Southwick Frederick S, Cranley Nicole M, Hallisy Julia A
Department of Medicine, University of Florida, Gainesville, Florida, USA.
Department of Behavioral Science and Community Health, College of Public Health and Health Professionals, University of Florida, Gainesville, Florida, USA.
BMJ Qual Saf. 2015 Oct;24(10):620-9. doi: 10.1136/bmjqs-2015-003980. Epub 2015 Jun 19.
Preventable medical errors continue to be a major cause of death in the USA and throughout the world. Many patients have written about their experiences on websites and in published books.
As patients and family members who have experienced medical harm, we have created a nationwide voluntary survey in order to more broadly and systematically capture the perspective of patients and patient families experiencing adverse medical events and have used quantitative and qualitative analysis to summarise the responses of 696 patients and their families.
Harm was most commonly associated with diagnostic and therapeutic errors, followed by surgical or procedural complications, hospital-associated infections and medication errors, and our quantitative results match those of previous provider-initiated patient surveys. Qualitative analysis of 450 narratives revealed a lack of perceived provider and system accountability, deficient and disrespectful communication and a failure of providers to listen as major themes. The consequences of adverse events included death, post-traumatic stress, financial hardship and permanent disability. These conditions and consequences led to a loss of patients' trust in both the health system and providers. Patients and family members offered suggestions for preventing future adverse events and emphasised the importance of shared decision-making.
This large voluntary survey of medical harm highlights the potential efficacy of patient-initiated surveys for providing meaningful feedback and for guiding improvements in patient care.
在美国乃至全世界，可预防的医疗差错仍是主要的死亡原因。许多患者在网站上以及出版的书籍中讲述了他们的经历。
作为经历过医疗伤害的患者及家属，我们开展了一项全国性的自愿调查，以便更广泛、系统地了解经历不良医疗事件的患者及患者家属的看法，并运用定量和定性分析方法总结了696名患者及其家属的回复。
伤害最常与诊断和治疗失误相关，其次是手术或操作并发症、医院相关感染和用药错误，我们的定量结果与之前由医疗服务提供者发起的患者调查结果相符。对450篇叙述的定性分析显示，主要问题包括患者感觉医疗服务提供者和医疗系统缺乏问责、沟通不足且不尊重患者以及医疗服务提供者不听患者意见。不良事件的后果包括死亡、创伤后应激障碍、经济困难和永久性残疾。这些情况和后果导致患者对医疗系统和医疗服务提供者失去信任。患者及家属就预防未来不良事件提出了建议，并强调了共同决策的重要性。
这项关于医疗伤害的大型自愿调查凸显了患者发起的调查在提供有意义的反馈以及指导改善患者护理方面的潜在功效。
