在已使用医院电子病历系统的环境中实施重症监护信息系统后医疗差错的减少：回顾性分析

The Reduction in Medical Errors on Implementing an Intensive Care Information System in a Setting Where a Hospital Electronic Medical Record System is Already in Use: Retrospective Analysis.

作者信息

Seino Yusuke, Sato Nobuo, Idei Masafumi, Nomura Takeshi

机构信息

Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan.

Department of Anesthesiology and Intensive Care Medicine, Yokohama City University, Yokohama, Japan.

出版信息

JMIR Perioper Med. 2022 Aug 31;5(1):e39782. doi: 10.2196/39782.

DOI:10.2196/39782

PMID:35964333

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9475405/

Abstract

BACKGROUND

Although the various advantages of clinical information systems in intensive care units (ICUs), such as intensive care information systems (ICISs), have been reported, their role in preventing medical errors remains unclear.

OBJECTIVE

This study aimed to investigate the changes in the incidence and type of errors in the ICU before and after ICIS implementation in a setting where a hospital electronic medical record system is already in use.

METHODS

An ICIS was introduced to the general ICU of a university hospital. After a step-by-step implementation lasting 3 months, the ICIS was used for all patients starting from April 2019. We performed a retrospective analysis of the errors in the ICU during the 6-month period before and after ICIS implementation by using data from an incident reporting system, and the number, incidence rate, type, and patient outcome level of errors were determined.

RESULTS

From April 2018 to September 2018, 755 patients were admitted to the ICU, and 719 patients were admitted from April 2019 to September 2019. The number of errors was 153 in the 2018 study period and 71 in the 2019 study period. The error incidence rates in 2018 and 2019 were 54.1 (95% CI 45.9-63.4) and 27.3 (95% CI 21.3-34.4) events per 1000 patient-days, respectively (P<.001). During both periods, there were no significant changes in the composition of the types of errors (P=.16), and the most common type of error was medication error.

CONCLUSIONS

ICIS implementation was temporally associated with a 50% reduction in the number and incidence rate of errors in the ICU. Although the most common type of error was medication error in both study periods, ICIS implementation significantly reduced the number and incidence rate of medication errors.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000041471; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047345.

摘要

背景

尽管已有报道称重症监护病房（ICU）中的临床信息系统，如重症监护信息系统（ICIS）具有诸多优势，但其在预防医疗差错方面的作用仍不明确。

目的

本研究旨在调查在已使用医院电子病历系统的环境中，ICIS实施前后ICU中差错的发生率和类型变化。

方法

一所大学医院的综合ICU引入了ICIS。经过为期3个月的逐步实施后，自2019年4月起，所有患者均使用该ICIS。我们利用事件报告系统的数据，对ICIS实施前后6个月期间ICU中的差错进行回顾性分析，并确定差错的数量、发生率、类型和患者结局水平。

结果

2018年4月至2018年9月，755例患者入住ICU，2019年4月至2019年9月，719例患者入住ICU。2018年研究期间差错数量为153例，2019年研究期间为71例。2018年和2019年的差错发生率分别为每1000患者日54.1（95%CI 45.9 - 63.4）次和27.3（95%CI 21.3 - 34.4）次（P <.001）。在两个时期内，差错类型的构成均无显著变化（P = 0.16），最常见的差错类型为用药差错。