WHO丨关于患者安全的10个事实（201908版）
WHO丨关于患者安全的10个事实（201908版）WHO SIFIC感染官微 患者安全是一个严肃的全球公共卫生问题。据估计，人们在乘飞机旅行期间死亡的几率为三百万分之一。而患者在医疗期间死于可预防的医疗事故的几率估计为三百分之一。航空和核工业等据认为风险较高行业的安全记录远远好于医疗行业。事实1：十分之一患者在医院接受治疗期间受到伤害据估计，在高收入国家，每10名患者即有1人在接受医院治疗时受到伤害。伤害可以由一系列不良事件造成，其中近50%的不良事件被认为是可以预防的。一项关于8个低收入和中等收入国家26家医院不良事件发生频率和可预防性的研究显示，不良事件发生率约为8%。在这些事件中，83%是可以预防的，约30%的不良事件造成患者死亡。Fact 1: One in every 10 patients is harmed while receiving hospital careEstimates show that in high-income countries, as many as one in 10 patients is harmed while receiving hospital care. The harm can be caused by a range of adverse events, with nearly 50% of them considered preventable.A study on the frequency and preventability of adverse events across 26 hospitals in eight low-and middle-income countries, showed the adverse event rate to be around 8%. Of these events, 83% were preventable, while about 30% were associated with death of the patient. 事实2：不安全治疗导致的不良事件可能是全世界十大死亡和残疾原因之一不安全治疗导致的不良事件可能是全球十大死亡和残疾原因之一。最近的证据表明，由于低收入和中等收入国家医院的不安全治疗，每年发生1.34亿起不良事件，导致每年260万人死亡。
据另一项研究，不安全治疗导致的所有不良事件中，约三分之二不良事件以及因残疾和死亡而损失的年数（称为残疾调整生命年）发生在低收入和中等收入国家中。Fact 2: The occurrence of adverse events due to unsafe care is likely one of the 10 leading causes of death and disability across the worldThe occurrence of adverse events, resulting from unsafe care, is likely to be one of the 10 leading causes of death and disability worldwide. Recent evidence suggests that 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries (LMICs), resulting in 2.6 million deaths annually.Another study has estimated that around two-thirds of all adverse events resulting from unsafe care, and the years lost to disability and death (known as disability adjusted life years, or DALYs), occur in LMICs.事实3：十分之四患者在初级和门诊治疗中受到伤害提供安全服务在各级医疗（包括在提供大部分服务的初级和门诊医疗）中极其重要。在全球范围内，多达十分之四的患者在这些环境中接受治疗时受到伤害，其中高达80%的伤害被认为是可以预防的。最有害的错误往往由诊断、处方和用药错误造成。
初级和门诊医疗伤害通常导致患者需要住院治疗。调查结果发现，在经济合作与发展组织（经合组织）各成员国中，患者伤害病例可能占医院病床天数的6%以上，住院次数超过700万次。Fact 3: Four out of every 10 patients are harmed in primary and outpatient health careThe provision of safe services is extremely important across all levels of health care, including in primary and outpatient (ambulatory) care, where the bulk of services are offered. Globally, as many as four out of 10 patients are harmed while receiving health care in these settings, with up to 80% of the harm considered to have been preventable. The most detrimental errors are related to diagnosis, prescription and the use of medicines.Harm in primary and ambulatory care often results in hospitalization. It has been found, that across Organisation for Economic Co-operation and Development (OECD) countries, patient harm may account for more than 6% of hospital bed days and more than 7 million admissions.事实4：在医院治疗中，每7加元中至少有1加元用于处理患者伤害的影响每7加元中至少有1加元用于处理患者医源性伤害的影响。最近的证据表明，经济合作与发展组织成员国医院总支出和活动的15%是不良事件直接造成的结果，最棘手的事件是血凝块（静脉血栓栓塞）、褥疮（压疮）和感染。
据估计，仅在这些国家中，每年伤害总代价就高达数万亿美元。Fact 4: At least 1 out of every 7 Canadian dollars is spent treating the effects of patient harm in hospital careA minimum of 1 out of every 7 Canadian dollars is spent treating the effects of patient harm in hospital care. Recent evidence shows that 15% of total hospital expenditure and activities in Organisation of Economic Co-operation and Development (OECD) countries is a direct result of adverse events, with the most burdensome events being blood clots (venous thromboembolism), bed sores (pressure ulcers) and infections.It is estimated that the total cost of harm in these countries alone amounts to trillions of US dollars every year.事实5：在患者安全领域进行投资可以节省大量资金为改善患者安全进行投资可以节省大量资金，更重要的是，这能够改善患者预后。预防成本通常远低于治疗成本。例如，仅在美国，2010年至2015年期间，由于有针对性地采取安全改进措施，医疗保险指定医院总共节省了约280亿美元。
鼓励患者进一步参与是提高医疗安全性的关键。鼓励患者参与并不贵，在经济上很合算。如果做得好，可以减少高达15%的伤害负担，每年节省大量资金。这是非常好的投资回报。Fact 5: Investment in patient safety can lead to significant financial savingsInvestment in improving patient safety can lead to significant financial savings and more importantly better patient outcomes. This is because the cost of prevention is typically much lower than the cost of treatment due to harm. As an example, in the United States alone, focused safety improvements led to an estimated US$ 28 billion in savings in Medicare hospitals between 2010 and 2015.Greater patient involvement is the key to safer care. Engaging patients is not expensive and represents a good value. If done well, it can reduce the burden of harm by up to 15%, saving billions of dollars each year– a very good return on investment.事实6：不安全用药和错误用药每年伤害众多患者，带来大量医疗费用不安全用药和错误用药，例如剂量或输液不正确、说明不清楚、使用缩写和处方不当等，是世界各地医疗服务中造成可避免的伤害的主要原因。除了工资、生产力或医疗费损失外，全球用药失误造成的代价估计为每年420亿美元，这几乎占全球卫生支出的1%。
如果处方、储存、制备、分配、给药和监控工作受到药物系统薄弱和/或人为因素（如疲劳、恶劣的工作条件或人员短缺）影响，就可能会发生用药错误。上述任何一种情况或多种情况都可能导致患者遭受严重伤害、残疾甚至死亡。Fact 6: Unsafe medication practices and medication errors harm millions of patients and costs billions of US dollars every yearUnsafe medication practices and errors – such as incorrect dosages or infusions, unclear instructions, use of abbreviations and inappropriate prescriptions – are a leading cause of avoidable harm in health care around the world. Globally, the cost associated with medication errors has been estimated at US$ 42 billion annually, not counting lost wages, productivity, or health care costs. This represents almost 1% of global expenditure on health.Medication errors may occur when weak medication systems and/or human factors such as fatigue, poor working conditions, or staff shortages affect prescribing, storage, preparation, dispensing, administration and monitoring practices. Any one or a combination of these can result in severe patient harm, disability and even death.事实7：诊断不准或拖延是造成患者伤害的一项最常见原因，影响到数以百万计的患者在美国门诊中，大约5%的成年人被误诊。误诊指的是医务人员未能准确及时地识别疾病性质。这些错误中，大约一半有可能造成严重伤害。对马来西亚初级医疗诊所的一项研究显示，误诊发生率为3.6%。
在美国，对过去几十年广泛尸检研究结果表明，误诊导致大约10%患者死亡。此外，病历审查结果表明，误诊占医院所有伤害事件的6%-17%。
来自低收入和中等收入国家的证据有限。据估计，考虑到诊断工作受到就医机会和诊断检测资源有限等因素影响，低收入和中等收入国家误诊率高于高收入国家。Fact 7: Inaccurate or delayed diagnosis is one of the most common causes of patient harm and affects millions of patientsDiagnostic error, that is the failure to identify the nature of an illness in an accurate and timely manner, occurs in about 5% of adults in the United States outpatient care settings. About half of these errors have the potential to cause severe harm. A study of primary care clinics in Malaysia established the occurrence of diagnostic errors at 3.6%. In the United States, extensive autopsy research performed in the past decades has shown that diagnostic errors contribute to approximately 10% of patient deaths. Furthermore, medical record reviews demonstrate that diagnostic errors account for 6–17% of all harmful events in hospitals.Evidence from low- and middle-income countries is limited, however, it is estimated that the rate is higher than in high-income countries as the diagnostic process is negatively impacted by factors such as limited access to care and diagnostic testing resources. 事实8：十分之一住院患者在院内受到感染在任何时候，高收入国家有7%的住院患者，低收入和中等收入国家有10%的患者会受到一种或多种医源性感染。全世界每年都有数亿患者受到医源性感染。有越来越多的人在医院感染了耐甲氧西林金黄色葡萄球菌。此种细菌对大多数抗生素具有耐药性。据估计，与非耐药性感染人群相比，感染此种细菌的患者死亡几率高出64%。
不管一国收入水平如何，如果采取各类干预措施，包括注意适当的手部卫生，就可以降低医源性感染率，最高降幅可高达55%。Fact 8: Hospital infections affect up to 10 out of every 100 hospitalized patientsOut of every 100 hospitalized patients, at any given time, seven in high-income countries and 10 in low- and middle-income countries will acquire one or more health care-associated infections (HAIs). Hundreds of millions of patients worldwide are affected by HAIs each year. People with methicillin-resistant Staphylococcus aureus (MRSA), a bacterium increasingly found in hospital settings that is resistant to most antibiotics, are estimated to be 64% more likely to die than people with a non-resistant form of the infection.Regardless of a country’s income level, different types of interventions, including appropriate hand hygiene, can reduce HAI rates by up to 55%. 事实9：每年有100多万患者死于手术并发症世卫组织的调查结果表明，在全球范围内，手术继续导致高发病率和高死亡率。不安全的外科医疗程序导致高达25%的患者发生并发症。每年有近700万外科患者发生严重并发症，其中100万人在手术期间或手术不久后死亡。
由于改善了患者安全措施，手术并发症死亡人数在过去50年中有所下降。但低收入和中等收入国家的手术并发症死亡率仍是高收入国家的2至3倍。Fact 9: More than 1 million patients die annually from complications due to surgeryFindings by WHO suggest that, globally, surgery still results in high rates of illness, disease and death. Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery.As a result of improved patient safety measures, deaths related to complications from surgery have decreased in the past 50 years. Nevertheless, they remain two to three times higher in low- and middle-income countries than in high-income countries.世卫组织/G.Reboux 事实10：医源性辐射是一个公共卫生和患者安全问题全世界每年进行超过36亿次X光检查，其中约10%检查对象是儿童。此外，每年还进行超过3700万次核医学和750万次放射治疗程序。医源性辐射的不恰当或不熟练使用可能对患者和医务人员的健康带来危害 。
辐射错误包括过度暴露在辐射中以及错误识别患者或错误定位等情况。对30年来发表的放射治疗安全性数据的审查结果显示，辐射错误总发生率约为每1万个疗程15例错误。Fact 10: Medical exposure to radiation is a public health and patient safety concernWorldwide, there are more than 3.6 billion x-ray examinations performed every year, with around 10% of them occurring in children. Additionally, there are over 37 million nuclear medicine and 7.5 million radiotherapy procedures annually. Inappropriate or unskilled use of medical radiation can lead to health hazards, both for patients and staff.Radiation errors involve overexposure to radiation and cases of wrong-patient or wrong-site identification. A review of 30 years of published data on safety in radiotherapy estimates that the overall incidence of errors is around 15 per 10 000 treatment courses. 文章来源：https://www.who.int/features/factfiles/patient_safety/zh/ 编者注：2019年8月，世界卫生组织（WHO）更新了《患者安全10个事实》，这是自2007年首次发布后的第三次更新，第一次更新是在2014年6月，第二次是2018年4月。
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