Radboud University Medical Center, Institute of Quality Assurance and Patient Safety, PO Box 9101 (internal code 628), Nijmegen, the Netherlands.
Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Int J Qual Health Care. 2019 Aug 1;31(7):8-15. doi: 10.1093/intqhc/mzy134.
To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety.
DESIGN, SETTING AND PARTICIPANTS: A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands.
INTERVENTION(S): Internal auditing and feedback focussed on improving patient safety.
MAIN OUTCOME MEASURE(S): The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety.
The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P < 0.001). The SMR, patient safety culture and team climate remained unchanged after the internal audit. The SWRs showed that medication safety and information security were improved (P < 0.05).
Internal auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit.
评估以提高患者安全为重点的医院护理内部审计的效果。
设计、设置和参与者：在荷兰一所大学医学中心的 8 个部门进行了一项前后混合方法评估研究。
内部审计和反馈重点关注提高患者安全。
使用线性混合模型，在内部审计后 15 个月，在患者、专业人员、团队和部门层面评估内部审计的效果。测量方法包括对不良事件（AE）的患者记录审查、关于患者体验、安全文化和团队氛围的调查、对医院行政数据（标准化死亡率，SMR）的分析和安全巡视（SWRs），以观察安全前线护理过程。
AE 发生率从 36.1%下降至 31.3%，可预防 AE 发生率从 5.5%下降至 3.6%；然而，审计前后的差异没有统计学意义。患者报告的关于患者安全的体验措施随着时间的推移略有改善（P<0.001）。SMR、患者安全文化和团队氛围在内部审计后保持不变。SWRs 显示药物安全和信息安全得到了改善（P<0.05）。
内部审计与改善患者体验和病房观察到的安全有关。内部审计后 15 个月，不良结果、安全文化和团队氛围没有变化。
