Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 294

A number of methods of studying errors and adverse events have evolved over time and been adapted to different contexts.¹⁹ Each method has particular advantages and disadvantages. Some methods are oriented toward detecting the incidence of errors and adverse events (Table 11.2), whereas others address the causes and contributory factors of those errors and adverse events (Table 11.3). There is no perfect way of estimating the incidence of adverse events or errors. For various reasons, all the approaches give a partial picture. Any retrospective review is vulnerable to hindsight or outcome bias, where knowledge that the outcome was bad leads to unjust simplification and criticism of preceding events. Record review is comprehensive and systematic but, by definition, is restricted to matters noted in the medical record. Reporting systems are strongly dependent on the willingness of staff to report and are a very imperfect reflection of the underlying rate of errors or adverse events. Michel, et al. compared three methods of estimating adverse events rates: cross‐sectional (data gathered in one day), prospective (data gathered during a hospital stay), and retrospective (review of medical records). The prospective and retrospective methods found similar numbers of cases; however, the former identified more preventable cases with high reliability and validity.²⁰ The cross‐sectional method showed a large number of false positives and did not pick up serious events.