Braddock Clarence H, Szaflarski Nancy, Forsey Lynn, Abel Lynn, Hernandez-Boussard Tina, Morton John
Department of Medicine, David Geffen School of Medicine University of California, Los Angeles 10833 Le Conte Avenue, Los Angeles, CA, 90095-1722, USA,
J Gen Intern Med. 2015 Apr;30(4):425-33. doi: 10.1007/s11606-014-3067-7. Epub 2014 Oct 28.
Improvements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective.
We aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units.
A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase.
Four medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants.
In situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork.
Hospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey.
Rates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p < 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p < 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents.
A multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses' perceptions of safety culture on inpatient study units.
医院患者安全已有所改善，但仍需创新方法来加速进展。越来越多的证据表明，采用微系统方法改善医院护理质量和安全是有效的。
我们旨在评估一项多方面、微系统层面的患者安全计划对住院科室临床结局和安全文化的影响。
进行了一项为期1年的前瞻性干预研究，随后是6个月的可持续发展阶段。
纳入了一所学术性大学医学中心的四个内科和外科住院科室，研究参与者包括注册护士和住院医师。
现场模拟培训；医疗紧急情况汇报；每月患者安全团队会议；患者安全倡导者角色；跨学科患者安全会议；模范团队表彰计划。
医院获得性严重脓毒症/脓毒性休克和急性呼吸衰竭；非计划转至更高护理级别（HLOC）；加权风险调整死亡率。使用广泛接受的、经过验证的调查来衡量安全文化。
研究科室中，医院获得性严重脓毒症/脓毒性休克和急性呼吸衰竭的发生率下降，每1000例科室出院患者中，分别从1.78降至0.64（p = 0.04）和从2.44降至0.43（p = 0.03）。严重脓毒症/脓毒性休克病例之间的平均天数从基线期到干预期有所增加（p = 0.03）。非计划转至HLOC的比例从每1000例科室转院中715例增至764例（p = 0.08）。所有研究科室的加权风险调整观察到预期死亡率从0.50降至0.40（p < 0.001）。1年干预后，研究科室的安全文化总体得分有所提高，护士得分显著提高（p < 0.001），但住院医师得分未显著提高（p = 0.06）。与住院医师的四个维度相比，护士在十二个调查维度中的九个维度得分显著提高。
一项多方面的患者安全计划表明，其与改善医院获得性并发症、加权风险调整死亡率以及提高护士对住院研究科室安全文化的认知有关。
