Department of General Internal Medicine, Inselspital, Bern University Hospital, Switzerland.
Department of General Medicine and Palliative Care, Lindenhofgruppe, Bern, Switzerland.
Swiss Med Wkly. 2019 Nov 10;149:w20149. doi: 10.4414/smw.2019.20149. eCollection 2019 Nov 4.
The purpose of the study was to describe the type, prevalence, severity and preventability of adverse events (AEs) that affected hospitalised medical patients. We used the previously developed and validated Global Trigger Tool from the Institute for Healthcare Improvement.
Using an adapted version of the Global Trigger Tool, we conducted a retrospective chart review of adult patients hospitalised in five medical wards at a university hospital in Switzerland. We reviewed a random sample of 20 patients’ charts for a total study period of 12 months (September 2016 to August 2017). Two trained nurses searched independently for triggers and possible AEs. All AEs were further validated by a senior physician. The number of triggers and AEs detected, as well as the severity and preventability of each, was assessed and analysed using descriptive statistics.
From a sample of 240 patient charts, we identified 1371 triggers and 336 AEs in 144 (60%) inpatients. This translates to an AE rate of 95.7 AEs per 1000 patient days. Most AEs (86.1%) caused temporary harm to the patient and required an intervention and/or prolonged hospitalisation. The estimated preventability of the in-hospital AEs was 29%. Healthcare-associated infections (25.8%) and neurological reactions (22.9%) were the most frequent AE types.
We found that about two thirds of patients suffered from AEs with harm during hospitalisation. It is common knowledge that AEs occur in hospitals and that they have potentially harmful consequences for patients, as well as a strong economic impact. However, to adequately prioritise patient safety interventions, it is essential to explore the nature, prevalence, severity and preventability of AEs. This is not only beneficial for the patients, but also cost effective in terms of shorter hospital stays.
本研究旨在描述影响住院内科患者的不良事件（AE）的类型、发生率、严重程度和可预防程度。我们使用了之前由医疗改善研究所开发和验证的全球触发工具。
使用经过改编的全球触发工具，我们对瑞士一所大学医院的五个内科病房的成年住院患者进行了回顾性病历审查。我们对 20 名患者的病历进行了随机抽样，总研究期为 12 个月（2016 年 9 月至 2017 年 8 月）。两名经过培训的护士独立搜索触发因素和可能的 AE。所有 AE 均由一名资深医生进一步验证。使用描述性统计方法评估和分析检测到的触发因素和 AE 的数量以及每个 AE 的严重程度和可预防程度。
从 240 份患者病历样本中，我们在 144 名住院患者（60%）中发现了 1371 个触发因素和 336 个 AE。这相当于每 1000 个患者日发生 95.7 个 AE。大多数 AE（86.1%）对患者造成暂时伤害，需要干预和/或延长住院时间。估计住院 AE 的可预防率为 29%。医疗保健相关感染（25.8%）和神经反应（22.9%）是最常见的 AE 类型。
我们发现，大约三分之二的患者在住院期间遭受了伤害性 AE。众所周知，AE 在医院中很常见，并且对患者有潜在的有害后果，同时也对经济产生了重大影响。然而，为了适当优先考虑患者安全干预措施，必须探讨 AE 的性质、发生率、严重程度和可预防程度。这不仅对患者有益，而且从缩短住院时间的角度来看也是具有成本效益的。
