Murray Matthew, McCarthy Sally
Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.
Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
Emerg Med Australas. 2018 Jun;30(3):293-308. doi: 10.1111/1742-6723.12864. Epub 2017 Oct 11.
As in any part of the hospital system, safety incidents can occur in the ED. These incidents arguably have a distinct character, as the ED involves unscheduled flows of urgent patients who require disparate services. To aid understanding of safety issues and support risk management of the ED, a comparison of published ED specific incident classification frameworks was performed. A review of emergency medicine, health management and general medical publications, using Ovid SP to interrogate Medline (1976-2016) was undertaken to identify any type of taxonomy or classification-like framework for ED related incidents. These frameworks were then analysed and compared. The review identified 17 publications containing an incident classification framework. Comparison of factors and themes making up the classification constituent elements revealed some commonality, but no overall consistency, nor evolution towards an ideal framework. Inconsistency arises from differences in the evidential basis and design methodology of classifications, with design itself being an inherently subjective process. It was not possible to identify an 'ideal' incident classification framework for ED risk management, and there is significant variation in the selection of categories used by frameworks. The variation in classification could risk an unbalanced emphasis in findings through application of a particular framework. Design of an ED specific, ideal incident classification framework should be informed by a much wider range of theories of how organisations and systems work, in addition to clinical and human factors.
与医院系统的任何部门一样，急诊科也可能发生安全事件。这些事件可以说具有独特的性质，因为急诊科涉及需要不同服务的紧急患者的非计划就诊流程。为了帮助理解安全问题并支持急诊科的风险管理，我们对已发表的急诊科特定事件分类框架进行了比较。我们使用Ovid SP检索Medline（1976 - 2016年），对急诊医学、卫生管理和普通医学出版物进行了综述，以确定任何类型的与急诊科相关事件的分类法或类似分类框架。然后对这些框架进行了分析和比较。该综述确定了17篇包含事件分类框架的出版物。对构成分类组成要素的因素和主题进行比较后发现了一些共性，但没有整体的一致性，也没有朝着理想框架发展的趋势。不一致性源于分类的证据基础和设计方法的差异，而设计本身就是一个固有的主观过程。不可能为急诊科风险管理确定一个“理想”的事件分类框架，而且各框架所使用的类别选择存在很大差异。分类的差异可能会因应用特定框架而导致研究结果的重点失衡。除了临床和人为因素外，急诊科特定的理想事件分类框架的设计还应参考更广泛的关于组织和系统运作方式的理论。
