初级保健中测量和监测安全性的方法的荟萃评价。

A meta-review of methods of measuring and monitoring safety in primary care.

机构信息

Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.

Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland.

出版信息

Int J Qual Health Care. 2021 Aug 28;33(3). doi: 10.1093/intqhc/mzab117.

DOI:10.1093/intqhc/mzab117

PMID:34405231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8397923/

Abstract

BACKGROUND

A major barrier to safety improvement in primary care is a lack of safety data. The aims of this systematic meta-review (registration: CRD42021224367) were to identify systematic reviews of studies that examine methods of measuring and monitoring safety in primary care; classify the methods of measuring and monitoring safety in the included systematic reviews using the five safety domains of Vincent et al.'s framework and use this information to make recommendations for improving the measurement and monitoring of safety in primary care.

METHODS

Four databases (Medline, Academic Search Complete, Web of Science and CINAHL) and the grey literature were screened in November 2020, with searches updated in January 2021. Systematic reviews were included if they addressed the measurement of patient safety in primary care and were published in English. Studies were assessed using the Critical Appraisal Skills Programme for systematic reviews.

RESULTS

A total of 6904 papers were screened, with 13 systematic reviews included. A commonly reported method of measuring 'past harm' was through patient record review. The most frequent methods for assessing the 'reliability of safety critical processes' were checklists, observations and surveys of staff. Methods used to assess 'sensitivity to operations' included observation, staff surveys, interviews, focus groups, active monitoring and simulated patients. Safety climate surveys were a commonly used as an approach to assess 'anticipation and preparedness'. A number of the reviews concluded that safety data could, and should, be used for 'integration and learning'. The main limitation of the meta-review was that it was of systematic reviews only.

CONCLUSIONS

Many of the methods for measuring and monitoring safety are readily available, quick to administer, do not require external involvement and are inexpensive. However, there is still a need to improve the psychometric properties of many measures. Researchers must support the development of psychometrically sound safety measures that do not over burden primary care practitioners. Policymakers must consider how primary care practitioners can be supported to implement these measures.

摘要

背景

初级保健中安全改进的一个主要障碍是缺乏安全数据。本系统综述的目的（注册：CRD42021224367）是确定系统地审查研究初级保健安全测量和监测方法的综述；使用 Vincent 等人的框架的五个安全领域对纳入系统综述的安全测量和监测方法进行分类，并利用这些信息为改进初级保健安全的测量和监测提出建议。

方法

2020 年 11 月筛选了四个数据库（Medline、Academic Search Complete、Web of Science 和 CINAHL）和灰色文献，并于 2021 年 1 月更新了搜索。如果综述涉及初级保健患者安全的测量且以英文发表，则纳入系统综述。使用系统评价的批判性评估技能计划对研究进行评估。

结果

共筛选了 6904 篇论文，纳入了 13 篇系统综述。报告测量“过去伤害”的常用方法是通过病历审查。评估“安全关键流程可靠性”最常用的方法是检查表、观察和员工调查。用于评估“对操作的敏感性”的方法包括观察、员工调查、访谈、焦点小组、主动监测和模拟患者。安全氛围调查是评估“预测和准备”的常用方法。许多评论得出的结论是，安全数据可以而且应该用于“整合和学习”。元综述的主要限制是它仅为系统综述。