Postdischarge Adverse Events among NICU Neonates

NICU 新生儿出院后不良事件

• 批准号: 9355215
• 负责人: Dennis Tsilimingras
• 金额: $ 39.95万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-20 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355215
• 关键词: Abnormal Laboratory Test Result; Acute; Address; Adult; Adverse drug event; Adverse event; Affect; Area; Birth; Caring; Characteristics; Child; Childhood; Colorado; Community Hospitals; Comorbidity; Consensus; Data; Diagnostic; Diagnostic Errors; Disease; Electronic Health Record; Event; Frequencies; Future; Health Professional; Health Services; Home environment; Hospitalization; Hospitalized Child; Hospitals; Incidence; Injury; Inpatients; Intervention; Interview; Lead; Medical; Medical center; Michigan; Mission; National Institute of Child Health and Human Development; Neonatal Intensive Care Units; Nosocomial Infections; Nurses; Outpatients; Patient Care; Patients; Pediatric Hospitals; Physicians; Policies; Population; Populations at Risk; Prevention; Procedures; Process; Prospective cohort study; Public Health; Recruitment Activity; Reporting; Research; Risk Factors; Severities; Symptoms; System; Telephone Interviews; Therapeutic; Time; United States; Utah; Woman; experience; follow-up; health care availability; health care delivery; health record; health service use; high risk; hospital readmission; improved; neglect; neonatal care; neonate; patient safety; pediatric patients; pediatrician; response; systemic intervention

Each year in the United States, 70,000 hospitalized children are estimated to experience an injury caused by medical management rather than the underlying disease or condition of the patient, defined as an “adverse event.” Approximately 60% of these adverse events are considered potentially preventable. Little has been done to examine adverse events specifically during the transition when children are discharged from the hospital to home – postdischarge adverse events. Postdischarge adverse events are important because while they result from care provided during a hospitalization, the majority are not detected until after patients have been discharged to home. Furthermore, the adverse events that are detected in the hospital and appropriately managed still lead to significant symptoms after the patients are sent home. As a result, the postdischarge incidence rates (19% - 28%) in three adult studies were about five to seven times higher than the inhospital adverse event incidence rates. Thus, it is plausible that the postdischarge adverse event incidence rate in children may be much higher than the inhospital rate, as with adults. Thus, efforts in children are needed to investigate postdischarge adverse events to estimate the burden and to identify the risk factors. This prospective cohort study will examine the frequency of adverse events, preventable adverse events, and ameliorable adverse events (aim 1) and identify the types of adverse events (aim 2) in neonatal intensive care unit (NICU) neonates discharged home from the hospital. In addition, the study will examine patient, system, and patient care factors associated with the occurrence of postdischarge adverse events (aim 3). Patients will be identified from the NICUs of Children's Hospital of Michigan and Hutzel Women's Hospital of the Detroit Medical Center. Nurses will recruit NICU neonates prior to discharge, contact their guardians within 4-weeks after discharge to conduct a follow-up telephone interview, and review health records for NICU neonates related to patient care received postdischarge. The nurses will combine the information obtained from the telephone interview and the outpatient health record to screen neonates for adverse events using the following criteria: 1) new or exacerbated symptoms; 2) unplanned health services utilization; and 3) abnormal laboratory test results. If nurses identify any of the above information from the interview responses or health record, they will refer to two physicians who will independently review that neonate's entire health record (inpatient/outpatient) and responses from the telephone interview to determine the occurrence of adverse events. This project addresses a neglected area of patient safety that is related to NICHD's overall mission to improve patient safety during neonatal care. Results from this study will help children's and community hospitals develop systemic interventions to improve the hospital discharge process and pediatric patient safety during the post-discharge period.

每年在美国，据估计有70,000名住院儿童 医疗管理而不是患者的潜在疾病或病情，定义为“不良 事件。“这些不良事件中约有60％被认为是可以预防的。几乎没有 为了在转变期间特别检查儿童出院时的不良事件 医院到家 - 放电后广告活动。解雇后广告活动很重要，因为 它们是由于住院期间提供的护理而导致的，直到患者有 出院回家。此外，医院发现并适当发现的不良事件 在将患者送回家后，管理仍会导致重大症状。结果，解雇后 在三项成人研究中的发病率（19％-28％）是保险公司的五到七倍 不良事件事件率。那是合理的 与成人一样，儿童可能比事故率高得多。那是需要儿童的努力 调查入院后不良事件以估计烧伤并确定危险因素。这 前瞻性队列研究将检查不良事件的频率，可预防的不良事件和 可改善不良事件（AIM 1）并确定新生儿重症监护中不良事件的类型（AIM 2） 单位（NICU）新生儿从医院出院。此外，该研究将检查患者，系统， 以及与发生后广告事件发生有关的患者护理因素（AIM 3）。患者会 可以从密歇根州儿童医院和底特律的Hutzel妇女医院中识别 医疗中心。护士将在出院前招募NICU NEONANES，与4周内的监护人联系 出院后进行后续电话采访，并查看NICU NEONATES的健康记录 与患者护理有关，接受了入院后。护士将结合从 电话采访和门诊健康记录，以筛选新生儿的广告事件 标准：1）新的或恶化的症状； 2）计划外健康服务利用； 3）异常实验室 测试结果。如果护士从面试答复或健康记录中识别出上述任何信息，他们就会 将参考两位医生，他们将独立审查Neonate的整个健康记录 （住院/门诊）和电话面试中的回复以确定逆境的发生 事件。该项目解决了一个被忽视的患者安全领域，该领域与NICHD的总体使命有关 改善新生儿护理期间的患者安全。这项研究的结果将有助于儿童和社区 医院开发系统干预措施，以改善医院出院过程和小儿患者安全 在分期后期。