196例医源性纠纷的调查分析

The investigation and analysis of 196 Cases iatrogenic dispute

[目的]了解南京市某医院医源性纠纷的现状,分析纠纷的原因,为减少纠纷的发生提出建议。[方法]收集南京市某医院2005年1月到2009年12月发生的医源性纠纷资料196例,运用Excel软件,将医源性纠纷基本情况、发生纠纷的医护人员分布、科室分布、纠纷的原因、责任的认定、处理方式、纠纷的补/赔偿情况进行统计分析。[结果]南京某医院2005年～2009年间医源性纠纷数量逐年增多,经济赔偿金额有所增加;发生纠纷的医护人员分布,以医类人员发生最多,约占42.35%;多数科室均发生过纠纷,但主要集中在外科;引起纠纷的原因主要是医疗规章制度执行不规范、医患沟通不够、医疗技术水平不高、医疗服务态度不好等;医源性纠纷的责任认定中,一般医疗差错共98例,占50%,严重医疗差错为共7例,占3.57%,非医疗过失91例,占46.43%;纠纷处理方式以协商解决为主,但行政调解和法律诉讼处理逐年增多。[结论]减少医源性纠纷的发生应从医院自身出发,严格规章制度,遵守诊疗常规;加强医患沟通,提高服务意识;完善业务培训,提高医疗水平;注重医德教育,构建良好医院文化;加强重点科室管理,确保医疗质量,减少纠纷的产生。

Objective The purpose of this study is to understand the status of iatrogenic dispute in a hospital in Nanjing ,to analyze the reasons in order to provide suggestions for reducing the disputes. Methods We collect 196 cases disputes information from Jan. 2005 to Dec. 2009. We analyze follow basic information, such as： distribution of doctors and nurses, distribution of departments, accident responsibility, process mode and compensation. Results It shows that iatrogenic dispute amount and compensation payment were on the rise from 2005 to 2009. Incidents expanded throughout departments of the hospital with a concentration on the surgical department. Most disputes occurred among the medical staffs, occupied 42.35%. Main reasons of dispute are that lack of regulations and standardization in the hospital, communication problems between medical staffs and patients, poor medical technology, worse medical service .Among this accident disputes responsibility, with 50% are common medical malpractice which it has 98 cases, 3.57% are serious which it has 7 cases, and 46.43% are not medical malpractice which it has 91 cases, Most of them are solved by negotiation, but more and more disputes are solved by administrative mediation and legal action. Conclusions The most important way to reduce the iatrogenic disputes is that to run the rules strictly, abide by common regulation, strengthen hospital-patient communication, improve medical service realization, perfect professional training ,improve health care level; To pay attention to education of medical ethics and legal system, build hospital culture, strengthen the management of key departments and insure health care quality.