Zegers Marieke, Hesselink Gijs, Geense Wytske, Vincent Charles, Wollersheim Hub
Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
Department of Experimental Psychology, University of Oxford, Oxford, UK.
BMJ Open. 2016 Sep 29;6(9):e012555. doi: 10.1136/bmjopen-2016-012555.
To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals.
Systematic review of systematic reviews.
PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015.
English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes.
Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design.
The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians.
概述旨在降低医院不良事件发生率的有效干预措施。
对系统评价进行的系统评价。
检索了PubMed、CINAHL、PsycINFO、Cochrane图书馆和EMBASE，以查找截至2015年10月发表的系统评价。
纳入了针对降低医院不良事件的干预措施的英文系统评价，包括具有实验设计并报告不良事件发生率的研究。两名评价者独立评估每项研究的质量，并提取有关研究人群、研究设计、干预特征和不良患者结局的数据。
纳入了60篇质量中等至高的系统评价。发现14种类型的干预措施具有统计学上显著的合并效应量，包括：（1）预防谵妄的多组分干预措施；（2）降低心肺骤停和死亡率的快速反应团队；（3）减少药物不良事件的药剂师干预措施；（4）预防跌倒的运动和多组分干预措施；（5）减少感染的护理束干预措施、检查表和提醒。大多数（82%）显著效应量基于5项或更少的采用实验性研究设计的原始研究。
全球医院实施的患者安全干预措施的证据不足。研究结果表明需要投资于高质量的研究标准，以确定对患者安全有实际影响的干预措施。预防谵妄、心肺骤停和死亡、药物不良事件、感染和跌倒的干预措施最为有效，因此临床医生应优先考虑。
