Maeda Yoshitaka, Inaba Hiromi, Sato Naganori, Suzuki Tomoko, Ohshima Mizuho, Tomimitsu Hiroyuki
Safety Control Section, JA Toride Medical Center, Japan.
J Rural Med. 2024 Oct;19(4):305-309. doi: 10.2185/jrm.2023-041. Epub 2024 Oct 1.
Safety reports are core components of secure medical systems, but their significance have remained obscure, mostly owing to limited quantitative approaches other than the numbers of reports. In 2005, we developed "management levels" and their equally converted points (p) of scores, which indicated the grades of required correspondences of medical systems. Moreover, products of those scores multiplied by risk levels (equally converted scores), "total scores" were also proposed for weighting harmful events from biphasic aspects; severity of patient damage and the required levels of correspondence as medical systems. In this study, we assessed this scoring system using extensive longitudinal experience.
Risk, management and total scores were retrospectively surveyed between 2012 and 2022 when a consistent reporting system had worked throughout the study period.
The aforementioned three scores inconsistently decreased along with a decrease in number of safety reports from 2,445 to 1,194 cases, or 2,069 to 1,052 cases/10 admitted patients (c/pap) in eleven years. Of the scores, the most prominent decrease was found in the management scores from 2,164 to 1,070 points/pap (p/pap). The risk and total scores had decreased even more modestly: from 1,879 to 1,484 p/pap, and 5,470 to 4,007 p/pap, respectively. When compared with the proportion (%) of risk and management levels in 2012, risk level 0 decreased, and risk level 1 and 3a increased in 2022. However, the proportion of management levels did not change during this period.
The proposed scoring system showed that the cumulative severity of patient damage did not worsen, or decrease in some years accompanied by decreasing correspondence levels of the medical system, although the numbers of reports also decreased. These findings show the appropriateness of the on-going safety activities of this hospital even when restricted to reported events. However, their effectiveness including unreported events, requires further study.
安全报告是安全医疗系统的核心组成部分，但其重要性一直不明确，主要是因为除了报告数量之外，定量方法有限。2005年，我们开发了“管理级别”及其等效转换分数（p），用于表示医疗系统所需对应等级。此外，还提出将这些分数与风险级别（等效转换分数）相乘的“总分”，以便从两个方面权衡有害事件：患者损害的严重程度以及作为医疗系统所需的对应级别。在本研究中，我们利用广泛的纵向经验对该评分系统进行了评估。
在2012年至2022年期间进行回顾性调查，研究期间一直采用统一的报告系统。
上述三个分数随着安全报告数量的减少而不一致地下降，从2445例降至1194例，或在11年中从2069例降至1052例/每10名入院患者（c/pap）。在这些分数中，管理分数下降最为显著，从2164分/pap降至1070分/pap（p/pap）。风险分数和总分下降幅度较小，分别从1879分/pap降至1484分/pap，以及从5470分/pap降至4007分/pap。与2012年风险和管理级别的比例（%）相比，2022年风险级别0下降，风险级别1和3a上升。然而，在此期间管理级别的比例没有变化。
所提出的评分系统表明，尽管报告数量减少，但患者损害的累积严重程度并未恶化，或在某些年份有所下降，同时医疗系统的对应水平也在下降。这些发现表明，即使仅限于报告的事件，该医院正在进行的安全活动也是适当的。然而，其包括未报告事件在内的有效性，还需要进一步研究。
