School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
BMJ Qual Saf. 2017 Sep;26(9):743-750. doi: 10.1136/bmjqs-2016-006339. Epub 2017 Mar 29.
Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE.
Data linkage was used to identify a random sample of 20 000 participants in the 45 and Up Cohort Study, out of 267 153 adults aged 45 years and over, who had been hospitalised in the prior 6 months. A cross-sectional survey was administered to these patients to capture their experiences, including whether they had an AE and received honest communication about it.
Of the 18 993 eligible participants, 7661 completed surveys were received (40% response rate) and 474 (7%) reported having an AE. Most AEs related to clinical processes and procedures (33%), or medications and intravenous fluids (21%). Country of birth and admission through emergency were significant predictors of the occurrence of an event. An earlier admission in the prior 6 months or a transfer to another healthcare facility was also associated with more AEs. Of those who suffered an AE, 58% reported serious or moderate effects.
Given the exclusions in our sample population (under 45 years), the AE rate reported by patients of 7% is similar to the approximately 10% rate reported in the general population by retrospective medical record reviews. AE data that include patient experience may provide contextual information currently missing. Capturing and using patient experience data more effectively is critical; there may be opportunities for applying co-design methodology to improve the management of AEs and be more responsive to patients' concerns.
了解患者的住院体验对于改善医疗服务和政策至关重要，但人们对他们在不良事件（AE）中的体验知之甚少。本研究通过调查新南威尔士州医院中遭受 AE 的患者的经历，弥补了这一不足。
使用数据链接从 267153 名 45 岁及以上的成年人中随机抽取了 20000 名参加 45 岁及以上研究的参与者，这些成年人在过去 6 个月内住院治疗。对这些患者进行了横断面调查，以了解他们的经历，包括是否发生 AE 以及是否收到有关 AE 的诚实沟通。
在 18993 名合格参与者中，收到了 7661 份有效调查问卷（40%的回复率），其中 474 人（7%）报告发生了 AE。大多数 AE 与临床过程和程序（33%）或药物和静脉输液（21%）有关。出生地和通过急诊入院是事件发生的显著预测因素。在过去 6 个月内更早入院或转至另一家医疗机构也与更多 AE 相关。在遭受 AE 的患者中，58%报告有严重或中度影响。
鉴于我们的样本人群（<45 岁）存在排除情况，患者报告的 AE 发生率为 7%，与回顾性病历审查中报告的约 10%的普通人群发生率相似。包括患者体验在内的 AE 数据可能提供目前缺失的背景信息。更有效地收集和使用患者体验数据至关重要；可能有机会应用共同设计方法来改善 AE 的管理，并更能回应患者的关注。
