From the Departments of Emergency Medicine.
Psychiatry, Washington University School of Medicine, St Louis, Missouri.
J Patient Saf. 2023 Mar 1;19(2):59-66. doi: 10.1097/PTS.0000000000001092. Epub 2023 Jan 7.
Near misses include conditions with potential for harm, intercepted medical errors, and events requiring monitoring or intervention to prevent harm. Little is reported on near misses or their importance for quality and safety in the emergency department (ED).
This is a secondary evaluation of data from a retrospective study of the ED Trigger Tool (EDTT) at an urban, academic ED (data from October 1, 2014, to October 31, 2015; 92,859 eligible visits). All patients 18 years and older completing a visit were eligible. We ran the EDTT, a computerized query for triggers on 13 months of ED visit data, reviewing 5582 selected records using a 2-tiered approach. Events were categorized by occurrence (ED vs present on arrival [POA]), severity, omission/commission, and type, using a taxonomy with categories, subcategories, and cross-cutting modifiers.
We identified 1458 ED near misses in 1269 of 5582 records (22.7%) and 80 near misses that were POA. Patient care events represented most ED near misses, including delays in diagnosis, treatment, and failure to monitor, primarily driven by ED boarding and crowding. Medication events were second most common (17%), including 80 medication administration errors. Of 80 POA events, 42% were related to overanticoagulation. We estimate that 19.3% of all ED visits include a near miss.
Near-miss events are relatively common (22.7% of our sample, 19.3% in the population) and are associated with an increased risk for an adverse event. Most events were patient care related (77%) involving delays due to crowding and ED boarding followed by medication administration errors. The EDTT is a high-yield approach for detecting important near misses and latent system deficiencies that impact patient safety.
接近失误包括有潜在伤害风险的情况、被拦截的医疗差错，以及需要监测或干预以防止伤害的事件。在急诊科（ED）中，接近失误及其对质量和安全的重要性报告很少。
这是对城市学术 ED 的 EDTriggerTool（EDTT）回顾性研究数据的二次评估（数据来自 2014 年 10 月 1 日至 2015 年 10 月 31 日；92859 名符合条件的就诊者）。所有 18 岁及以上完成就诊的患者均符合条件。我们运行 EDTT，这是一种针对 13 个月 ED 就诊数据的触发查询，使用两级方法审查 5582 份选定记录。使用具有类别、子类别和交叉修改符的分类法，根据发生情况（ED 与到达时存在[POA]）、严重程度、遗漏/委员会和类型对事件进行分类。
我们在 5582 份记录中的 1269 份记录中确定了 1458 例 ED 接近失误，其中 80 例为 POA。患者护理事件代表了大多数 ED 接近失误，包括诊断、治疗和监测延误，主要由 ED 留滞和拥挤造成。药物事件是第二常见的（17%），包括 80 例药物管理错误。在 80 例 POA 事件中，42%与过度抗凝有关。我们估计，19.3%的 ED 就诊者存在接近失误。
接近失误事件相对常见（我们样本的 22.7%，人群中的 19.3%），与不良事件的风险增加相关。大多数事件与患者护理有关（77%），涉及由于拥挤和 ED 留滞导致的延误，其次是药物管理错误。EDTT 是一种高收益的方法，可用于检测重要的接近失误和影响患者安全的潜在系统缺陷。
