Thurtle Danielle P, Daffron Sara B, Halvorson Elizabeth E
Department of Pediatrics, Wake Forest Shool of Medicine, Winston-Salem, North Carolina.
Department of Pediatrics, Wake Forest Shool of Medicine, Winston-Salem, North Carolina
Hosp Pediatr. 2019 Feb;9(2):134-138. doi: 10.1542/hpeds.2018-0142. Epub 2019 Jan 10.
Adverse events are increasingly important to health care delivery and financial reimbursement. Most hospitals use voluntary event reporting (VER) systems to detect safety events, which may be vulnerable to individual and systemic biases. We tested the hypothesis that patient demographic factors such as weight status and race would be associated with safety event reporting in the acute care setting.
We reviewed all acute care encounters for patients 2 to 17 years of age and corresponding safety events entered in the VER system of a tertiary-care children's hospital from February 2015 to February 2016. Data collected included patient demographics, clinical characteristics, incident description, and reported harm score. Our primary outcome was any report of a safety event. Using χ and multivariable logistical regression methods, we determined patient characteristics associated with safety event reporting.
A total of 22 056 patient encounters were identified, and 341 (1.5%) of those had a reported safety event. In univariate analysis, age, weight category, and race were found to be significantly associated with event reporting, whereas sex and insurance provider were not. In the multivariable logistic regression model, obesity (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.49-0.97) and African American race (OR 0.65; 95% CI 0.46-0.93) were negatively associated with event reporting, whereas length of stay was positively associated (OR 1.51; 95% CI 1.46-1.55).
We identified associations between patient demographic factors and voluntary safety event reporting in the acute care setting. In future studies, we will compare VER to event identification by more objective measures, such as a trigger tool.
不良事件对医疗服务提供和经济补偿的重要性日益凸显。大多数医院使用自愿事件报告(VER)系统来检测安全事件,而这些系统可能容易受到个体和系统偏差的影响。我们检验了这样一个假设,即在急性护理环境中,患者的人口统计学因素(如体重状况和种族)与安全事件报告相关。
我们回顾了2015年2月至2016年2月期间一家三级儿童医院VER系统中录入的所有2至17岁患者的急性护理诊疗情况及相应的安全事件。收集的数据包括患者人口统计学信息、临床特征、事件描述和报告的伤害评分。我们的主要结局是任何安全事件报告。使用χ检验和多变量逻辑回归方法,我们确定了与安全事件报告相关的患者特征。
共识别出22056例患者诊疗情况,其中341例(1.5%)有安全事件报告。在单变量分析中,发现年龄、体重类别和种族与事件报告显著相关,而性别和保险提供者则不然。在多变量逻辑回归模型中,肥胖(优势比[OR]0.69;95%置信区间[CI]0.49 - 0.97)和非裔美国人种族(OR 0.65;95% CI 0.46 - 0.93)与事件报告呈负相关,而住院时间呈正相关(OR 1.51;95% CI 1.46 - 1.55)。
我们在急性护理环境中确定了患者人口统计学因素与自愿安全事件报告之间的关联。在未来的研究中,我们将把VER与通过更客观的措施(如触发工具)进行的事件识别进行比较。