作者hahawow (哇哈哈)
看板medache
標題[討論] preventability of death after CABG
時間Thu Jun 19 18:07:24 2008
做這樣的study,不知道會不會有消費者團體提起集體訴訟?
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:很像醫生在指控醫生的醫術不好，感覺不是很好 06/19 21:38
2F：→ Duarte:醫師怕被 '揭發' 嗎? 那樣要怎樣懇切的檢討錯誤呢? 06/19 21:41
3F：→ Duarte:最初使用石炭酸洗手的外科醫師, 也是基於改進治療的目標啊! 06/19 21:44
4F：→ ufish:也不是怕被揭發，只是可預防的死亡，感覺好像出醫療疏失 06/19 21:54
5F：→ ufish:很多外科醫師都會做事後檢討啊～Mortality Meeting的用意 06/19 21:55
6F：→ ufish:不就是互相討論如何讓照顧病人的品質變得更好嗎 06/19 21:55
7F：→ ufish:只是我覺得這種東西應該是關起門來討論的，不然以現在的醫療 06/19 21:56
8F：→ ufish:環境，有誰願意自己的親人過世是因為可預防的死亡？ 06/19 21:56
9F：→ ufish:不過這篇取樣是從1998到2003，蠻想知道之後的mortality rate 06/19 21:58