Department of Pediatrics, Division of Neonatology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
Owen Graduate School of Management, Vanderbilt University.
J Patient Saf. 2021 Dec 1;17(8):e694-e700. doi: 10.1097/PTS.0000000000000680.
The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)-events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation-in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room.
A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children's hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in 109 neonates were observed. The incidence and description of NREs were collected via structured researcher-administered survey tool of involved clinicians. Primary measurements included clinicians' ratings of NRE severity and contributory factors and trained research assistants' ratings of preventability.
One or more NREs were reported in 101 (78%) of 129 observed cases for 247 total NREs. Clinicians reported 2 (2) (median, interquartile range) NREs per NRE case with a maximum severity of 3 (1) (possible range = 1-5). Trained research assistants rated 47% of NREs as preventable and 11% as severe and preventable. The relative risks for National Surgical Quality Improvement Program - pediatric major morbidity and 30-day mortality were 1.17 (95% confidence interval = 0.92-1.48) and 1.04 (95% confidence interval = 1.00-1.08) in NRE cases versus non-NRE cases.
The incidence of NREs in neonatal perioperative care at an academic children's hospital was high and of variable severity with a myriad of contributory factors.
本研究旨在确定非计划性事件（NREs）的发生率、类型、严重程度、可预防性及其促成因素，这些事件是根据临床情况，由医护人员或熟练观察者认为是手术新生儿围手术期（即术前、术中和术后）护理中的偏离最佳护理的情况。
本前瞻性观察性研究纳入了在城市学术儿童医院接受围手术期新生儿重症监护病房和手术室护理的非心脏手术新生儿，研究时间为 2016 年 11 月 1 日至 2018 年 3 月 31 日。共观察了 109 例新生儿的 129 例手术病例。通过涉及临床医生的结构化研究人员管理的调查工具收集 NRE 的发生率和描述。主要测量指标包括临床医生对 NRE 严重程度和促成因素的评估，以及经过培训的研究助理对可预防性的评估。
在观察到的 129 例病例中，有 101 例（78%）报告了 1 个或多个 NRE，共发生 247 例 NRE。临床医生报告每例 NRE 事件发生 2 次（中位数，四分位间距），NRE 事件的最大严重程度为 3 次（1 次）（可能范围= 1-5）。经过培训的研究助理评估了 47%的 NRE 是可预防的，11%的 NRE 是严重且可预防的。在 NRE 病例与非-NRE 病例中，国家外科质量改进计划-儿科主要发病率和 30 天死亡率的相对风险分别为 1.17（95%置信区间= 0.92-1.48）和 1.04（95%置信区间= 1.00-1.08）。
学术儿童医院围手术期新生儿护理中 NRE 的发生率很高，严重程度不一，且有多种促成因素。
