香港医疗风险管理模式的实践与思考

医疗风险无处不在,医疗风险管理实践与研究受到国内外医院管理者的高度关注。国内医院虽然有各种形式的医疗风险管理模式,但普遍存在医疗风险管理碎片化及对高风险识别及应对不足等问题。香港大学深圳医院作为深圳市公立医院改革试点单位,肩负着引入国际医院管理理念和模式的重任。通过介绍香港风险管理模式在香港大学深圳医院的实践,结合其特点、效果、存在的问题等进行阐述,以期为其他医院提供借鉴     

医疗活动中注重防范非医疗意外的发生

随着社会的飞速发展,人们因社会压力、对疾病的认知和医疗费用等问题,可能导致患者就医期间发生非医疗意外,其所致纠纷已占医院纠纷中的一定比例.因此,医院必须与时俱进地调整管理思路、工作方法和服务模式,进一步加强对病人心理、社会问题的关注,规范对病人、设备、设施、医务人员的管理,研究适合本院院情的管理对策,预防非医疗意外的发生.     

防范儿童住院患者给药错误的最佳证据总结

目的 总结儿童用药给药错误管理与预防的最佳实践证据,为临床用药提供参考。方法 根据澳大利亚JBI循证卫生保健中心的问题开发工具构建循证问题,检索用药错误相关指南和共识,由研究者对纳入文献进行质量评价,对符合质量标准的文献进行证据提取和汇总。结果 共纳入文献9篇,包括循证指南2篇,专家共识7篇。最终从管理、环境与设备、标签、信息、核查、医嘱、给药、高危药品管理等方面共总结34条最佳证据。结论 防范儿童用药给药错误证据较全面,纳入指南质量相对较高,但儿科人群指南尚不足,且防范儿童给药错误偏重剂量错误的预防,未来需开展更多用药错误类型的防范策略研究。     

浅析侵权责任法与医疗风险防范

《中华人民共和国侵权责任法》（以下简称侵权责任法）是继物权法之后，我国民法典中另一部支柱性法律，是我国民法典的重要组成部分之一。该法对之前分布在其他法律法规之中的民事侵权责任进行了系统的归纳整理，对一些法律仅有原则性指导没有具体法律规范的民事侵权行为作出了明确规定，填补了很多“权利空白”，     

医院加强医疗风险管理初探

在参阅相关文献基础上,结合医院开展医疗风险管理的实践,对医疗风险的概念、特点及成因进行简要介绍与分析,并从树立正确医疗风险意识、强化能力培养、完善相关处理机制、加大监管力度等方面,提出加强医疗风险管理的主要措施,旨在健全与完善医疗风险管理机制,促进医院安全、健康发展。     

加强疼痛管理 防范医疗风险

医疗纠纷主要包括医疗服务缺陷和医疗差错两方面。本文就特定的医院环境下对忽视疼痛管理引发医疗纠纷的潜在风险进行分析、鉴定、评估，并就如何建立对应的医疗风险管理制度和措施，降低风险，更好地提升病人满意度进行了阐述。     

加强医疗安全管理 防范医疗缺陷

医疗安全是医院生存和发展的基础，是医疗质量高低的重要标志之一，在大量的医疗活动中，医疗安全伴随其中，稍有不慎即可造成差错，甚至酿成事故。加强医院安全管理，控制和解决医疗缺陷，是医院各级管理者不可忽视的永久性课题，现将我院近几年的做法介绍如下。一、强化...     

健康体检中的医疗安全防范

健康体检属于医疗活动范畴,健康体检是对健康人群身体状况的一种医学检查,由各科医师、技术人员、护理人员参与,对人体各器官的功能现状进行检测,以期达到早期发现问题,早期治疗的目的。在医疗活动中发生的技术、服务、管理等方面的不完善或失误,均属医疗缺陷。构成医疗缺陷有不可控因素和可控因素,把可控因素控制在最低范围,积极主动做好预防,防患于未然,就有可能实现医疗服务的安全性和医疗质量目标。     

甲氨蝶呤用药错误案例解析

通过对1例甲氨喋呤用药错误案例的回顾,从用药错误产生的环节、归属的类型、用药错误分级、发生用药错误的危险因素等角度进行分析。并从技术和管理两个层面提出改进策略,提出可通过信息系统支持、加强制度落实、加强员工培训、营造安全文化等方面防范用药错误的发生。     

上海市某三甲专科医院医疗风险相关事件调查分析

目的对某三甲专科医院医疗风险相关事件,从事件分类、发生地点、发生科室、发生时间等角度进行调查分析,以了解医疗风险发生现状,为医疗机构内部风险管理提供参考。方法收集2012年-2014年医疗风险相关事件数据,运用描述性分析法分析事件分类情况,运用Excel 2013表格建库录入数据,SPSS 16.0统计软件进行整理和分析。结果共得到726例医疗风险相关事件。按事件基本特征分类,“医疗差错”事件最多,占67.91%;按事件发生结果分类,“隐患事件”最多,占73.28%。从事件的发生部门来看,住院部风险高于门诊。3年内医疗风险发生数量有逐年递增趋势;每年呈现暑期和年底两个高峰。医院信息化系统建成后,风险事件主动上报率提升。结论医疗风险在该专科医院临床工作中频现,管理状况大体良好,但各科室风险管理现状略有不同,专科医院仍需结合自身专业特点加强医疗风险管理。     

四国医疗风险与预警监测管理模式分析

通过检索英国、美国、加拿大、澳大利亚4国医疗风险管理相关官网资料,比较4国医疗风险管理相关机构设置、政策法规和不良事件上报管理机制.4国均设立国家级病人安全管理机构,采取国家、地方、医疗机构和非政府组织多级综合管理;美国以法律法规,英国、澳大利亚以指南作为医疗安全的政策保障;4国通过国家主导或与行业协会合作,管理不良事件上报.启示我国要加强医疗安全管理的组织机构建设,健全医疗安全管理制度并倡导安全文化,建立国家级医疗安全事件报告和学习系统,提高医疗风险管理水平.

Abstract：

Comparison of the institutional setup, policies and adverse event report mechanism for medical risk control in the countries of UK, USA, Canada, and Australia by means of browsing information on their official websites. It is found that these countries maintain a national patient safety authority, coupled with a tiered management at national, local, medical institutions and NGOs level; the USA pattern features laws and regulations, that of UK and Australia features guidelines as policy guarantee for medical safety; these countries regulate adverse event reporting by either government leadership or cooperation with trade associations. Inspirations from this study suggest China to enhance institutional construction, complete regulations, and advocate the culture for medical safety, and to build the national-level reporting and study system for medical safety events, and improve medical risk management.     

What do health professionals think about patient safety?

Introduction  Patient safety is a main determinant of the quality of healthcare services. The literature shows that the occurrence of medical errors is quite important in countries where it has been measured. Various actions like legislative measures, financial, or educational measures may help, but they are not always effective in controlling the level of avoidable errors. That happens because patient safety is strongly related to the culture specific to healthcare organizations. This study is aimed at getting some perspective on the organizational culture in Romanian hospitals in regard to patient safety. Objectives  The main objectives are (1) to identify the views of healthcare professionals about patient safety in Romanian hospitals and compare them with other countries, (2) to identify to which extent the views about patient safety relate to the specific organizational culture in healthcare, and (3) find out if there are differences in perceptions of professional categories about their own work and that of the clinical team. Method  A survey was conducted, based on a questionnaire. The questionnaire was aimed at realizing a screening of the problem, to get some specific views of respondents from their work experience, and eventually to get suggestions on how to improve patient safety. The same questionnaire has been previously applied in four other countries: Australia, Singapore, Sweden and Norway. Overall views of hospital professionals from Romania were compared to those from the other countries. Also, views per professional categories—clinical vs. non-clinical staff, doctors vs. nurses, and senior vs. junior staff—were compared. Results  Answers from 100 respondents from Romania indicate that patient safety is a major concern of hospital professionals, and it should be improved. Basically, they show as much interest and willingness to improve as observed in the other countries. This indicates that no major differences in the organizational culture exist in regard to patient safety. However, differences among professional categories have been noticed; for example, nurses are more aware than doctors on the need to take action for improving patient safety. Conclusions  Patient safety is a major concern of health policy in many countries. In Romania, this study shows concern of professionals about patient safety, although they are facing many barriers such as inadequate leadership, lack of communication between professional categories, between senior and junior staff, and most of all with the patients. This is a problem of organizational culture, which requires complex, multi-level strategies, targeting a long-term change. Results of this initial study should be viewed as a baseline for a larger study.

加强风险管理保障病人安全

事实表明医院并不像大多数人们所想象的那样安全。近来国际上对病人安全问题给予了高度重视。加强医院风险管理是减少医疗差错、改善病人安全的有效途径。文章简要介绍了全面医院风险管理项目的要求和内容。     

应用风险管理防范产房护理缺陷

目的探讨风险管理在产房护理管理中的应用及减少护理缺陷的效果。方法将2003年1月-2005年12月3947例产妇设为I组（对照组）,2006年1月-2008年12月4780例产妇设为Ⅱ组（观察组）。回顾性分析过去6年产房工作中52例护理缺陷的原因,比较2006年1月实施风险管理措施前后两组护理缺陷发生率、产妇难产率及满意度。结果Ⅱ组护理缺陷发生率、难产率较I组均明显下降（P〈0．01或P〈0．05）,满意度较I组升高（P〈0．05）。结论产房应用风险管理可明显减少护理缺陷的发生,提高护理质量及产妇的满意度。     

Perceptions of preventable medical errors in Alberta, Canada.

OBJECTIVE: (i) To compare public perceptions of the frequency, responsibility, causes and solutions for preventable medical errors for persons who report and do not report having experienced a preventable medical error while receiving healthcare services in Alberta, Canada. (ii) To describe public opinion about confidentiality and disclosure of preventable medical error. (iii) To examine the relationship between reporting preventable medical error and perceived quality of the healthcare system. METHODS: Population-based telephone survey. Households selected by random digit dialing and individual in household selected by most recent birthday. Province of Alberta, Canada. Representative sample of adult Albertans (N = 1500). Public perceptions of the frequency, responsibility, causes and solutions for preventable medical error; opinions about confidentiality and disclosure; perceived quality of the healthcare system. RESULTS: Five hundred and fifty-nine (37.3%; 95% CI 34.8-39.8%) of 1500 respondents reported that they or a family member had ever experienced a preventable medical error while receiving health care in Alberta, Canada. Respondents who reported a preventable medical error were more likely to believe that preventable medical errors occur with greater frequency, were less likely to think that their doctor would tell them if a preventable medical error was made in their care, and tended to rate the quality of the healthcare system less favourably. CONCLUSION: This paper provides healthcare managers and policymakers with insight into the public's perceptions of preventable medical error and may facilitate the development of strategies to improve patient safety, public confidence and public satisfaction with the healthcare system.     

The impact of medical errors on ninety-day costs and outcomes: an examination of surgical patients

Objective. To estimate the effect of medical errors on medical expenditures, death, readmissions, and outpatient care within 90 days after surgery. Data Sources. 2001–2002 MarketScan insurance claims for 5.6 million enrollees. Study Design. The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were used to identify 14 PSIs among 161,004 surgeries. We used propensity score matching and multivariate regression analyses to predict expenditures and outcomes attributable to the 14 PSIs. Principal Findings. Excess 90‐day expenditures likely attributable to PSIs ranged from $646 for technical problems (accidental laceration, pneumothorax, etc.) to $28,218 for acute respiratory failure, with up to 20 percent of these costs incurred postdischarge. With a third of all 90‐day deaths occurring postdischarge, the excess death rate associated with PSIs ranged from 0 to 7 percent. The excess 90‐day readmission rate associated with PSIs ranged from 0 to 8 percent. Overall, 11 percent of all deaths, 2 percent of readmissions, and 2 percent of expenditures were likely due to these 14 PSIs. Conclusions. The effects of medical errors continue long after the patient leaves the hospital. Medical error studies that focus only on the inpatient stay can underestimate the impact of patient safety events by up to 20–30 percent.     

Risk factors for patient‐reported medical errors in eleven countries

Objectives The aim of this study was to identify common risk factors for patient‐reported medical errors across countries. In country‐level analyses, differences in risks associated with error between health care systems were investigated. The joint effects of risks on error‐reporting probability were modelled for hypothetical patients with different health care utilization patterns. Design Data from the Commonwealth Fund’s 2010 lnternational Survey of the General Public’s Views of their Health Care System’s Performance in 11 Countries. Setting Representative population samples of 11 countries were surveyed (total sample = 19 738 adults). Utilization of health care, coordination of care problems and reported errors were assessed. Regression analyses were conducted to identify risk factors for patients’ reports of medical, medication and laboratory errors across countries and in country‐specific models. Results Error was reported by 11.2% of patients but with marked differences between countries (range: 5.4–17.0%). Poor coordination of care was reported by 27.3%. The risk of patient‐reported error was determined mainly by health care utilization: Emergency care (OR = 1.7, P < 0.001), hospitalization (OR = 1.6, P < 0.001) and the number of providers involved (OR three doctors = 2.0, P < 0.001) are important predictors. Poor care coordination is the single most important risk factor for reporting error (OR = 3.9, P < 0.001). Country‐specific models yielded common and country‐specific predictors for self‐reported error. For high utilizers of care, the probability that errors are reported rises up to P = 0.68. Conclusions Safety remains a global challenge affecting many patients throughout the world. Large variability exists in the frequency of patient‐reported error across countries. To learn from others’ errors is not only essential within countries but may also prove a promising strategy internationally.     

A community survey of medical errors in New York.

OBJECTIVE: To assess factors related to experiences with medical errors by health care consumers in the community. DESIGN: Using a random telephone survey of New York State residents screened for knowledge of health care utilization, we gathered information about demographic factors, health care attitudes, experiences with the health care system, and use of information to make health care decisions. SETTING: The State of New York, USA. PARTICIPANTS: Adults living in the State of New York who possessed a telephone. INTERVENTIONS: None. RESULTS: Approximately one-fifth (21.1%) of New Yorkers reported that either they or someone in their household had experienced a medical error, with logistic regression models for ever experiencing a household medical error revealed that respondents who were divorced/separated/widowed, African American, and those from higher income households were less likely to report medical errors. Conversely, those between the ages of 30 and 65 years, those who had frequent doctor visits, and those who were better informed about health care were more likely to report them. The results were similar for household medical errors in the past 5 years. In all multivariate models, greater use of medical information was consistently related to experiencing household medical errors. Having a regular doctor, having health insurance, and concern about health care delivery were not related to either of these outcomes. CONCLUSIONS: Our study indicated that one-fifth of New York State households had experienced a medical error, with one in 10 reporting experiencing a household medical error within the past 5 years. Greater knowledge about health care increased the likelihood of reporting a household medical error. Thus, a greater consumer orientation in health care and provision of more medical information may increase rather than reduce the reporting of medical errors by the public.     

Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea

Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.