Petersen L A, Orav E J, Teich J M, O'Neil A C, Brennan T A
Career Development Award Program, Veterans Affairs Health Services Research and Development Service, Brockton/West Roxbury Veterans Affairs Medical Center, Massachusetts 02132, USA.
Jt Comm J Qual Improv. 1998 Feb;24(2):77-87. doi: 10.1016/s1070-3241(16)30363-7.
Many medical injuries are preventable, but there are few reported successful strategies to prevent such injuries. Previous work identified coverage by house staff not primarily responsible for the patient (cross-coverage) as a significant correlate of risk for preventable adverse events. A four-month intervention--computerized sign-outs--was introduced in 1993 in an urban teaching hospital to improve continuity of care during cross-coverage and thereby reduce risk for preventable adverse events.
A previously tested confidential self-report system was used to identify adverse events, which were defined as unexpected complications of medical therapy that resulted in increased length of stay or disability at discharge. A panel of three board-certified internists confirmed events and evaluated preventability based on case summaries.
After the intervention, the rate of preventable adverse events among the 3,747 patients admitted to the medical service decreased from 1.7% to 1.2% (p < 0.10). Both univariate and multivariate analysis revealed no association between cross coverage and preventable adverse events after the intervention. In the baseline period, the odds ratio (OR) for a patient suffering a preventable adverse event during cross coverage was 5.2 (95% confidence interval [CI], 1.5-18.2; p = 0.01), but was no longer significant after the intervention (OR, 1.5; 95% CI, 0.2-9.0).
House staff are willing participants in efforts to measure and improve the quality of health care systems. The intervention may have reduced the risk for medical injury associated with discontinuity of inpatients care. Four years after the end of the study, the computerized sign-out program remained an integral part of the computing support system for house staff and was widely used.
许多医疗伤害是可以预防的，但鲜有成功预防此类伤害的策略被报道。此前的研究发现，由并非主要负责该患者的住院医生进行的交叉查房是可预防不良事件风险的一个重要相关因素。1993年，一家城市教学医院引入了一项为期四个月的干预措施——计算机化交班，以改善交叉查房期间的护理连续性，从而降低可预防不良事件的风险。
采用一个先前经过测试的保密自我报告系统来识别不良事件，不良事件被定义为医疗治疗中导致住院时间延长或出院时出现残疾的意外并发症。由三名获得董事会认证的内科医生组成的小组对事件进行确认，并根据病例摘要评估可预防性。
干预后，入住内科的3747名患者中可预防不良事件的发生率从1.7%降至1.2%（p<0.10）。单因素和多因素分析均显示，干预后交叉查房与可预防不良事件之间无关联。在基线期，患者在交叉查房期间发生可预防不良事件的优势比（OR）为5.2（95%置信区间[CI]，1.5 - 18.2；p = 0.01），但干预后不再显著（OR，1.5；95%CI，0.2 - 9.0）。
住院医生愿意参与衡量和改善医疗保健系统质量的工作。该干预措施可能降低了与住院患者护理不连续相关的医疗伤害风险。研究结束四年后，计算机化交班程序仍是住院医生计算支持系统的一个组成部分，并被广泛使用。
