作者hahawow (哇哈哈)
看板medache
标题[讨论] preventability of death after CABG
时间Thu Jun 19 18:07:24 2008
做这样的study,不知道会不会有消费者团体提起集体诉讼?
Relationship between preventability of death after coronary artery bypass
graft surgery and all-cause risk-adjusted mortality rates.
Circulation. 2008 Jun 10;117(23):2969-76.
http://www.ncbi.nlm.nih.gov/pubmed/18541752?dopt=Abstract
BACKGROUND: The goal of this study was to determine the relationship between
all-cause, risk-adjusted, in-hospital mortality after coronary artery bypass
graft surgery and the proportion of preventable in-hospital deaths as a
measure of quality of care at an institution level.
METHODS AND RESULTS: We conducted a retrospective analysis of 347 randomly
selected in-hospital deaths after isolated coronary artery bypass graft
surgery at 9 institutions in Ontario over the period of 1998 to 2003.
Nurse-abstracted chart summaries were reviewed by 2 experienced cardiac
surgeons who were blinded to patient, surgeon, and hospital and used a
standardized implicit tool to identify preventable death. A third reviewer
reassessed all cases in which the first 2 reviewers disagreed. Rates of
preventable deaths were estimated for each hospital and compared with
all-cause mortality rates. A structured adverse event audit completed by
each surgeon-reviewer was used to identify quality improvement
opportunities for the preventable deaths.
A total of 111 of 347 deaths (32%)
were judged preventable despite a low risk-adjusted mortality range
(1.3% to 3.1%) across hospitals. No significant correlation was found between
all-cause, risk-adjusted in-hospital mortality rates and the proportion of
preventable deaths at the hospital level (Spearman coefficient, -0.42; P=0.26).
A large proportion of preventable deaths were related to problems in the
operating room (86%) and intensive care unit (61%). Many
deaths were associated with deviations in perioperative care
(32% based on concurrence of 2 reviewers, and another 42% in cases in
which 1 reviewer reached that opinion).
CONCLUSIONS: Approximately one third of in-hospital coronary artery bypass
graft deaths were judged preventable by surgeon reviewers. All-cause
risk-adjusted mortality rates are convenient measures of institutional
quality of care but were not correlated with preventable mortality in our
jurisdiction. Providers should conduct detailed adverse event audits to drive
meaningful improvements in quality.
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1F：→ ufish:很像医生在指控医生的医术不好，感觉不是很好 06/19 21:38
2F：→ Duarte:医师怕被 '揭发' 吗? 那样要怎样恳切的检讨错误呢? 06/19 21:41
3F：→ Duarte:最初使用石炭酸洗手的外科医师, 也是基於改进治疗的目标啊! 06/19 21:44
4F：→ ufish:也不是怕被揭发，只是可预防的死亡，感觉好像出医疗疏失 06/19 21:54
5F：→ ufish:很多外科医师都会做事後检讨啊～Mortality Meeting的用意 06/19 21:55
6F：→ ufish:不就是互相讨论如何让照顾病人的品质变得更好吗 06/19 21:55
7F：→ ufish:只是我觉得这种东西应该是关起门来讨论的，不然以现在的医疗 06/19 21:56
8F：→ ufish:环境，有谁愿意自己的亲人过世是因为可预防的死亡？ 06/19 21:56
9F：→ ufish:不过这篇取样是从1998到2003，蛮想知道之後的mortality rate 06/19 21:58