Occelli Pauline, Quenon Jean-Luc, Kret Marion, Domecq Sandrine, Denis Angélique, Delaperche Florence, Claverie Olivier, Castets-Fontaine Benjamin, Amalberti René, Auroy Yves, Parneix Pierre, Michel Philippe
Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.
Health Services and Performance Research (EA 7425 HESPER), Université de Lyon 1, Lyon, France.
Int J Qual Health Care. 2019 Apr 1;31(3):212-218. doi: 10.1093/intqhc/mzy126.
To assess the impact of a vignette-based analysis of adverse events (AEs) on the safety climate (SC) of care units.
Prospective, open, cluster (a unit) randomised controlled trial.
Eighteen acute care units of seven hospitals in France.
Healthcare providers who worked in the units.
Vignette-based analyses of AEs were conducted with unit's providers once per month for six consecutive months. The AEs were real cases that occurred in other hospitals. The hospital risk manager conducted each analysis as follows: analysis of the immediate and root causes of the AE; assessment of the care unit's vulnerabilities and existing barriers in the occurrence of an identical AE and search for solutions.
SC was measured using the French version of the Hospital Survey on Patient Safety Culture questionnaire. The primary outcome was the difference in the 'Organisational learning and continuous improvement' dimension score, from before to after the analyses.
Median participation rate in the analyses was 20% (range: 7-45%). Before intervention, the response rate to the SC survey was 80% (n = 210) in the intervention group and 73% (n = 191) in the control group. After intervention, it was 59% (n = 141) and 63% (n = 148), respectively. The dimension score evolved differently for the groups from before to after intervention (intervention: +10.2 points ±8.8; control: -3.0 points ±8.5, P = 0.04). Side effects were not measured.
Vignette-based analysis was associated with the improvement of the perception of participants regarding their institution's capacity for organisational learning and continuous improvement.
评估基于案例的不良事件分析对护理单元安全氛围的影响。
前瞻性、开放性、整群（单元）随机对照试验。
法国七家医院的18个急性护理单元。
在这些单元工作的医护人员。
连续六个月每月一次与单元医护人员进行基于案例的不良事件分析。这些不良事件是其他医院发生的真实案例。医院风险管理人员按以下方式进行每次分析：分析不良事件的直接原因和根本原因；评估护理单元在发生相同不良事件时的脆弱性和现有障碍，并寻找解决方案。
使用法国版《患者安全文化医院调查问卷》测量安全氛围。主要结局是分析前后“组织学习与持续改进”维度得分的差异。
分析的中位参与率为20%（范围：7%-45%）。干预前，干预组安全氛围调查的回复率为80%（n = 210），对照组为73%（n = 191）。干预后，分别为59%（n = 141）和63%（n = 148）。干预前后两组维度得分变化不同（干预组：+10.2分±8.8；对照组：-3.0分±8.5，P = 0.04）。未测量副作用。
基于案例的分析与参与者对其机构组织学习和持续改进能力的认知改善有关。
