new legal protections afforded for error disclosure. If the health care system is to realize the benefits of error reporting systems, greater education of physicians regarding their legal protections may be needed.
2005 年的《患者安全与质量改进法案》（PSQIA）是受医学研究所（IOM）1999 年报告《犯错是人》的启发而制定的，它提供了联邦保护，以换取对错误的披露。然而，除非一线医护人员意识到该法案的存在，否则 PSQIA 不太可能有效。在这项研究中，我们评估了医学文献中关于该保护的出版物数量。
四位审稿人独立评估了通过 PubMed 数据库搜索确定的 2060 篇与安全相关的文章，以确定它们是否讨论了自愿报告医疗错误的实际（或拟议的）国家法律保护。使用基于标准 Delphi 共识模型的审稿人方法，如果至少有 4 位审稿人中的 3 位同意该决定，则达成一致意见。
文章分为 IOM 报告前（1990-1999 年）和 IOM 报告后（2000-2008 年）文献。在 IOM 报告前的时期（n=624），没有一篇文章被确定为“相关主题”。在 IOM 报告后的时期（n=1436），有 27 篇文章被认为是“相关主题”，占该时期总数的 1.8%（95%置信区间，1.2%-2.6%）。在 27 篇相关主题文章中，有 7 篇发表在实践相关的期刊上，而其余 20 篇则发表在卫生政策或卫生保健管理重点的期刊上。
在临床期刊中发现的描述 PSQIA 的已发表研究很少。这引起了严重的关注，并表明医生可能不知道为错误披露提供的新的法律保护。如果医疗保健系统要实现错误报告系统的好处，可能需要对医生进行更多关于其法律保护的教育。
