英美澳加和中国台湾地区ICU医疗风险管理分析

Descriptive Analysis on ICU Medical Risk Management in United Kingdom,United States,Australia,Canada and Taiwan

目的通过分析四国一区ICU风险管理政策指南、机构管理和运行机制等,为我国ICU风险管理提供决策依据和政策建议。方法计算机检索PubMed,、EMbase,Cochrane Library等数据库,纳入美国、英国、加拿大、澳大利亚和中国台湾地区ICU风险管理相关指南、研究报告等文献,综合分析四国一区风险管理的机构和运行机制,并重点关注英国模式。结果共纳入31篇文献,包括1篇指南、5篇综述、2篇调查报告和23篇研究。英国以标准和指南形式指导ICU风险管理,制定明确的事件分级工具和相应响应机制。美国借鉴澳大利亚经验建立了ICU安全报告系统,二者均将ICU作为整个医疗风险管理的一部分,设立专门的管理板块。结论英国将ICU风险管理纳入国家病人安全管理范围,单独设立报告系统,是目前较完备的系统。澳、美由国家机构设立ICU风险管理研究项目,行业协会和非政府组织主导风险研究,由试点单位使用后逐步推广使用。

Objective To analyze the policy and guideline,the institutional management and the operation mechanism of ICU medical risk management in the United Kingdom,the United States,Australia,Canada and Taiwan,so as to provide evidence and recommendations for health care risk management policy in China.Methods Such databases as PubMed,EMBASE,The Cochrane Library were searched to include the literatures such as the guideline documents and the research reports on ICU medical risk management in the United Kingdom,the United States,Australia,Canada and Taiwan;the institutional management and the operation mechanism of the risk management in the above four countries and one area were comprehensively analyzed,and especially the UK model was highly emphasized.Results A total of 31 literatures were included,including 1 guideline,5 reviews,2 investigative reports and 23 research documents.The United Kingdom guided the ICU risk management in forms of the standard and the guideline,formulated a clear tool of event classification and corresponding response mechanism.The United States learned from Australia＇s experience and established the ICU safety reporting system;both of them regarded ICU as one part of the medical risk management and set up a special management column.Conclusion The ICU risk management with the independent report system in the United Kingdom is brought into the scope of national patient safety management,and is regarded as the relative complete system at present.In Australia and the USA,the national institutions are in charge of setting up the research projects of ICU risk management;the industry associations and the non-governmental organizations lead the risk research;and the experimental units popularize gradually after self-application.