Marquet Kristel, Claes Neree, De Troy Elke, Kox Gaby, Droogmans Martijn, Schrooten Ward, Weekers Frank, Vlayen Annemie, Vandersteen Marjan, Vleugels Arthur
1Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2Antwerp Management School, Health Care Management, Antwerp, Belgium. 3Vzw Jessa ziekenhuis, Hasselt, Belgium. 4Ziekenhuis Oost Limburg, Genk, Belgium. 5Algemeen Ziekenhuis Turnhout, Turnhout, Belgium. 6Center for Health Services and Nursing Research, Catholic University Leuven, Belgium.
Crit Care Med. 2015 May;43(5):1053-61. doi: 10.1097/CCM.0000000000000932.
The objectives of this study are to determine the prevalence and preventability of adverse events requiring an unplanned higher level of care, defined as an unplanned transfer to the ICU or an in-hospital medical emergency team intervention, and to assess the type and the level of harm of each adverse event.
A three-stage retrospective review process of screening, record review, and consensus judgment was performed.
Six Belgian acute hospitals.
During a 6-month period, all patients with an unplanned need for a higher level of care were selected.
The records 6-month period, the records of all patients with an unplanned need for a higher level of care were assessed by a trained clinical team consisting of a research nurse, a physician, and a clinical pharmacist.
Adverse events were found in 465 of the 830 reviewed patient records (56%). Of these, 215 (46%) were highly preventable. The overall incidence rate of patients being transferred to a higher level of care involving an adverse event was 117.6 (95% CI, 106.9-128.3) per 100,000 patient days at risk, of which 54.4 (95% CI, 47.15-61.65) per 100,000 patient days at risk involving a highly preventable adverse event. This means that 25.9% of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event. The adverse events were mainly associated with drug therapy (25.6%), surgery (23.7%), diagnosis (12.4%), and system issues (12.4%). The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%). Although the direct causality is often hard to prove, it is reasonable to consider these adverse events as a contributing factor.
Adverse events were found in 56% of the reviewed records, of which almost half were considered highly preventable. This means that one fourth of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event.
本研究的目的是确定需要非计划性更高护理级别的不良事件的发生率和可预防性，该不良事件定义为非计划性转入重症监护病房（ICU）或医院内医疗急救团队的干预，并评估每个不良事件的类型和伤害程度。
进行了一个三阶段的回顾性审查过程，包括筛查、记录审查和共识判断。
比利时的六家急性病医院。
在6个月的期间内，选取所有需要非计划性更高护理级别的患者。
在6个月期间，由一名研究护士、一名医生和一名临床药剂师组成的经过培训的临床团队对所有需要非计划性更高护理级别的患者记录进行评估。
在830份审查的患者记录中，有465份（56%）发现存在不良事件。其中，215份（46%）是高度可预防的。涉及不良事件的患者被转至更高护理级别的总体发生率为每10万风险患者日117.6例（95%可信区间，106.9 - 128.3），其中每10万风险患者日54.4例（95%可信区间，47.15 - 61.65）涉及高度可预防的不良事件。这意味着所有非计划性转至更高护理级别的患者中，25.9%与高度可预防的不良事件相关。不良事件主要与药物治疗（25.6%）、手术（23.7%）、诊断（12.4%）和系统问题（12.4%）有关。伤害程度从暂时伤害（55.7%）到长期或永久性损伤（19.1%）和死亡（25.2%）不等。尽管直接因果关系往往难以证明，但将这些不良事件视为一个促成因素是合理的。
在审查的记录中，56%发现存在不良事件，其中近一半被认为是高度可预防的。这意味着所有非计划性转至更高护理级别的患者中，四分之一与高度可预防的不良事件相关。
