Vanderbilt University Medical Center, Nashville, TN, USA.
The University of Texas Health Science Center at Houston, TX, USA.
Stud Health Technol Inform. 2022 Jun 6;290:359-363. doi: 10.3233/SHTI220096.
Non-routine events (NREs) are any aspect of care perceived by clinicians as a deviation from optimal care. The reporting of NREs to peers (or care teams) may help healthcare organizations improve patient safety in high-risk work environments (e.g., surgery). While various factors, including care structure and organizational factors may influence a clinician's NRE reporting behavior, their role has not been systematically studied. We conducted a retrospective study relying on NREs and electronic health records to determine if perioperative interaction structures among clinicians are associated with the frequency of NRE reporting in a large academic medical center. The data covers November 1, 2016, to January 31, 2019 and includes 295 perioperative clinicians, 225 neonatal surgical cases, and 543 NREs. Using network analysis, we measured a clinician's status in interaction structures according to the sociometric factors of degree, betweenness, and eigenvector centrality. We applied a proportional odds model to measure the relationship between each sociometric factor and NRE reporting frequency. Our findings indicate that the centrality of clinicians is directly associated with the quantity of NREs per surgical case.
非例行事件（NREs）是临床医生认为偏离最佳护理的任何护理方面。向同行（或护理团队）报告 NRE 可能有助于医疗保健组织改善高风险工作环境（例如手术）中的患者安全。虽然包括护理结构和组织因素在内的各种因素可能会影响临床医生的 NRE 报告行为，但他们的作用尚未得到系统研究。我们进行了一项回顾性研究，依赖 NRE 和电子健康记录来确定临床医生之间的围手术期相互作用结构是否与大型学术医疗中心 NRE 报告的频率相关。该数据涵盖了 2016 年 11 月 1 日至 2019 年 1 月 31 日，包括 295 名围手术期临床医生、225 例新生儿手术病例和 543 例 NRE。我们使用网络分析根据度、中介性和特征向量中心性的社会计量因素来衡量临床医生在相互作用结构中的地位。我们应用比例优势模型来衡量每个社会计量因素与 NRE 报告频率之间的关系。我们的研究结果表明，临床医生的中心性与每个手术病例中的 NRE 数量直接相关。
