Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
Department of Quality and Safety, Bradford Institute for Health Research, Bradford, UK.
BMJ Qual Saf. 2018 Sep;27(9):673-682. doi: 10.1136/bmjqs-2017-006974. Epub 2018 Mar 15.
Patient safety measurement remains a global challenge. Patients are an important but neglected source of learning; however, little is known about what patients can add to our understanding of safety. We sought to understand the incidence and nature of patient-reported safety concerns in hospital.
Feedback about the experience of safety within hospital was gathered from 2471 inpatients as part of a multicentre, waitlist cluster randomised controlled trial of an intervention, undertaken within 33 wards across three English NHS Trusts, between May 2013 and September 2014. Patient volunteers, supported by researchers, developed a classification framework of patient-reported safety concerns from a random sample of 231 reports. All reports were then classified using the patient-developed categories. Following this, all patient-reported safety concerns underwent a two-stage clinical review process for identification of patient safety incidents.
Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.
Our findings suggest that patients can provide insight about safety that complements existing patient safety measurement, with a frequency of reported patient safety incidents that is similar to those obtained via case note review. However, patients provide a unique perspective about hospital safety which differs from and adds to current definitions of patient safety incidents.
ISRCTN07689702; pre-results.
患者安全测量仍然是一个全球性的挑战。患者是一个重要但被忽视的学习来源；然而，我们对患者可以为我们对安全的理解增添什么知之甚少。我们试图了解医院中患者报告的安全问题的发生率和性质。
作为一项干预措施的多中心、候补名单集群随机对照试验的一部分，从 2471 名住院患者中收集了关于医院内安全体验的反馈意见，该试验于 2013 年 5 月至 2014 年 9 月在三个英国国民保健署信托基金的 33 个病房内进行。患者志愿者在研究人员的支持下，从 231 份报告的随机样本中制定了一个患者报告的安全问题分类框架。然后，使用患者开发的类别对所有报告进行分类。在此之后，所有患者报告的安全问题都经过了两阶段的临床审查过程，以确定患者安全事件。
在招募的 2471 名住院患者中，有 579 名患者提供了 1155 份患者报告的事件报告。报告分类制定了 14 个类别，其中沟通问题最为常见（22%），其次是人员配备问题（13%）和护理环境问题（12%）。根据标准定义，临床医生将 1155 份患者事件报告中的 406 份归类为患者安全事件。每 10 名患者中就有 1 名（264 名患者）发现了患者安全事件，其中药物错误是报告最多的事件。
我们的研究结果表明，患者可以提供有关安全的见解，补充现有的患者安全测量，报告的患者安全事件的频率与通过病历审查获得的频率相似。然而，患者提供了一个关于医院安全的独特视角，与当前患者安全事件的定义不同，并对其进行了补充。
ISRCTN07689702；预结果。
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