Rovati Lucrezia, Privitera Daniele, Finch Alexander S, Litell John M, Brogan Autumn M, Tekin Aysun, Castillo Zambrano Claudia, Dong Yue, Gajic Ognjen, Madsen Bo E
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Mayo Clinic, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 200 First Street SW, Rochester, 55905, USA.
Intern Emerg Med. 2024 Oct 1. doi: 10.1007/s11739-024-03760-y.
Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. A three-round modified Delphi consensus process was conducted with a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.
急诊科存在医疗差错的高风险。在其他高风险临床环境中，以及用于解决急诊护理的特定方面时，实施清单程序与改善患者预后相关。本研究的目的是制定一份适用于不同国际急诊科环境的急诊安全清单。对急诊医学和患者安全领域的多学科、多国专家小组进行了三轮改良德尔菲共识程序。通过系统的文献回顾确定了初始清单项目。在两轮基于网络的调查和一次在线共识会议期间，对每个项目进行评估以纳入最终清单。纳入的共识事先定义为合并同意率达到80%的阈值。来自世界七大区域34个国家的80名小组成员参与了该研究，低收入、中等收入和高收入国家有相当的代表性。最终清单包含86项，分为：（1）一份侧重于诊断评估、患者重新评估和处置的通用急诊安全清单，以及（2）五份侧重于交接班、侵入性操作、分诊、治疗处方和治疗给药的特定领域急诊安全清单。该清单包括预防医疗差错的关键临床任务，以及改善急诊团队成员之间以及与患者及其家属沟通的项目。这份新颖的急诊安全清单定义了高质量急诊护理的基本要素，并有可能确保其在全球范围内的一致实施。
