From the Department of Critical Care Medicine.
Department of Community Health Sciences & O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Patient Saf. 2021 Dec 1;17(8):e1285-e1295. doi: 10.1097/PTS.0000000000000889.
This study aimed to estimate the frequency of hospital adverse events (AEs) and explore the rate of AEs over time, and across and within hospital populations.
Validated search terms were run in MEDLINE and EMBASE; gray literature and references of included studies were also searched. Studies of any design or language providing an estimate of AEs within the hospital were eligible. Studies were excluded if they only provided an estimate for a specific AE, a subgroup of hospital patients or children. Data were abstracted in duplicate using a standardized data abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis estimated the occurrence of hospital AEs, and meta-regression explored the association between hospital AEs, and patient and hospital characteristics.
A total of 45,426 unique references were identified; 1,265 full-texts were reviewed and 94 studies representing 590 million admissions from 25 countries from 1961 to 2014 were included. The incidence of hospital AEs was 8.6 per 100 patient admissions (95% confidence interval [CI], 8.3 to 8.9; I2 = 100%, P < 0.001). Half of the AEs were preventable (52.6%), and a third resulted in moderate/significant harm (39.7%). The most evaluated AEs were surgical AEs, drug-related AEs, and nosocomial infections. The occurrence of AEs increased by year (95% CI, -0.05 to -0.04; P < 0.001) and patient age (95% CI = -0.15 to -0.14; P < 0.001), and varied by country income level and study characteristics. Patient sex, hospital type, hospital service, and geographical location were not associated with AEs.
Hospital AEs are common, and reported rates are increasing in the literature. Given the increase in AEs over time, hospitals should reinvest in improving hospital safety with a focus on interventions targeted toward the more than half of AEs that are preventable.
本研究旨在估计医院不良事件（AE）的发生频率，并探讨其随时间变化的发生率，以及在医院人群中的分布情况。
在 MEDLINE 和 EMBASE 中使用经过验证的检索词进行检索；还检索了纳入研究的灰色文献和参考文献。符合条件的研究为任何设计或语言，提供了医院内 AE 估计值。如果研究仅提供特定 AE、特定医院患者亚组或儿童的估计值，则将其排除在外。使用标准化数据提取表格对数据进行了重复提取。使用纽卡斯尔-渥太华量表评估研究质量。采用随机效应荟萃分析估计医院 AE 的发生情况，并进行荟萃回归以探讨医院 AE 与患者和医院特征之间的关系。
共确定了 45426 个独特的参考文献；对 1265 篇全文进行了审查，纳入了来自 25 个国家的 94 项研究，这些研究共涉及 5.9 亿例住院患者，时间跨度为 1961 年至 2014 年。医院 AE 的发生率为每 100 例患者住院 8.6 例（95%置信区间[CI]：8.3 至 8.9；I2=100%，P<0.001）。一半的 AE 是可以预防的（52.6%），三分之一导致中度/显著伤害（39.7%）。评价最多的 AE 是手术 AE、药物相关 AE 和医院获得性感染。AE 的发生随着时间的推移（95%CI：-0.05 至 -0.04；P<0.001）和患者年龄（95%CI：-0.15 至 -0.14；P<0.001）而增加，且因国家收入水平和研究特征而异。患者性别、医院类型、医院服务和地理位置与 AE 无关。
医院 AE 很常见，且文献报道的发生率呈上升趋势。鉴于 AE 随时间的增加，医院应重新投资于改善医院安全，重点关注针对一半以上可预防 AE 的干预措施。
