Griffey Richard T, Schneider Ryan M, Todorov Alexandre A
Jt Comm J Qual Patient Saf. 2020 Apr;46(4):192-198. doi: 10.1016/j.jcjq.2019.12.003. Epub 2020 Jan 18.
The emergency department (ED) is the natural venue for the provision of acute unscheduled care. However, little is known about the nature and proportion of this care that goes to addressing adverse events (AEs)-physical injury to a patient due to health care that requires some intervention-that are present on arrival (POA) to the ED. Described here are AEs that are POA, and population prevalence estimates for these events.
This retrospective observational study tested the ED Trigger Tool, using data from an urban academic medical center. Patients aged ≥18 completing an ED visit were eligible (N = 92,859). A total of 5,582 visits with triggers (findings that increase the likelihood of an AE) were reviewed using the two-tier trigger approach. AEs were categorized by severity, type, and whether they were POA. POA AEs, and sociodemographic and trigger associations with AEs are described.
Of 1,181 AEs identified, 718 (60.8%) were POA to the ED. Patients with POA AEs were more often white (51.1% vs. 39.7%, p < 0.001) and older (median age 62 vs. 50, p < 0.001). The majority of POA AEs were medication-related and patient care-related events. In the population at this center, POA AEs account for an estimated 7.6% of ED visits (95% confidence interval = 6.9%-8.2%).
In this single-center study, the majority of AEs detected using the ED Trigger Tool were POA. These findings highlight the importance of the ED as a safety net for harm occurring across the health system.
急诊科是提供急性非预约护理的自然场所。然而，对于在患者到达急诊科时就已存在的不良事件（即因医疗保健导致的需要某种干预的身体损伤），这种护理的性质和比例却知之甚少。本文描述了到达时即存在的不良事件以及这些事件在人群中的患病率估计。
这项回顾性观察研究使用了一家城市学术医疗中心的数据对急诊科触发工具进行测试。年龄≥18岁且完成急诊科就诊的患者符合条件（N = 92,859）。采用两层触发方法对总共5,582次有触发因素（增加不良事件可能性的发现）的就诊进行了审查。不良事件按严重程度、类型以及是否在到达时即存在进行分类。描述了到达时即存在的不良事件以及社会人口统计学因素和触发因素与不良事件的关联。
在识别出的1,181例不良事件中，718例（60.8%）在到达急诊科时即已存在。到达时即存在不良事件的患者更常为白人（51.1%对39.7%，p < 0.001）且年龄更大（中位年龄62岁对50岁，p < 0.001）。大多数到达时即存在的不良事件是与药物相关和与患者护理相关的事件。在该中心的人群中，到达时即存在的不良事件估计占急诊科就诊的7.6%（95%置信区间 = 6.9% - 8.2%）。
在这项单中心研究中，使用急诊科触发工具检测到的大多数不良事件在到达时即已存在。这些发现凸显了急诊科作为整个卫生系统中伤害安全网的重要性。
