Department of Emergency Medicine, Onze Lieve Vrouwe Gasthuis.
Department of Emergency Medicine, Amsterdam University Medical Center, Amsterdam.
Eur J Emerg Med. 2019 Oct;26(5):350-355. doi: 10.1097/MEJ.0000000000000572.
Over the past two decades, several quality improvement projects have been implemented in emergency departments (EDs) in the Netherlands, one of these being the training and deployment of emergency physicians. In this study we aim to perform a trend analysis of ED quality of care in Dutch hospitals, as measured by the incidence of medical malpractice claims.
We performed a multicentre retrospective cohort study of malpractice claims in five Dutch EDs over the period 1998-2014. Incidence risk ratios were calculated to demonstrate any relation of specific quality improvement initiatives with the primary outcome, defined as the number of claims per 10 000 ED visits per year.
During the study period, the cumulative number of ED visits increased significantly from 99 145 in 1998 to 162 490 in 2014 (P < 0.01). In total, 228 of 2 348 417 ED visits (0.97 per 10 000) resulted in a malpractice claim. At the same time, the yearly number of ED claims filed decreased with 0.07 (0.03-0.10) per 10 000 each year. The claim rate was higher in the period before emergency physicians were employed in the ED [1.18 (0.98-1.41) claims per 10 000 visits] compared with the period after they were employed [0.81 (0.67-0.97), incidence risk ratio 0.69 (0.53-0.89), P < 0.01].
Even though the number of ED visits increased significantly over the past two decades, the number of malpractice claims filed after an ED visit decreased. Various quality improvement initiatives, including the training and employment of emergency physicians, may have contributed to the observed decrease in claims.
在过去的二十年中，荷兰的急诊科已经实施了多个质量改进项目，其中之一是培训和部署急诊医师。在这项研究中，我们旨在通过医疗事故索赔的发生率来分析荷兰医院急诊科的护理质量趋势。
我们对五家荷兰急诊科的医疗事故索赔进行了一项多中心回顾性队列研究，时间为 1998 年至 2014 年。计算发病率风险比，以证明特定质量改进举措与主要结果之间的关系，主要结果定义为每年每 10000 次急诊科就诊的索赔数。
在研究期间，急诊科就诊的累计次数从 1998 年的 99145 次显著增加到 2014 年的 162490 次（P<0.01）。总共有 228 次/2348417 次急诊科就诊（0.97/10000）导致医疗事故索赔。与此同时，每年提交的急诊科索赔数量每年减少 0.07（0.03-0.10）/10000。在急诊医师被聘用之前的时期，索赔率较高[1.18（0.98-1.41）/10000 次就诊]，而在他们被聘用之后的时期，索赔率较低[0.81（0.67-0.97），发病率风险比为 0.69（0.53-0.89），P<0.01]。
尽管在过去的二十年中急诊科就诊的人数显著增加，但就诊后的医疗事故索赔数量却有所减少。各种质量改进举措，包括急诊医师的培训和就业，可能促成了索赔数量的减少。
