新疆医疗争议案件再次鉴定的分析

目的分析医疗争议案件,总结医疗纠纷的发生原因、发展规律和经验教训,为制定有针对性的医疗安全措施提供依据。方法对受理的再次鉴定的医疗争议案件的资料进行收集整理,应用构成比进行分析,对某省级医学会医疗事故技术鉴定办公室2008年1月—2011年6月申请再次鉴定并已鉴定完毕的175例案件按照医疗机构等级及事故等级分布、医疗争议涉及专业情况、医疗争议涉及科室情况、医疗事故等级及责任分布、医疗事故原因分布进行分析。结果 175例医疗争议案件中二级医院的例数较多,占68.00%(119例),构成医疗事故131例,其医疗事故构成比为69.47%(91/131);175例医疗争议案件共涉及28个专业,发生次数366次,平均每例医疗争议都会涉及2个或2个以上的专业;175例医疗争议案件涉及的18个科室中骨科、普外科、产科3个科室共105例(60.00%);131例鉴定为医疗事故中院方负完全责任的有6例(4.58%),负主要责任的有46例(35.11%),负次要责任的有50例(38.17%),负轻微责任的有29例(22.14%)。例因素数共有320个,平均每例医疗事故具有2个或2个以上的原因。结论在医疗纠纷的防范中,应将重点放在二级医疗机构上;在对骨科、普外科、产科患者的诊疗护理过程中应该注意其并发症及后遗症的发生;医务人员应重视对患者及其家属的医疗知识的教育;正确履行告知义务,尊重患者的知情同意权;对患者病情的发展作出全面的分析,科学合理地处理每一位患者的病情发展;医疗结构应当加强医疗质量管理,加强病历书写质量及时监控。

Analysis of medical controversy with veappraision in Xinjiang

Objective To find out the characteristics,the causes and its underlying regular pattern of current medical controversies by analyzing the case of medical controversies,so relevant medical safety precautions can be formulated.Methods Relevant materials concerning medical negligence cases happened from January 2008 to June 2011 and accepted and reappraised by the Office of Technical Appraisement Medical Negligence at provincial level have been collected and simple analysis of levels and incident grade distribution of medical institutions,medical dispute involving professional medical dispute involving departments,medical malpractice,the grade and responsibilities of distribution,distribution of medical malpractice reason had been carried out by simply proportion ratio.Results The 175 cases medical negligence happening in secondary hospitals took up the majority of relevant cases,about 68.00% and the proportion ratio of medical proportion ratio was as high as 69.47%;that altogether 28 majors were involved and the number of the cases reached as many as 366 times and two or over two majors would be involved in the relevant cases for each case of medical negligence;that of the 175 cases there were 105 cases concerning 3 departments(orthopedics department,general surgery department and gynaecology and obstetrics department),which took up 60.01% of the total number and that 131 cases were reappraised as medical negligence;in all of the cases,there were 6 cases that the hospital should take full responsibility(accounting for 4.58% of all cases),46 cases for mainly responsibility(35.11%),50 cases for secondary responsibility(38.17%) and 29 cases for slight responsibility;involving 320 factors and there were two or over two factors for each case of medical negligence.Conclusion The prevention stress of medical negligence should be laid on the secondary medical institutions;that for the patients concerning departments in orthopedics department,general surgery department,gynaecology and obstetrics department,more attention and precaution should be put on complication and the happening of sequelae;that apart from treatment of illnesses and diseases,education of medical knowledge should be given to patients and their family members;that the patients and their families should be informed correctly and their informed consent should be respected;medical stuff should improve their professional ability and basic skills;that in the process of diagnosis and treatment,the doctors should give comprehensive analysis and scientific treatment about the development of the patients′ illness,but not overestimate their own experience in diagnosis and treatment;and that the medical institutions should enhance the management of medical business and more stress is laid on the quality and timely monitoring of medical record.