Department of Anaesthesiology and Intensive Care, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, 583 81, Linköping, Sweden.
BMC Psychiatry. 2020 Feb 4;20(1):44. doi: 10.1186/s12888-020-2447-2.
The vast majority of patient safety research has focused on somatic health care. Although specific adverse events (AEs) within psychiatric healthcare have been explored, the overall level and nature of AEs is sparsely investigated.
Cohort study using a retrospective record review based on a two-step trigger tool methodology in the charts of randomly selected patients 18 years or older admitted to the psychiatric acute care departments in all Swedish regions from January 1 to June 30, 2017. Hospital care together with corresponding outpatient care were reviewed as a continuum, over a maximum of 3 months. The AEs were categorised according to type, severity and preventability.
In total, the medical records of 2552 patients were reviewed. Among the patients, 50.4% were women and 49.6% were men. The median (range) age was 44 (18-97) years for women and 44.5 (18-93) years for men. In 438 of the reviewed records, 720 AEs were identified, corresponding to the AEs identified in 17.2% [95% confidence interval, 15.7-18.6] of the records. The majority of AEs resulted in less or moderate harm, and 46.2% were considered preventable. Prolonged disease progression and deliberate self-harm were the most common types of AEs. AEs were significantly more common in women (21.5%) than in men (12.7%) but showed no difference between age groups. Severe or catastrophic harm was found in 2.3% of the records, and the majority affected were women (61%). Triggers pointing at deficient quality of care were found in 78% of the records, with the absence of a treatment plan being the most common.
AEs are common in psychiatric care. Aside from further patient safety work, systematic interventions are also warranted to improve the quality of psychiatric care.
绝大多数患者安全研究都集中在躯体保健上。虽然已经探讨了精神保健中特定的不良事件（AE），但 AE 的总体水平和性质仍鲜有研究。
这是一项队列研究，使用回顾性记录审查，基于两步触发工具方法，对 2017 年 1 月 1 日至 6 月 30 日期间在瑞典所有地区的精神科急症病房随机选择的 18 岁或以上患者的图表进行分析。审查了医院护理和相应的门诊护理，时间最长为 3 个月。根据类型、严重程度和可预防程度对 AE 进行分类。
总共审查了 2552 名患者的病历。患者中，50.4%为女性，49.6%为男性。女性的中位（范围）年龄为 44（18-97）岁，男性为 44.5（18-93）岁。在审查的 438 份记录中，发现了 720 起 AE，占记录中 17.2%（95%置信区间，15.7-18.6）的 AE。大多数 AE 导致的伤害程度较轻或为中度，46.2%可预防。疾病进展延长和故意自残是最常见的 AE 类型。女性（21.5%）AE 发生率明显高于男性（12.7%），但不同年龄组之间无差异。在 2.3%的记录中发现了严重或灾难性的伤害，大多数受影响者为女性（61%）。在 78%的记录中发现了指向护理质量不足的触发因素，其中最常见的是缺乏治疗计划。
AE 在精神保健中很常见。除了进一步的患者安全工作外，还需要系统干预来提高精神保健的质量。
