美国的医疗差错和不良事件报告系统

在美国，越来越多的实践证明，医疗差错和不良事件报告系统能促进医疗质量和医疗安全，其价值被逐渐接受，人们对开展新的自愿报告系统的兴趣不断增高。为了迅速、恰当地处理医疗差错并减少医疗事故诉讼的可能性，几乎所有的医院都制订了医疗差错的上报制度。     

基于保密原则的医疗差错报告系统研究

医疗行业风险管理研究借鉴了航空业的风险管理模式,正在变被动的、严厉处罚的管理向主动的积极报告模式转变。随着人们对医疗行业要求的提高,医疗行业存在的大量问题也不断暴露出来。只有寻找到提高医疗质量的办法,才可能减少风险的发生。航空业保密原则的差错报告系统,给医疗行业处理医疗差错带来了希望和启迪。     

国外处理医疗差错的经验

医疗差错已经是一个全世界的问题；在美国，占死因的第8位。因此，制定相应的预防医疗差错的制度是当务之急。本借国际经验，分析医疗差错的流行病学数据、预防措施及其不足；并提出相应的对策。     

发达国家和地区医疗风险管理的措施及借鉴意义

目的　研究发达国家和地区医疗风险管理的措施及其对医疗行业的借鉴意义。方法　我们搜集相关医疗风险管理资料供研究及分析。结果 发达国家和地区在电子记录、质量反馈系统和病人安全监测系统方面取得了很大进步,减少了医疗差错及医疗风险;同时,也强调信息收集与信息报告制度,特别注重医疗风险分析及管理以保障公共健康。结论 发达国家和地区在医疗风险管理方面取得了显著成绩, 对我国建立医疗风险监测和管理机制具有借鉴意义。     

美国“公开揭露机制”对我国处理医疗差错的启示

医患双方开诚布公的讨论医疗差错有利于预防再犯和维护良好的医患关系.在对美国公开揭露机制的发展过程进行阐释后,论证该机制对我国转变应对医疗差错的理念、倡导医疗机构公开面对医疗差错、创新医患纠纷协商解决机制等方面具有重要的借鉴意义.     

以三级医院评审为动力 加强医疗质量管理

医院的一切工作均围绕医疗这个中心,而医务处作为全院医疗行政管理的职能处室,在主管院长的领导下,全面负责医疗质量的管理,促进医疗质量提高。几年来,我们尝试了一些方法,尤其在医院达标上等的过程中,取得较好效果。现将我们的主要做法及结果介绍如下:1 医疗质量检查 从1994年开始,我们结合医院达标上等,在全院临床、医技科室建立并逐步完善了医疗质量检查制度。制定医疗质量评估制度及医疗质量评估办法,以病案质量、病床使用率、医疗差错事故控制为重点狠抓医疗质量。根据《北京地区三级综合医院评审工作手册》的要求,我们要求各科室甲级病案率要     

完善医疗差错预防机制与合理利用医院医疗资源的构想

文章从分析医疗差错成因入手，分析国外医疗差错监测与预警的历史、现状，并结合我国实际，提出建立客观、有效、灵敏的医疗差错预防机制对合理利用医院医疗资源的构想。     

围手术期医疗差错事故的防范

造成围手术期医疗差错事故的原因有很多,防范医疗差错事故是一个很复杂的系统工程,必须采取综合措施,从最基本的医疗程序抓起,同时不放过任何一个细小的环节.只有拥有必要的医疗设备,遵守规章制度,提高医疗技术水平,医疗差错是可以防范的.     

建立医疗核心制度督导长效机制的探讨

医疗核心制度是医师进行诊疗工作的最基本的医疗制度,是保证医疗质量和医疗安全的基石.卫生部开展"医疗质量万里行"检查,一直将"严格落实医疗质量和医疗安全的核心制度"作为考核的重要内容.为了加强医疗核心制度落实的监管,我院从2006年起建立了医疗核心制度督导长效机制,通过该机制的建立和坚持不懈的运行,促进了医疗核心制度的落实,较好地保障了医疗质量和医疗安全.     

美国医疗差错管理策略对我国医院质量管理的启示

目的阐述美国医疗差错管理的七项策略,研究其对医院提高医疗质量、减少医疗差错的借鉴意义。探讨这些策略在我国如何应用。方法采用问卷调查和现场访谈的方法,调查了34所医院的184位医院质量管理者对七项策略重要性的理解和执行情况,以及对执行策略障碍的认识。结果被调查者们认为最重要的三个策略为:(1)与医院相关利益者进行合作;(2)教育和培训;(3)文化变迁。实施减少医疗差错管理策略的主要阻碍因素是媒体的影响、缺乏人力物力资源、缺乏对差错的认识和害怕承担责任。结论我们应该借鉴国外经验,结合实际情况。逐步把七项策略应用到医疗差错管理中去。     

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.     

Barriers to acceptance of medical error: the case for a teaching programme

There is need for a teaching programme aiming to impart a tolerance of error to undergraduate medical students. The implementation of such a programme may have to challenge the institutional norms that encourage authoritarianism, intolerance of uncertainty and denial of error. Acceptance of error is a prerequisite for its candid reporting, and reporting of errors is a prerequisite for their analysis with a view to their prevention. A curriculum on medical error may, therefore, not only help medical students cope with their future mistakes, but also reduce their frequency. Teaching intervention aiming to promote an acceptance of medical error as both inevitable and reducible may also encourage students' epistemological development by making them realize that their doubts and uncertainties are shared by their peers and instructors.     

我国医疗不良事件报告系统研究与应用现状述评

医疗不良事件报告是防范医疗不良事件重复发生、提高医疗质量的一个重要措施.从我国医疗不良事件报告系统的政策和制度入手,对我国现有医疗不良事件报告系统进行概述和分析,总结其特点与缺陷,并对完善我国医疗不良事件报告系统提出了展望.     

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.     

不良事件报告系统医务人员使用影响因素分析

目的了解本院医务人员主动使用不良事件报告系统的现状,为完善不良事件报告系统提供依据。方法采用自行设计的问卷,对本院747名医务人员进行无记名调查。结果医务人员对主动上报不良事件和对不良事件报告系统的使用均不够满意;64.41%的人员认为本院不良事件上报率<50%;不愿意上报不良事件中19.93%的因为工作繁忙,65.30%的担心处罚或责备。仅19.74%的人员登陆过不良事件上报系统;39.49%的人员认为系统应改为匿名上报;42.56%的人员认为系统操作繁琐。结论医务人员工作繁忙和担心处罚或责备,是影响不良事件上报率的主要因素;加大宣传培训和改进不良事件上报系统,是提高不良事件上报系统使用率的关键因素。     

医疗不良事件报告系统的设计与应用

目的设计科学合理的医疗不良事件报告系统,建立全面的、统一的医疗不良事件标准分类系统和患者安全术语,使不良事件上报管理更加标准化和科学化。方法通过借鉴国内外医疗不良事件报告系统的先进经验,本系统对医疗不良事件从类型、原因、对患者的影响、事后处理、原因分析等项目均设置了大量统一、规范的预设项,报告输入时采用选择题式和简单的描述性语言即可完成不良事件的上报。结论应用医疗不良事件报告系统后,不仅简化了医务人员工作量,提高了不良事件上报率,而且便于管理者对不良事件进行不同角度和纬度的统计分析,采取改进措施,避免类似事件的再次发生。     

医疗不良事件报告系统的研究进展

医疗不良事件报告系统对于提高医疗质量、保障患者安全的积极作用已经在世界范围内被人们所肯定和接受。从医疗不良事件的定义、分类、发生情况和医疗不良事件报告系统的建立、分类以及国内外的研究进展等方面对医疗不良事件报告系统的研究进展作了简要概述,并就如何加快我国医疗不良事件报告系统地建设与完善,充分保障患者安全提出了分析与思考。     

Career Success and Life Satisfaction for Female and Male Healthcare Managers

Medical errors cause up to 98,000 people to die annually in the United States. They are the fifth leading cause of death and cost the United States $29 billion annually (Kohn 1999). Medical errors fall into 4 main categories: diagnostic, treatment, preventative, and other. A review of literature reveals several proposed solutions to the medical error problem. One solution is to change the system for reporting medical errors. This would allow for the tracking of errors and provide information on potential problematic areas. A National Center for Patient Safety is proposed, which would set national goals towards medical errors. Another solution is the setting of performance standards among individual entities of healthcare delivery, such as hospitals and clinics. Another solution involves implementing a culture of safety among healthcare organizations. This would put the responsibility of safety on everyone in the organization. A change in education is yet another proposed solution. Informing medical students about errors and how to deal with them will help future physicians prevent such errors. The final solution involves improvements in information technology. These improvements will help track errors, but also will prevent errors. A combination of these solutions will change the focus of the healthcare industry toward safety and will eventually lead to billions in savings, but more importantly, the saving of lives.     

医疗不良事件报告系统利用现状调查

目的了解我国医疗不良事件报告系统的利用现状。方法采用分层随机抽样的方法,调查山东省6个样本市30家二级、三级医院对原卫生部和中国医院协会报告系统的利用上报情况。结果有41.38%的医院表示利用过原卫生部的报告系统,13.79%的医院表示原卫生部的2个报告系统都利用过,只有10.34%的表示原卫生部的2个报告系统和中国医院协会的报告系统都用过。报告的数量也十分有限,基本都是在个位数。结论现有的不良事件报告系统利用率不足,可以通过完善报告系统和反馈机制、加强政策执行力等方式,提高不良事件报告系统利用率和不良事件报告率。