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约翰内斯堡学术性急诊科不良事件的报告

The reporting of adverse events in Johannesburg Academic Emergency Departments.

作者信息

Zoghby Matthew Gabriel, Hoffman Deidre, Mahomed Zeyn

机构信息

Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg 2193, South Africa.

出版信息

Afr J Emerg Med. 2021 Mar;11(1):207-210. doi: 10.1016/j.afjem.2020.10.005. Epub 2020 Nov 7.

Abstract

INTRODUCTION

Adverse events (AE) are a common occurrence in healthcare systems; however, the frequency of AEs occurring in South Africa and especially Emergency Departments (ED) is unknown. The aims of this study were to describe the frequency of AEs experienced by Healthcare providers (HCP) and the frequency of formal reporting thereafter over a 12-month period.

METHODS

A cross sectional descriptive study was performed amongst HCPs at Helen Joseph Hospital and Chris Hani Baragwanath Academic Hospital EDs. The questionnaire incorporated ED relevant AEs using the South African National Procedural Manual for Patient Safety Incident Reporting and Learning.

RESULTS

The questionnaires from 51 doctors and 49 nurses were analysed. All HCPs experienced >10 AEs over 1 year. Nurses were 21 times more likely than doctors to report >10 AEs (p < 0.001). Twenty four percent of AEs experienced were deemed to be minor, very minor or not adverse.

CONCLUSION

There are low levels of formal AE reporting, especially amongst doctors, within Johannesburg Academic EM Departments despite large numbers of AEs experienced. There are multiple barriers, which influence these reporting practices. Improved reporting systems are needed to affect a change in the current environment.

摘要

引言

不良事件(AE)在医疗系统中很常见;然而,南非尤其是急诊科(ED)发生不良事件的频率尚不清楚。本研究的目的是描述医疗服务提供者(HCP)经历的不良事件频率以及之后12个月内正式报告的频率。

方法

在海伦·约瑟夫医院和克里斯·哈尼·巴拉干纳特学术医院急诊科对医疗服务提供者进行了横断面描述性研究。问卷采用《南非国家患者安全事件报告与学习程序手册》纳入了与急诊科相关的不良事件。

结果

分析了51名医生和49名护士的问卷。所有医疗服务提供者在1年内都经历了超过10起不良事件。护士报告超过10起不良事件的可能性是医生的21倍(p < 0.001)。所经历的不良事件中有24%被认为是轻微、非常轻微或无不良影响的。

结论

尽管约翰内斯堡学术急诊部门经历了大量不良事件,但正式不良事件报告水平较低,尤其是在医生中。存在多种影响这些报告行为的障碍。需要改进报告系统以改变当前环境。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be38/7910192/371cdc110d2a/gr1.jpg

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