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医疗保健中的不良事件审查:患者及其家属关心什么?一项探索患者和家属观点的定性研究。

Adverse event reviews in healthcare: what matters to patients and their family? A qualitative study exploring the perspective of patients and family.

机构信息

Person Centred Care, NHS Education for Scotland West Region, Glasgow, UK

Intensive Care, Royal Infirmary of Edinburgh, Edinburgh, UK.

出版信息

BMJ Open. 2022 May 9;12(5):e060158. doi: 10.1136/bmjopen-2021-060158.

Abstract

OBJECTIVES

Explore what 'good' patient and family involvement in healthcare adverse event reviews may involve.

DESIGN

Data was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach.

SETTING

NHS Scotland.

PARTICIPANTS

19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare or their family member.

RESULTS

Four key themes were derived from these interviews: trauma, communication, learning and litigation.

CONCLUSIONS

There are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. This study suggests eight recommendations for involving patients and families in adverse event reviews using the APICCTHS model (table 3) which includes an apology, person-centred inclusive communication, closing the loop, timeliness, putting patients and families at the heart of the review with appropriate support for staff involved. Communicating in a compassionate manner could also decrease litigation claims following an adverse event.

摘要

目的

探讨患者和家属积极参与医疗不良事件审查可能涉及的内容。

设计

使用半结构化电话访谈收集数据。使用归纳主题分析方法对访谈记录进行分析。

地点

苏格兰国民保健署。

参与者

对在医疗保健过程中经历过不良事件的患者或其家属进行了 19 次访谈。

结果

从这些访谈中得出了四个关键主题:创伤、沟通、学习和诉讼。

结论

积极让患者及其家属参与不良事件审查有很多好处。人们认为,开放、协作、以患者为中心的方法,倾听并让患者及其家属参与其中,将导致更好的结果。对于患者及其家属来说,这有助于缓解创伤事件后的和解,并有助于恢复他们对医疗体系的信心。对于医疗服务机构而言,倾听和参与将有助于学习,随后改善医疗服务提供,并降低其他患者发生类似事件的风险。本研究提出了使用 APICCTHS 模型(表 3)让患者及其家属参与不良事件审查的八项建议,包括道歉、以患者为中心的包容性沟通、循环结束、及时性、将患者及其家属置于审查的核心并为相关工作人员提供适当的支持。以同情的方式进行沟通也可以减少不良事件后的诉讼索赔。

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