Morsø Lars, Birkeland Søren, Walløe Sisse, Gudex Claire, Brabrand Mikkel, Mikkelsen Kim L, Bogh Søren Bie
Jt Comm J Qual Patient Saf. 2022 May;48(5):271-279. doi: 10.1016/j.jcjq.2022.01.010. Epub 2022 Feb 2.
The Healthcare Complaints Analysis Tool (HCAT) offers a validated way of systematically extracting content from patient complaints for further analysis of complaint hot spots with harm or near misses, and blind spots with, for example, systemic problems or quality problems arising during discharge. This study analyzed a Danish national sample of compensations claims about emergency care using the HCAT.
Through use of the HCAT, compensation claims about Danish emergency care from 2013 to 2017 (N = 712) were coded and then grouped to identify and highlight hot spot problem areas (harm and near misses) and blind spot problem areas (admission/discharge, systemic problems, errors of omission). Two assessors coded the compensation claims by entering data into a database.
The HCAT analyses of the sample resulted in coding of 1,305 problems. Most problems concerned quality and safety issues at the examination/diagnosis stage of care (63.9%). In 91.2% of the cases, the level of harm was moderate or major. Harm hot spots most often involved diagnostic errors (189 problems). Eighty-nine problems related to errors of omission, all causing moderate or major harm. For systemic blind spots, patient harm significantly increased in cases of multiple problem types in the compensation claim (odds ratio = 1.6, 95% confidence interval = 1.3-2.0).
Systematic coding and analytic approach to the HCAT can highlight potential quality problems in emergency care and point to areas for further consideration. From the perspective of future health care harm prevention, there seems to be a strong incentive for further analysis of the amount, nature, and prevention of diagnostic errors in emergency care.
医疗投诉分析工具（HCAT）提供了一种经过验证的方法，可系统地从患者投诉中提取内容，以便进一步分析存在伤害或险些发生伤害情况的投诉热点，以及例如出院期间出现的系统问题或质量问题等盲点。本研究使用HCAT分析了丹麦全国范围内关于急诊护理的赔偿索赔样本。
通过使用HCAT，对2013年至2017年丹麦急诊护理的赔偿索赔（N = 712）进行编码，然后分组以识别和突出热点问题领域（伤害和险些发生伤害情况）和盲点问题领域（入院/出院、系统问题、漏诊错误）。两名评估人员通过将数据输入数据库对赔偿索赔进行编码。
对样本进行的HCAT分析产生了1305个问题的编码。大多数问题涉及护理检查/诊断阶段的质量和安全问题（63.9%）。在91.2%的案例中，伤害程度为中度或重度。伤害热点最常涉及诊断错误（189个问题）。89个问题与漏诊错误有关，均造成中度或重度伤害。对于系统性盲点，在赔偿索赔中存在多种问题类型的情况下，患者伤害显著增加（优势比 = 1.6，95%置信区间 = 1.3 - 2.0）。
HCAT的系统编码和分析方法可以突出急诊护理中潜在的质量问题，并指出需要进一步考虑的领域。从未来预防医疗伤害的角度来看，似乎有强烈的动机进一步分析急诊护理中诊断错误的数量、性质和预防措施。
