使用改良德尔菲法开发电子儿科全因伤害测量工具
Development of an Electronic Pediatric All-Cause Harm Measurement Tool Using a Modified Delphi Method.
作者信息
Stockwell David Christopher, Bisarya Hema, Classen David C, Kirkendall Eric S, Lachman Peter I, Matlow Anne G, Tham Eric, Hyman Dan, Lehman Samuel M, Searles Elizabeth, Muething Stephen E, Sharek Paul J
机构信息
From the *Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, The George Washington University, Washington, DC; †Center for Quality and Improvement Science, Children's National Medical Center, Washington, DC; ‡Children's Hospital Association, Overland Park, KS; §Department of Infectious Disease, School of Medicine, University of Utah, Salt Lake City, UT; ∥Pascal Metrics, Washington, DC; ¶Division of Biomedical Informatics, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH; #James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; **Medical Directors Office, Quality and Safety, Great Ormond Street Hospital NHS Foundation Trust, London, England; ††Departments of Paediatrics and Medicine and Centre for Patient Safety, University of Toronto, Toronto, ON; ‡‡Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO; §§Research Institute, and ∥∥Department of Quality and Patient Safety, Children's Hospital Colorado, Aurora, CO; ¶¶Department of Anesthesia and Critical Care Medicine, and ##Department of Quality, Children's Hospital Central California, Madera, CA; ***Division of General Pediatrics, Department of Pediatrics, School of Medicine, Stanford University palo Alto, CA; and †††Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA.
出版信息
J Patient Saf. 2016 Dec;12(4):180-189. doi: 10.1097/PTS.0000000000000139.
OBJECTIVES
To have impact on reducing harm in pediatric inpatients, an efficient and reliable process for harm detection is needed. This work describes the first step toward the development of a pediatric all-cause harm measurement tool by recognized experts in the field.
METHODS
An international group of leaders in pediatric patient safety and informatics were charged with developing a comprehensive pediatric inpatient all-cause harm measurement tool using a modified Delphi technique. The process was conducted in 5 distinct steps: (1) literature review of triggers (elements from a medical record that assist in identifying patient harm) for inclusion; (2) translation of triggers to likely associated harm, improving the ability for expert prioritization; (3) 2 applications of a modified Delphi selection approach with consensus criteria using severity and frequency of harm as well as detectability of the associated trigger as criteria to rate each trigger and associated harm; (4) developing specific trigger logic and relevant values when applicable; and (5) final vetting of the entire trigger list for pilot testing.
RESULTS
Literature and expert panel review identified 108 triggers and associated harms suitable for consideration (steps 1 and 2). This list was pared to 64 triggers and their associated harms after the first of the 2 independent expert reviews. The second independent expert review led to further refinement of the trigger package, resulting in 46 items for inclusion (step 3). Adding in specific trigger logic expanded the list. Final review and voting resulted in a list of 51 triggers (steps 4 and 5).
CONCLUSIONS
Application of a modified Delphi method on an expert-constructed list of 108 triggers, focusing on severity and frequency of harms as well as detectability of triggers in an electronic medical record, resulted in a final list of 51 pediatric triggers. Pilot testing this list of pediatric triggers to identify all-cause harm for pediatric inpatients is the next step to establish the appropriateness of each trigger for inclusion in a global pediatric safety measurement tool.
目的
为减少儿科住院患者的伤害，需要一个高效可靠的伤害检测流程。本研究描述了该领域公认专家开发儿科全因伤害测量工具的第一步。
方法
一个由儿科患者安全和信息学领域的国际领导者组成的小组负责使用改进的德尔菲技术开发一种全面的儿科住院患者全因伤害测量工具。该过程分5个不同步骤进行：（1）对纳入的触发因素（病历中有助于识别患者伤害的要素）进行文献综述；（2）将触发因素转化为可能相关的伤害，提高专家排序的能力；（3）使用伤害的严重程度、频率以及相关触发因素的可检测性作为标准，对每个触发因素和相关伤害进行评分，应用改进的德尔菲选择方法并达成共识标准，进行2次应用；（4）在适用时制定具体的触发逻辑和相关值；（5）对整个触发因素列表进行最终审核以进行试点测试。
结果
文献和专家小组审查确定了108个适合考虑的触发因素和相关伤害（步骤1和2）。在2次独立专家审查中的第一次审查后，该列表缩减至64个触发因素及其相关伤害。第二次独立专家审查导致触发因素包进一步完善，最终纳入46项（步骤3）。添加具体的触发逻辑扩展了列表。最终审查和投票产生了一份包含51个触发因素的列表（步骤4和5）。
结论
在一份由专家构建的包含108个触发因素的列表上应用改进的德尔菲方法，重点关注伤害的严重程度和频率以及电子病历中触发因素的可检测性，最终得到了一份包含51个儿科触发因素的列表。对这份儿科触发因素列表进行试点测试以识别儿科住院患者的全因伤害，是确定每个触发因素是否适合纳入全球儿科安全测量工具的下一步。
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