Baines Rebecca, Langelaan Maaike, de Bruijne Martine, Spreeuwenberg Peter, Wagner Cordula
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands Dept. of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
BMJ Qual Saf. 2015 Sep;24(9):561-71. doi: 10.1136/bmjqs-2014-003702. Epub 2015 Jul 6.
To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives.
Retrospective patient record review at three points in time.
In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively.
In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012.
The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes.
Rates of both AEs and preventable AEs.
Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008.
Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety.
评估与前几年相比，2011/2012年医院护理是否变得更安全，表现为可预防不良事件（AE）发生率下降以及患者安全举措。
在三个时间点进行回顾性患者记录审查。
在三项全国性AE研究中，分别对2004年的21家医院、2008年的20家医院和2011/2012年的20家医院中2004年、2008年和2011/2012年的患者记录进行审查。在每家医院中，分别抽取了400份、200份和200份患者记录。
该研究共纳入15997例患者入院病例，其中2004年7926例，2008年4023例，2011/2012年4048例。
2004年至2012年期间，国家层面医院护理中的主要患者安全举措包括小型和大型多方面项目。
AE和可预防AE的发生率。
未经校正的总体AE粗率在2011/2012年与2008年相比无变化，而可预防AE率下降了45%。经过多水平校正后，2011/2012年可预防AE率的下降仍清晰可见，与2008年相比下降了30%（p = 0.10）。与2008年相比，2011/2012年在老年人群或与手术过程相关的可预防AE较少。
我们的研究表明，在全国综合性安全计划所涉及的领域中，可预防AE有一些改善。有迹象表明，这样的计划对患者安全有积极影响。
