江苏省某三甲医院患者安全文化认知的影响因素及提升策略研究

目的 探究影响江苏省某三甲医院患者安全文化认知的因素,并对其展开分析及提升策略研究,为医院进一步提升患者安全、提高医疗安全质量提供方法和对策。方法 采用问卷调查法、简单随机抽样法,以医院患者安全文化问卷为调查工具,共收回有效问卷779份,对基本情况采用描述性统计,对不同特征研究对象的认知现状进行方差分析,对患者安全文化的影响因素运用多重线性回归分析,以P<0.05表示差异有统计学意义。结果 该院职工患者安全文化的总体平均得分为(4.13±0.91)分;工作岗位、最高学历、参加工作年限、职称为该院患者安全文化认知的影响因素。结论 医院管理者应在现有优势的情况下,平衡人员分配,将人力资源向工作压力大、任务繁重的科室倾斜,营造非惩罚文化氛围,保障患者安全。     

医院患者安全文化的调查研究

目的了解重庆市某三级甲等综合医院职工的患者安全文化认知现状,为改进患者安全管理提供依据和政策建议。方法采用在线填写调查问卷形式,对613名医院不同岗位职工进行随机调查,运用SAS 8.0统计软件进行分析处理。结果医院患者安全文化的总体得分为(3.77±0.98)分,总体积极反应率为67.09%。"科室内部团队合作""对患者安全的医院管理支持""管理者对促进患者安全的期望和行动""组织学习与持续改进""对差错的反馈和交流"5个维度为优势领域;"人员配置"和"对差错的非惩罚性反应"2个维度为待改进领域;年龄、教育程度、岗位类别、职称、科室工作年限、每周工作时长为医院患者安全文化的影响因素;认为自己所在科室患者安全工作评级为"优秀"或"良好"的占86.78%;医院职工感知的不良事件积极填报率为46.66%。结论该院患者安全文化建设与国内外其他医疗机构相比有一定优势,建议持续优化人力资源配置,营造积极的文化氛围,妥善处理不良事件,明确重点人群与重点任务,定期测评并持续改进。     

江苏省老年医院医务人员患者安全文化的认知状况分析

目的:通过对老年医院医务人员患者安全文化水平的测评,了解这类医疗机构患者安全文化的特点及影响因素,为开发提升老年医院服务质量的适宜干预策略提供证据.方法:便利抽取江苏省老年医院的215名医务人员为调查对象,使用中文版患者安全文化调查表(HSOPSC)进行调查.结果:老年医院医务人员对患者安全文化的得分为3.72±0.455,整体积极反应率为65.29％;女性、护理学专业的医务人员对患者安全的总体评价得分较高(P<0.05);护理学专业医务人员的"对于错误的反馈和交流"、"医院管理支持"、"对患者安全的全面理解"、"管理者在促进患者安全方面的意愿和行动"、"医院各部门之间的协作"这五个维度的认知得分均高于非护理专业医务人员.结论:该院医务人员患者安全文化认知处于中等水平,建议通过构建非惩罚性的不良事件上报系统、建设配套的制度环境,借鉴护理学专业的优势加强错误反馈、组织支持等患者安全培训,建立更完善、更全面的患者安全文化,更好地保证患者安全.     

员工对患者安全文化认知的现状调研

目的 了解某医院患者安全文化现状,为持续改善医疗质量提供依据。方法 对全院员工发放中文版医院患者安全文化调查表（HSOPSC）,计算量表各维度及各条目的积极反应率。结果 共1 208名员工参与调查,组织的学习与持续改进、科室内团队合作、对医院安全的总体评价、管理者在促进患者安全方面的意愿和行动、管理者对患者安全的支持、交接班和转科等维度积极反应率均大于75%,为优势区域;人员配置、对错误的非惩罚性反应、沟通开放程度、不良事件报告频率等维度积极反应率均小于50%,为待改进区域。不同职称、学历、下班延误时间、年龄、岗位、与患者直接接触等因素对医院患者安全文化总分有显著影响。结论 该院员工对患者安全文化认知现状较好,但在人员配置等方面需继续改进。     

一例新生儿PICC置管体内断裂的应对处置流程分析

目的:分析院内一例不良事件的应急处置过程,探讨医院不良事件预防和改进措施,为医院改进流程、提高质量、保障安全提供借鉴.方法:对近期医院发生的一例新生儿PICC置管不足48小时体内断裂不良事件的处置过程进行分析和思考.结果:领导重视,各部门配合,医院有效、及时、妥善处理了事件.但也暴露出医院在护理团队核心能力、医疗服务流程、后勤保障能力等方面存在缺陷和不足.结论:医院应在护理专科核心能力、医疗服务流程、后勤保障方面加大加快建设力度,提升能力,保障医疗质量,维护患者安全.     

医疗联合体内部不同医疗机构医患双方认知情况研究

目的研究目前医疗联合体(简称医联体)建设情况并对相关问题进行总结分析,为推进医联体建设提出意见和参考。方法以北京市某医联体内的三级医院及社区卫生服务机构的医生和患者为研究对象,使用调查问卷的方式,研究双方对医联体认知差异以及医联体建设现况,并分析影响医联体认知差异的影响因素。共发放问卷412份,回收有效问卷351份,使用统计学方法进行统计分析。结果医院医生和社区卫生机构医生在医联体认知上存在差异(P0.05);双方对医联体建设顾虑上基本接近;对医联体了解程度、职称是影响医生对医联体认可度的因素。医院患者和社区患者对医联体认知程度均较低;双方对医联体需求略有差异;文化程度、医疗负担是影响患者对医联体认可度的因素。结论医联体建设已取得一定成效,但仍需完善管理体系,加快信息和医保调整,提高基层服务水平,加大医联体宣传力度。     

医院文化在医院经营中的作用

医院文化建设作为医院建设与发展的重要组成部分,对促进医院的发展起着重要的作用,尤其是在医院经营方面起着不可替代的作用.医院经营从实质上讲,就是如何提高医院的医疗质量和医疗安全.本文主要通过分析医院文化建设的内涵,阐述医院文化、医疗质量与医疗安全的内在联系,提出通过加强医院文化建设,加强医疗管理,促进医疗质量与医疗安全的发展和提高.     

江苏省某三甲医院患者安全文化现状分析△

目的：探究江苏省某三甲医院职工患者安全文化的态度、认知及行为的现状,为医院进一步展开患者安全研究提供数据资料和支持。方法：以医院患者安全文化问卷（HSOPSC）为调查工具,通过问卷调查法、简单随机抽样法,共收回有效问卷779份。对基本情况采用描述性统计,对不同特征研究对象的认知现状进行方差分析,对影响认知的各维度关系运用相关性分析,针对患者安全文化的影响因素运用多重线性回归分析,以P < 0.05作为差异有统计学意义。结果：该院职工的总体平均得分为（4.13±0.91）,“新事物在医疗过程中的管理和使用”“对错误的反馈和沟通”“管理者对患者安全的支持”等九个维度为优势维度;“人员配置”“开放性沟通”“对错误的非惩罚性反应”等为弱势领域。结论：该院患者安全文化位于中等水平,仍有待改进之处,如存在管理者患者安全理念与医院实际运行情况冲突、开放性沟通存在困难、职工害怕惩罚等问题。     

新建综合性医院医护人员患者安全文化研究

目的了解某新建综合性医院医护人员患者安全文化现状,寻找薄弱环节和潜在隐患,为患者安全文化水平持续改进与不断提升提供参考依据。方法采用美国医疗服务质量和研究组织通行的患者安全问卷调查法,计算正性回答率,获得该医院患者安全文化数据,和AHRQ同类医院正性反应率进行比较。结果该医院部门/区域安全等级评分正性反应率为75.5%。差错的反馈和交流、组织文化-不断改善、科室内部团队合作3个维度为患者安全优势领域。对差错的非惩罚性处理、人员配备、不良事件上报频率、科室间团队合作4个维度,为患者安全待改进领域;正性反应率最低的维度及与AHRQ差值最大的维度差错的非惩罚性处理、不良事件报告频率,提示为制约新建医院患者安全文化建设的关键环节及影响因素。结论建立公正文化,可促进不良事件上报,提升患者安全水平。     

老年患者就医流向及影响因素调查研究

目的 分析老年患者就医流向的原因与因素,为合理引导老年患者适宜就医、提高医疗有效利用率、缓解医疗供需矛盾提出参考建议.方法 利用SPSS20.0描述性统计和x2检验对数据进行分析.结果 老年患者在生病时首选三级医院就医的比例最高,其次为社区卫生服务中心,二级医院比例最低.就医流向的影响因素有:年龄、医疗保障情况、文化程度、家庭平均月收入.结论 应通过加强宣教、合理引导,强化社区医疗机构服务能力建设,畅通双向转诊/转查渠道,积极推进二级医院的转型发展,来吸引老年就医群,优化老年人群就医流向,提高医疗资源的有效使用效率.     

A Study of Doctors' and Patients' Perceptions of Information Processing and Communication Competence During the Medical Interview

Although considerable attention has been given to doctor-patient communica- tion, little work has examined how doctors and patients process information obtained through interaction. The purpose of this research was to examine differences in doctors' and patients' thoughts and feelings and their perceptions of information exchange and relational communication during a medical interview. The results indicate that doctors and patients differ in their thoughts and feelings along several lines and in their views of communication functions. The results are discussed in terms of previous research on doctor-patient communi- cation and implications for communication skills training for both doctors and patients.     

Is hospital patient care becoming safer? A conversation with Lucian Leape. Interview by Peter I. Buerhaus

According to Lucian Leape, patient safety in hospitals is improving, and it is now possible to get to a level of zero defects. Growing recognition of the need for team training, use of trigger tools, improving the competency of physicians, and full disclosure and compensation to injured patients exemplify positive developments. Yet formidable barriers remain, including separatism in how doctors, nurses, and pharmacists learn; inadequate instruction in communication and team-building skills; poorly developed quality and safety curricula; lack of leadership among CEOs and hospital boards; physician apathy; absence of effective systems for accountability; and failure to believe in the possibility of eliminating medical errors and injuries.     

Patients' Perceptions of Medical Encounters in Great Britain: Variations With Health Loci of Control and Sociodemographic Factors

The purpose of this research was to examine how patients' perceptions of their medical encounters varied by patients' health loci of control and their sociodemographic characteristics. Each of 68 general practitioners agreed to have between 40 and 60 patients fill out a questionnaire immediately after an encounter. Patients were asked to evaluate how well the doctors accomplished seven consultation tasks; to indicate their internal, fate, and doctor health loci of control; and to provide sociodemographic information. Based on the responses of more than 3,000 patients, we found a pattern of significant results that link patients' perceptions of the doctors' information and responsibility sharing with patients' perceived control, social status, and concern.     

2009年乌鲁木齐市患者对医药卫生行政管理体制改革的意见调查

[目的]从医药体制实施范围和对象等方面,了解患者对医药卫生行政管理体制的满意度及对相关方面的看法,为进一步推进改革提供参考。[方法]2009年,在乌鲁木齐市新疆医科大学6所附属医院,抽取门诊病人进行调查。[结果]发放问卷330份,收回有效问卷300份,对目前医院医药体制表示满意的占8.33%,认为目前医药卫生体制存在体系混乱的占68.33%,医院垄断的占59.67%,医德降低的占41.00%,不同地区药价不同的占45.00%,医保与非医保药价有差异的占34.67%;看病时遇到的较大困难认为医疗水平低的占43.00%,没有使用医保的占51.33%,费用高的占93.33%,用药多的占47.33%;认为药价普遍高的原因是政府监管不够占81.67%,药品流通环节太多的占75.33%,医院抬高药价的占89.33%,药品采购欠缺透明度的占71.00%,医生人为选用高价药的占94.33%。[结论]患者对目前医院医药体制的满意度很低,由于患者的基本情况不同,他们对目前医院医药体制的看法存在差异。     

Blood pressure measurement by junior hospital doctors--a gap in medical education?

A questionnaire survey, combined with an observational study, evaluated the knowledge of doctors in training grades on the practical aspects of blood pressure measurement. Eighty (non-consultant) junior hospital doctors, graduates from 30 separate medical schools, participated in the study. The results show that 27 (33%) doctors acknowledged no formal education on how to measure blood pressure. This lack of precise theoretical knowledge was matched by an observed poor clinical technique in over one third of the study group. The precision and accuracy of blood pressure recording is fundamental to the clinical examination of patients, and crucial in their management in both hospital and community settings. The findings of this study support the urgent need for further training and assessment of blood pressure measurement at undergraduate, and postgraduate level.     

新疆医科大学三所附属医院安全文化

目的 描述新疆医科大学某三所附属医院的安全文化现状及其影响因素、存在问题及建设对策.方法 采用分层随机抽样方法,选取新疆医科大学某三所附属医院共700名员工,利用美国得克萨斯大学所研制的"安全态度问卷"(缩减版),在2016年4—6月期间对三所医院员工进行问卷调查,对各医院的安全文化现状进行评价.结果 共收回有效问卷659份,有效回收率为94.14%;新疆医科大学某三所医院总体比较结果为A>C>B.结论 新疆医科大学某三所附属医院员工的安全文化总体较好,但需在某些方面完善提高,B、C医院更应注重安全文化的建设.     

基于应用视角下贵州省远程医疗建设现状与发展对策

[目的]分析贵州省远程医疗服务的发展现状及存在问题,为构建覆盖省、市、县、乡、村(社区)五级医疗机构远程医疗服务体系提供参考。[方法]采用文献调研法,查阅贵州和全国卫生统计年鉴,收集并分析相关数据。[结果]贵州基层首诊率得到有效提升,与2017年相比,2018年县级公立医院诊疗人次数增加17%;乡镇卫生院诊疗人次数增加15%;2018年开展的远程会诊中,面向乡镇卫生院的远程诊断占86.36%。[结论]贵州省开展远程医疗有效缓解了基层医疗机构诊疗能力不足、群众看病难看病贵问题,但仍存在医疗人才匮乏、医生积极性不高、远程医学教育效果不佳、医患双方认知程度不高等问题。因此,政府应加强医学人才培养、完善远程医疗补偿和远程医学教育机制以及重视远程医疗宣传工作。     

Elective surgical patients' narratives of hospitalization: The co-construction of safety

This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n = 72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of ‘chaos’ and ‘suffering’ emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient–clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety.     

Patients' Attitude Towards Medical Students Involvement in Their Health Care at Tikur Anbessa Specialized Hospital,Addis Ababa,Ethiopia, 2010

Background

Patients'' willingness to the involvement of medical students in their health care is the mandatory input to medical education. Admitted patients'' willingness level should be known and factors affecting willingness should be identified and it is necessary to act upon them for better medical care.

Methodology

A cross-sectional hospital based survey was conducted to assess the admitted patients'' attitude towards medical students'' involvement in their health care at Tikur Anbesa Specialized Hospital in 2010. Data were collected from 422 adult patients admitted in Tikur Anbesa Specialized Hospital from April to May 2010 using structured questionnaire and by interview method. The data gathered in this way were then processed using SPSS version 15.

Result

Three hundred and ninety-two participants had responded to all questions they were asked (response rate = 92.8%). One hundred and five (26.8%) patients had negative attitude to medical students'' involvement in their health care. The proportion of patients'' having positive attitude towards students was slightly reduced from medical to surgical and to gynecology wards 77.4%, 72.0%, 69.2% respectively. Patients who had previous interactions with students were more likely to have negative attitude (AOR (95% CI) = 1.72(1.03, 2.87). The odds patients admitted in gynecology and obstetrics ward to prefer female students to care for them was higher (AOR (95% CI) =1.93(1.13, 3.30).

Conclusion

Almost half of the patients admitted to Tikur Anbessa Specialized Hospital objected to clinical procedures on them even physical examination, hence developing clinical skills in TASH might be challenging for the majority of students. The challenge might be worsened for male students in gynecology wards.