系统医生交叉核对对减少急诊科不良事件的影响：CHARMED 集群随机试验。
Effect of Systematic Physician Cross-checking on Reducing Adverse Events in the Emergency Department: The CHARMED Cluster Randomized Trial.
机构信息
Sorbonne Université, Paris, France.
Emergency department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
出版信息
JAMA Intern Med. 2018 Jun 1;178(6):812-819. doi: 10.1001/jamainternmed.2018.0607.
IMPORTANCE
Emergency departments (ED) are environments that are at high risk for medical errors. Previous studies suggested that the proportion of medical errors may decrease when more than 1 physician is involved.
OBJECTIVE
To reduce the proportion of medical errors by implementing systematic cross-checking between emergency physicians.
DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized crossover trial includes a random sample of 14 adult patients (age ≥18 years) per day during two 10-day period in 6 EDs (n = 1680 patients) in France.
INTERVENTIONS
Systematic cross-checking between emergency physicians, 3 times a day, which included a brief presentation of one physician's case to another, followed by the second physician's feedback to the first.
MAIN OUTCOMES AND MEASURES
Medical error in the ED, defined as an adverse event (either a near miss or a serious adverse event). The primary end point was identified using a 2-level error detection surveillance system, blinded to the strategy allocation.
RESULTS
Among the 1680 included patients (mean [SD] age, 57.5 [21.7] years), 144 (8.6%) had an adverse event. There were 54 adverse events among 840 patients (6.4%) in the cross-check group compared with 90 adverse events among 840 patients (10.7%) in the standard care group (relative risk reduction [RRR], 40% [95% CI, 12% to 59%]; absolute risk reduction [ARR], 4.3%; number needed to treat [NNT], 24). There was also a significant reduction rate of near misses (RRR, 47% [95% CI, 15% to 67%]; ARR, 2.7%; NNT, 37) but not of the rate of preventable serious adverse events (RRR, 29% [95% CI, -18% to 57%]; ARR, 1.2%; NNT, 83).
CONCLUSIONS AND RELEVANCE
The implementation of systematic cross-checking between emergency physicians was associated with a significant reduction in adverse events, mainly driven by a reduction in near misses.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02356926.
重要性
急诊部（ED）是医疗失误风险较高的环境。先前的研究表明，当涉及多名医生时，医疗失误的比例可能会降低。
目的
通过在急诊医生之间实施系统的交叉核对来降低医疗失误的比例。
设计、地点和参与者：这项集群随机交叉试验包括法国 6 家急诊部（ED）在两个 10 天期间每天随机抽取的 14 名成年患者（年龄≥18 岁）（n=1680 名患者）。
干预措施
急诊医生之间每天进行 3 次系统的交叉核对，包括一名医生简要介绍另一名医生的病例，然后第二名医生向第一名医生反馈。
主要结果和测量指标
ED 中的医疗失误，定义为不良事件（包括接近失误或严重不良事件）。主要终点使用 2 级错误检测监测系统确定，对策略分配设盲。
结果
在纳入的 1680 名患者中（平均[标准差]年龄，57.5[21.7]岁），有 144 名（8.6%）发生了不良事件。交叉核对组中有 840 名患者（6.4%）发生 54 例不良事件，而标准护理组中有 840 名患者（10.7%）发生 90 例不良事件（相对风险降低[RRR]，40%[95%CI，12%至 59%]；绝对风险降低[ARR]，4.3%；需要治疗的人数[NNT]，24）。接近失误的发生率也显著降低（RRR，47%[95%CI，15%至 67%]；ARR，2.7%；NNT，37），但可预防的严重不良事件发生率并未降低（RRR，29%[95%CI，-18%至 57%]；ARR，1.2%；NNT，83）。
结论和相关性
在急诊医生之间实施系统的交叉核对与不良事件的显著减少相关，主要是由于接近失误的减少。
试验注册
ClinicalTrials.gov 标识符：NCT02356926。
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