本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2063

摘要内容如下：

背景

尽管相当重视提供安全护理，但还是发生了严重的患者伤害。尽管大多数护理发生在门诊环境中，但对门诊不良事件（AE）的了解仍然有限。

客观

测量门诊环境中的不良事件。

设计

电子健康档案（EHR）的回顾性审查。

设置

2018年马萨诸塞州的11个门诊站点。

病人

3103名接受门诊治疗的患者。

测量

使用触发方法，护士审查员确定可能的不良事件，医生对其进行判定，对严重程度进行分级，并评估可预防性。广义估计方程用于评估至少1例不良事件与年龄、性别、种族和主要保险之间的关系。分析了不同地点的不良事件发生率的变化。

结果

3103名患者（平均年龄52岁）通常为女性（59.8%）、白人（75.1%）、英语使用者（90.8%）和私人保险（70.4%），2018年平均有4次门诊就诊。总体而言，7.0%（95%CI，4.6%至9.3%）的患者至少有1次不良事件（每年每100名患者8.6次事件）。药物不良事件是最常见的不良事件（63.8%），其次是卫生保健相关感染（14.8%）和手术或程序事件（14.2%）。17.4%的不良事件严重，2.1%危及生命，从未致命。总体而言，23.2%的不良事件是可以预防的。至少有1例不良事件与年龄为18至44岁的患者的关联低于年龄为65至84岁的患者（标准化风险差异，-0.05[CI，-0.09至-0.02]），与黑人的关联高于亚洲人（标准化风险差异，0.09[CI，0.01至0.17]）。在各研究中心，1.8%至23.6%的患者至少有1例不良事件，不良事件的临床类别差异很大。

局限性

回顾性EHR审查可能会遗漏不良事件。

结论

门诊伤害比较常见，且往往比较严重。药物不良事件最常见。老年人的发病率更高。迫切需要采取干预措施来减少门诊病人的伤害。

主要资金来源

风险控制保险公司和哈佛医疗机构风险管理基金会。

英文原文如下：

Abstracts

BACKGROUND  Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited.

OBJECTIVE  To measure AEs in the outpatient setting.

DESIGN  Retrospective review of the electronic health record (EHR).

SETTING  11 outpatient sites in Massachusetts in 2018.

PATIENTS  3103 patients who received outpatient care.

MEASUREMENTS  Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites.

RESULTS  The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially.

LIMITATION  Retrospective EHR review may miss AEs.

CONCLUSION  Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed.

PRIMARY FUNDING SOURCE  Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.

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