Hesselink Gijs, Berben Sivera, Beune Thimpe, Schoonhoven Lisette
Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands.
Regional Emergency Healthcare Network, Radboud University Medical Center, Nijmegen, The Netherlands Faculty of Health and Social Studies, Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.
BMJ Open. 2016 Jan 29;6(1):e009837. doi: 10.1136/bmjopen-2015-009837.
To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.
A systematic review of the literature.
PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.
Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.
Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.
系统评价旨在改善急诊护理中患者安全管理的干预措施在有效性、可靠性、有效性和可行性方面的情况。
文献系统评价。
检索了1990年1月至2014年7月期间发表在PubMed、EMBASE、护理及相关健康文献累积索引、Cochrane系统评价数据库和PsychInfo上的研究。我们纳入了评估与高层管理相关的干预措施的研究，这些措施用于监督和管理院前急救医疗服务（EMS）机构和医院急诊科（ED）中的患者安全。两名评审员独立选择候选研究、提取数据并评估研究质量。研究根据研究质量、环境、样本、干预特征和结果进行分类。
在纳入的18项研究中，13项（72%）为非实验性研究。9项研究（50%）报告了干预措施的可靠性和/或有效性数据。8项研究（44%）报告了干预措施的可行性。只有4项研究（22%）报告了具有统计学意义的效果。基于模拟的培训计划和精心设计的事件报告系统分别导致急诊科工作人员的安全知识和态度有统计学意义的改善，以及急诊科内事件报告的增加。
本评价纳入的干预措施的特征（例如，匿名事件报告和由独立方对事件报告进行验证）可为设计一种有效的工具提供有用的信息，以管理EMS机构和急诊科中的患者安全。然而，管理人员不能依赖一套强大的基于证据且可行的工具来管理其急诊护理组织和急诊护理链中的患者安全。需要在急诊护理环境中使用具有有效结局指标的实验设计来评估其他高风险部门的既定策略，以加强证据基础。
