Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Background: There is limited research, and guidance, on how to address safety in general practice proactively.
Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined.
Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs.
Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n = 6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs.
Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.

背景：目前针对如何主动在全科医疗中保障患者安全的相关研究与指导规范均较为匮乏。研究目的：本综述旨在整合相关文献，阐述在初级保健中利用病历审查（Patient Record Review, PRR）衡量并提升患者安全的实践，同时对所采用的PRR方法学及其最终产出结果进行分析。研究方法：本研究于2017年2月利用Medline、Embase、CINAHL及PsycINFO数据库开展文献检索，同时对纳入研究的参考文献列表以及现有综述文献进行筛选。本研究纳入以英语发表、经同行评议且利用PRR识别全科医疗中发生的患者安全事件（Patient Safety Incidents, PSIs）的相关研究。两名研究人员独立从文献中提取数据，并采用《多设计研究质量评价工具》（Quality Assessment Tool for Studies with Diverse Designs）对研究进行质量评估。研究结果：本次共筛选3265项研究，最终纳入15项。触发工具（Trigger tools）是PRR最常使用的方法（n=6）。每100份病历中平均检出12.6例安全事件。纳入研究显示，平均30.6%的安全事件会导致严重伤害（范围8.6%~50%），且平均55.6%的安全事件被认为是可预防的（范围32.7%~93.5%）。最常被识别的患者安全事件类型涉及药物治疗与处方开具、诊断、沟通及诊疗操作。共有3项研究报道了PRR实施后所采取的改进措施。研究结论：本综述表明，PRR或许是主动识别患者安全事件并为安全改进提供依据的有效手段。