现代医院的风险管理

随着我国法制的日益健全及广大患者自身保护意识的增强,使得医疗纠纷数量明显增多。医疗纠纷大幅上升,不但影响着医院的正常工作秩序,同时也给医院造成直接经济损失。所以,如何加强医院管理,防止医疗纠纷的发生,成为医院管理的头等大事,本文就如何加强风险管理,从而防范医疗纠纷的发生进行简要论述。     

医院感染中医疗纠纷处理的制约因素

目的探讨由医院感染引发的医疗纠纷处理的制约因素及解决办法。方法列举分析处理医院感染医疗纠纷时的几个制约因素。结果在依法处理医院感染医疗纠纷时存在几个制约因素:一是医院感染无法消灭和卫生服务供给的专业性,决定了由医院感染引发的医疗纠纷将长期存在;二是我国现阶段医院感染管理的法制化建设还处于建立健全时期,主要表现为医疗过失行为的判定标准不完善,现行的医院感染规章及规范中部分内容可行性不强;三是部分由医院感染引发的医疗纠纷其取证受医院医疗条件、医疗费用和医疗文书的限制,上述几个制约因素导致医院往往在不能查清医院感染原因的情况下,为了息事宁人而对患者予以赔偿。结论解决以上问题的应对措施主要有:加强医院感染的法制化建设,维护医患双方的合法权益;建立健全医疗风险保险制度;医务人员严格操作规程;医务人员对患者发生了医院感染切忌隐瞒不报;以预防和减少医疗纠纷。     

医疗纠纷及投诉档案管理创新

时代在不断进步,患者对医疗服务质量的要求越来越高,医疗纠纷及投诉也随之增加.医院只有妥善处理好医疗纠纷及投诉,科学管理纠纷及投诉档案,并不断总结经验,加强医院管理,提升自身服务质量,才能保证医院在激烈的医疗市场竞争中站稳脚跟,和谐发展.文章针对医院纠纷及投诉档案管理工作中的难点问题,提出几点建议,旨在增强医院服务意识,优化服务流程,改善就诊环境,加强医患沟通,努力构建和谐医患关系.     

加强医患沟通 减少医疗纠纷事件的发生

医疗纠纷一直以来都是医院和患者之间所存在的问题,近年来随着医疗事业的改革,医保制度在国内的普及,有关医疗纠纷的事件并没有出现下降的局面。一些恶意的医疗纠纷事件也在国内一些医院出现,为了保障医院的安宁的住院医治环境,为此国家出台了相关法律制度,严谨在医院等公共场合进行干扰医院正常运行事件的出现,并对违反此规定并造成严重事件者追求法律责任。但是这种制度的出现一方面保障了医院的正常秩序,但是没有从源头解决医疗纠纷。笔者通过多年的医院工作经验分析,除了少数为医疗技术水平,工作责任心不强引发医疗纠纷外,大多数的医疗纠纷与医患沟通不到位有关,所以减少医疗纠纷最好的办法就是加强医生和患者或者患者家属之间的沟通。这种方式可以从源头减少大量医疗纠纷的发生。本文从现阶段国内实际医患关系出发,整理总结各种医疗纠纷事故,对将加强医患沟通减少医疗纠纷进行详细的论述。     

加强事前管理防范医疗纠纷

医疗纠纷的日益增多已不同程度地困扰着各级医院 ,如何防范医疗纠纷的发生已成为各级医院管理者研究的课题。近年来对医疗纠纷发生原因的调查表明 ,虽然绝大多数医疗纠纷不属医疗事故 ,但医疗工作中仍存在这样那样的不足和问题。防范医疗纠纷必须加强事前管理 ,已成为广大医院管理者的共识。为此 ,安徽医科大学附属医院在加强事前管理方面进行了有益的尝试 ,有了一些措施 ,并取得了一定成效。1　强化医德医风建设 ,加强医德教育 ,转变服务观念强化医德医风建设 ,加强医德建设 ,转变服务观念是防范医疗纠纷的重要措施。在我国建立社会主义市…     

加强病案质量管理 提高病案法律效应

<正> 病案是病人在医院治疗过程的全部文字记录,是处理医疗纠纷、司法办案的法律依据。随着人们的法律意识不断增强,随着<医师法>及<医疗事故处理条例>相继出台,因病案质量引起的医疗纠纷越来越多,大家越来越认识到病案质量的重要性及病案在司法活动中的法律效应。医院必须把病案的质量作为医院管理中的一个重要目标来加强管理,以提高病案的法律效应。     

制度及支持系统建设对防范急诊科医疗纠纷的作用探讨

急诊科做为医院抢救危急重症患者的第一线,是医疗纠纷的高发窗口,医院管理工作中的重要环节.科学合理的制度及配套支持体系的建设,是提高医疗质量,保证医疗安全,防范医疗纠纷风险的关键.本文总结近年来科室自身实践,从加强医院急诊科制度建设和及完善配套支持体系人手,探讨急诊科医疗纠纷的防范管理和医疗质量提高.     

加强医院管理对预防医疗纠纷的作用浅析

目的通过分析某院2007—2010年医疗纠纷发生及不断增多的原因,探讨防范医疗纠纷的对策,旨在为降低医疗纠纷的发生提供依据。方法对某院2007—2010年所发生的医疗纠纷事件进行回顾性调查,针对发现的问题进行整改,加强医院各级管理。结果 2007—2010年发生的医疗纠纷事件共9例,经过一系列管理措施的实施后,2011年医疗纠纷事件下降为零。结论加强医院管理,建立完善的医疗质量监控体系、加强医疗质量教育培训、强化医疗质量各环节的质量控制、建立科学的医务人员评价机制等,可以有效预防医疗纠纷的发生。     

广东省公立医院医疗纠纷变化趋势与解决途径分析

目的了解广东省公立医院医疗纠纷变化趋势、分布特点、解决途径及影响。方法采用信访方式对广东省公立医院医疗纠纷的发生、处理及影响情况进行调查;通过现场调查方式对随机抽取的17所医院的医务人员进行访谈。结果广东省公立医院医疗纠纷发生数量呈逐年上升趋势;三级医院医疗纠纷发生频次高于二级医院,珠三角地区医院医疗纠纷发生频次高于非珠三角地区医院,隶属于设区的市、区医院医疗纠纷发生水平高于隶属于县和县级市的医院;医疗纠纷以双方协商解决为最主要的解决途径;由医疗纠纷引起的医患冲突发生起数和医患冲突数占当年纠纷数比例均呈逐年上升趋势。结论广东省公立医院医疗纠纷发生数量逐年上升;不同级别、区域和行政隶属医院发生医疗纠纷的程度存在差异;由医疗纠纷引起的医患冲突给公立医院的正常运行带来了很大影响。应当切实采取有效措施,防范医疗纠纷的产生,对已发生的纠纷要采取适当的途径解决,防止其演化为医患冲突。     

依法加强医院管理,预防医疗纠纷发生

近年来,国家高度重视社会医疗卫生事业的发展,我国社会医疗卫生改革取得了很大的成果,各地医院也进入了快速发展的时期,然而部分医院的管理并没有跟上其发展的步伐,使得医疗纠纷不断增多.引起医疗纠纷的原因有很多,不仅仅治疗过程中的医疗差错和医疗事故可能引发医疗纠纷,而且医患双方缺乏及时有效地沟通、双方不能相互体谅也会引起医疗纠纷的产生.医疗纠纷不仅影响了医院的正常运营秩序,也不利于社会的稳定团结.文章深入调查分析了本院发生医疗纠纷的各种原因,提出了一系列加强医院管理,预防医疗纠纷的措施,从而促进医院健康持续发展.     

Effective teaching of communication skills for medical practice: selecting an appropriate clinical context

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical practice, they must be taught within an appropriate clinical context. The present paper describes and provides rationale for seven criteria by which to select clinical issues which are appropriate foci for communication skills courses. The criteria are : (1) the issue must be one which is encountered frequently in clinical practice; (2) the issue must be associated with a high burden of illness; (3) there must be evidence that practitioners need to improve skills for dealing with the issue; (4) there must be an intervention, of which communication skills are an integral component, that is demonstrably effective for dealing with the clinical issue; (5) the intervention must represent a cost-effective means of dealing with the issue; (6) the intervention must be acceptable to doctors and be able to be incorporated into routine medical practice; (7) the intervention must be acceptable to patients. Examples of clinical issues which fit these criteria are given in the paper and include smoking, hazardous alcohol consumption, non-adherence to treatment instructions, overdue cervical screening, inappropriate diet, recovery from medical interventions, and breaking bad news to patients.     

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.     

Training physicians in communication skills with adolescents using teenage actors as simulated patients

Role-play exercises with simulated patients may serve the purpose of training professionals to develop appropriate communication skills with adolescents. Authentic adolescent responses toward the physicians may be achieved by actors who themselves are in their teenage years. We describe our experience in continuing medical education programmes for primary care physicians aimed at improving their skills in communicating with adolescents, using simulation methodology with teenage actors. Eight 16-17-year-old actors from the drama department of a high school for the arts were trained to simulate 20 cases with characteristic adolescent medical problems, as well as confidentiality issues and home and school problems. The actors performed in front of large groups of 20-30 paediatricians, family practitioners, or gynaecologists in continuing medical education. Diagnostic issues as well as therapeutic and management approaches were discussed, while the actors provided feedback to the trainees about their understanding and their feeling regarding the issues raised during the exercises. Normally, smaller learning groups are more suitable for such training purposes; nevertheless the participants could appreciate learning the principles of careful listening, a non-judgmental approach and assuring confidentiality. A collaboration of medical schools and postgraduate programmes with high schools which have drama departments may be fruitful in the teaching of adolescent medicine with special emphasis on communication skills with teenagers.     

Training medical practitioners in information transfer skills: the new challenge

Summary. Traditionally, undergraduate medical education has concentrated on teaching students how to gather information or take medical histories from their patients. However, research increasingly indicates that there is a need for medical practitioners to improve their skills in information transfer in a way which will increase the probability that patients are active collaborators in their treatment. Consequently, Newcastle Medical School has sought to develop training packages for medical students in information transfer skills. This paper describes the resulting training programme with particular emphasis on the areas selected for training, the methods by which students are taught, the necessary interactional skills and the assessment procedures which are applied.     

Communication Skills Training and Patients' Satisfaction

Effective physician-patient encounters require the doctor to have consulting skills that facilitate communication flow. When adequate communication does not occur, patients express dissatisfaction with their medical interactions. Many medical students show interview behaviors that may not contribute to patients' satisfaction. Poor communication skills reduce the reliability of elicited medical information and lead to reduced satisfaction for both patients and students. In the present study, a communication skills training course was evaluated using ratings of students' videotaped history-taking interviews with patients and patients' satisfaction ratings. Trained students showed significantly improved consultation skills and techniques compared with a group of control students who displayed few changes in behavior over the course of the study. Satisfaction ratings given by patients of students improved significantly after training, whereas ratings given by patients of control group students decreased over the same period.     

Trained lay observers can reliably assess medical students' communication skills

Context  Our project investigated whether trained lay observers can reliably assess the communication skills of medical students by observing their patient encounters in an out-patient clinic.
Methods  During a paediatrics clerkship, trained lay observers (standardised observers [SOs]) assessed the communication skills of Year 3 medical students while the students interviewed patients. These observers accompanied students into examination rooms in an out-patient clinic and completed a 15-item communication skills checklist during the encounter. The reliability of the communication skills scores was calculated using generalisability analysis. Students rated the experience and the validity of the assessment. The communication skills scores recorded by the SOs in the clinic were correlated with communication skills scores on a paediatrics objective structured clinical examination (OSCE).
Results  Standardised observers accompanied a total of 51 medical students and watched 199 of their encounters with paediatric patients. The reliability of the communication skills scores from nine observed patient encounters was calculated to be 0.80. There was substantial correlation between the communication skills scores awarded by the clinic observers and students' communication skills scores on their OSCE cases ( r  = 0.53, P  < 0.001). Following 83.8% of the encounters, students strongly agreed that the observer had not interfered with their interaction with the patient. After 95.8% of the encounters, students agreed or strongly agreed that the observers' scoring of their communication skills was valid.
Conclusions  Standardised observers can reliably assess the communication skills of medical students during clinical encounters with patients and are well accepted by students.     

A systematic review of medical skills laboratory training: where to from here?

OBJECTIVES: The aim of this review was to evaluate the effectiveness of medical skills laboratories or simulators. In particular, it aimed to determine if performance in medical skills laboratories is transferable to actual clinical performance and maintained over time. METHODS: A range of databases was utilised to search for relevant papers published from 1998 to June 2006. Articles were included in the review if they met a number of criteria that included the evaluation of a skills laboratory or simulator for the purpose of procedural skills training, that participants were either undergraduate medical students or postgraduate medical trainees, and that the study used a randomised, controlled trial (RCT) research design in evaluation. RESULTS: A total of 44 RCTs were identified for inclusion in the review. Overall, 32 (70%) studies reported that simulator training significantly improved procedural skills performance in comparison with standard or no training. Twenty (45%) RCTs assessed the transfer of simulator performance to clinical skills performance; however, 8 of these used animal models, not real patients. Only 2 studies assessed the maintenance of skills post-intervention, both at 4-month follow-up periods. CONCLUSIONS: Medical skills laboratories do lead to improvement in procedural skills compared with standard or no training at all when assessed by simulator performance and immediately post-training. However, there is a lack of well designed trials addressing the crucial issues of transferability to clinical practice and retention of skills over time. Further research must be carried out to address these matters if medical skills laboratories are to remain an integral component of medical education.     

药房窗口服务中的医患沟通技巧

医患交流作为人际交流在医学领域的特殊体现,在提高患者治疗依从性等方面具有重要意义.结合实践经验,就门诊药房窗口服务中的医患沟通技巧进行了总结,认为理解是情感交流的基础,同时应掌握语言交流技巧和非语言交流技巧.     

Consulting skills training and medical students' interviewing efficiency

In more traditional medical education, medical students took a patient's medical history by asking a series of sequenced, routine questions, covering presenting medical problem(s); medical history; social and personal history; systems review; and physical examination. Following this process, the student then attempted to derive the patient's medical problems. This inductive problem-solving paradigm may not assist students to prepare for their future interviewing needs, given doctors use a hypothetico-deductive, problem-solving approach when interviewing patients and numerous researchers have developed specialized communication skills training programmes designed to enhance students' interviewing skills. Students given specific consulting skills training have tended to show significantly greater interpersonal effectiveness and improved interview behaviours compared with students who experience traditional patient clerking training. These improvements in interviewing tend to persist over the period of students' medical training. The aim of the present study was to determine whether specialized communication skills training helped students elicit greater quantity and quality of information from patients and if so, whether such information assisted students in improving their diagnostic skills. Videotaped history-taking interviews conducted by students trained in communication skills and untrained (control) students were rated for their interview efficiency. A comparison of ratings given by experimentally naive, independent observers revealed that trained students were more efficient, but took no longer than their control group counterparts to elicit fuller, more relevant information. However, the student groups did not differ in the accuracy or scope of their medical diagnoses. It is argued that students' lack of medical knowledge in this early phase of their clinical training militated against their being able to use their interviewing competence to derive more potentially accurate medical diagnoses.     

Randomised, controlled study investigating the optimal instructor: student ratios for teaching suturing skills

INTRODUCTION: Recently, there has been a shift away from practising procedures on patients for the first time and towards bench model teaching of clinical skills to undergraduate medical students. However, guidelines for the most effective instructor : student ratio for technical skills training are unclear. This has important implications for staffing laboratory based teaching sessions. The purpose of this study was to assess the optimal ratio of teachers to learners during the teaching of a simulated wound closure. METHODS: A total of 108 undergraduate medical students participated in a 1-hour course on wound closure. They were randomised to 3 groups, each with a different instructor:student ratio (Group A: 6-12; Group B: 3-12; Group C: 1-12). Students were evaluated on a pre-test, an immediate post-test and a delayed retention test using an objective, computer-based technical skills assessment method. Collectively termed the "economy of movements", the total time taken to complete the task and the number of movements executed were the primary outcome measures. RESULTS: Improvements in the economy of movements were the same for Groups A and B and were better than in Group C (P < 0.005). DISCUSSION: The optimal instructor:student ratio was 1 instructor for 4 students. Higher ratios of instructors to students resulted in no improvements in learning, and lower ratios of instructors to students resulted in significantly less learning. These findings are in keeping with current motor learning theories.