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Risks, dangers and competing clinical decisions on venous thromboembolism prophylaxis in hospital care

机译：预防静脉血栓栓塞的风险，危险和竞争性临床决策

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摘要

Drawing on wider sociologies of risk, this article examines the complexity of clinical risks and their management, focusing on risk management systems, expert decision-making and safety standards in health care. At the time of this study preventing venous thromboembolism (VTE) among in-patients was one of the top priorities for hospital safety in the English National Health Service (NHS). An analysis of 50 interviews examining hospital professionals' perceptions about VTE risks and prophylaxis illuminates how National Institute for Health and Clinical Excellence (NICE) guidelines influenced clinical decision-making in four hospitals in one NHS region. We examine four themes: the identification of new risks, the institutionalisation and management of risk, the relationship between risk and danger and the tensions between risk management systems and expert decision-making. The implementation of NICE guidelines for VTE prevention extended managerial control over risk management but some irreducible clinical dangers remained that were beyond the scope of the new VTE risk management systems. Linking sociologies of risk with the realities of hospital risk management reveals the capacity of these theories to illuminate both the possibilities and the limits of managerialism in health care.
机译：本文利用更广泛的风险社会学方法，研究了临床风险及其管理的复杂性，重点关注风险管理系统，专家决策和医疗保健安全标准。在本研究进行时，在英国国家卫生服务局（NHS）中，防止住院患者的静脉血栓栓塞（VTE）是医院安全的重中之重。对50项访谈进行了分析，考察了医院专业人员对VTE风险和预防的看法，这阐明了美国国家卫生与临床卓越研究所（NICE）准则如何影响一个NHS地区中四家医院的临床决策。我们研究了四个主题：新风险的识别，风险的制度化和管理，风险与危险之间的关系以及风险管理系统与专家决策之间的紧张关系。 NICE预防VTE指南的实施扩展了对风险管理的管理控制，但是仍然存在一些不可消除的临床危险，这些危险超出了新VTE风险管理系统的范围。将风险社会学与医院风险管理的现实联系起来，揭示了这些理论阐明医疗保健管理主义的可能性和局限性的能力。

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